RASHES IN PREGNANCY

Kate Hooks

WHY? A Common Consultation

AIMS: To distinguish rashes which may have

complications from those which do not. To develop a management strategy Some understanding of other skin

rashes in pregnancy.

INFECTIVE RASHES IN PREGNANCY Detailed hx/bloods at booking All women advised to contact GP or

Midwife urgently if they are in contact with or develop a rash.

CHICKENPOX / VZ Common illness Highly contagious- 90% of adults are

immune Complicates 3/1000 pregnancies Incubation- 14-21 days- infectious from

2 days before the rash until crusting Features- Fever, Rash-

papules/vesicles/centripetal/itchy/mucus membranes

Risk to Mother10% risk of pneumonia- inc with gestationMortality 1/1000 infectionsRefer if rash worsening for >6 daysAdmit:Chest symptomsNeurological symptomsHaemorrhagic rashImmunosuppressedRisk- term, smoker, poor social

circumstances

Risk to Foetus/NewbornGestation- <28wks 5-10%

>30wks 50%Presentation <20wks- ^Miscarriage

1-2% FVS20-37wks – risk of FVS rare

Baby especially vulnerable 4 days before to 2 days after delivery- 20% risk of overwhelming neonatal infection- SPECIALIST ADVICE

Management Mother clear hx of chickenpox- reassure Not- Send Serum Specific IgG- positive –

reassure Negative- VZ-IgG- if less than 10 days

from exposure- and close monitoring.

RUBELLA Vaccination- rare 1-2% adult women are susceptible Reinfection can occur in those

vaccinated Incubation- 14-21 Infectious- 7 days before-10 days after

rash. Fever, lymphadenopathy and pink

maculopapular rash

Risk to Foetus <11wks- 90% risk transmission- 90%

adverse outcome risk 11-16wks- 55% risk transmission- 20%

adverse outcome risk >16wks- 45% risk transmission- risk

deafness only >20wks- foetal development not

affected

Management Non vesicular rash- check for rubella

antibodies or reassure only if immunisation x2. Also check Parvovirus B19.

IgG- reassure No antibodies- send another sample 1

month after contact IgM- Confirm- inform mother result and

implications

PARVOVIRUS/B19 Risk infection in pregnancy 1/400 50% young women not immune 50% risk of child fifths disease- non

immune mother. Inc- 13-18 days- infectious from 10 days

before the rash appears to the onset. Fever, arthritis, lace like rash trunk and

extremities, ‘slapped cheeks’.

Risk to FoetusRisk of transmission increases

significantly with increased gestation.

<20 weeks- 9% increase risk of miscarriage

3% affected foetuses- Hydrops- 50% will die

ManagementCheck for antibodies B19IgG- reassureNone- send further sample in 1 month or

if rash developsIgM- confirm- Refer for specialist care

No known Rx to prevent transmission2 Weekly USS for hydrops

MEASLES Rare- MMR Coryzal, lymphadenopathy, conjunctivitis,

maculopapular rash, Koplick spots

No evidence to support an association between measles in pregnancy and congenital defects.

But- Inc- maternal mortality, foetal loss and prematurity.

Management- identify susceptible exposed women- specialist care- human normal immunoglobulin

HAND, FOOT AND MOUTH Enterovirus Febrile illness o young children If contracted if 1st trimester- intrauterine

growth retardation and spontaneous abortion

Refer for specialist care

Others- EBV, CMV

NON INFECTIVE RASHES

POLYMORPHIC ERUPTION OF PREGNANCY Itchy In stretch marks in later stages Allergic response

Rx- emollients and topical steroids

PEMPHIGOID GESTATIONIS Rare Autoimmune Second and third trimester Itchy, blistering, initially around the

umbilicus and then the rest of the body

Specialist advice- skin biopsy Rx- topical or oral steroids

TAKE HOME Common consultation If infectious exposure always check

antibodies and seek specialist advice if no clear history.