Rashes In pregnancy

1. Rashes In pregnancy Kate Hooks

2. 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.

3. 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.

5. 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

6. Risk to Mother 10% risk of pneumonia- inc with gestation Mortality 1/1000 infections Refer if rash worsening for >6 days Admit: Chest symptoms Neurological symptoms Haemorrhagic rash Immunosuppressed Risk- term, smoker, poor social circumstances

7. Risk to Foetus/Newborn Gestation- <28wks 5-10% >30wks 50% Presentation <20wks- ^Miscarriage 1-2% FVS 20-37wks – risk of FVS rare Baby especially vulnerable 4 days before to 2 days after delivery- 20% risk of overwhelming neonatal infection- SPECIALIST ADVICE

8. 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.

10. 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

11. 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

12. 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

14. 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’.

15. Risk to Foetus Risk of transmission increases significantly with increased gestation. <20 weeks- 9% increase risk of miscarriage 3% affected foetuses- Hydrops- 50% will die

16. Management Check for antibodies B19 IgG- reassure None- send further sample in 1 month or if rash develops IgM- confirm- Refer for specialist care No known Rx to prevent transmission 2 Weekly USS for hydrops

18. 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

20. 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

21. Non infective Rashes

22. Polymorphic Eruption of pregnancy • Itchy • In stretch marks in later stages • Allergic response • Rx- emollients and topical steroids

24. PemphiGoidgestationis • 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

25. Take Home • Common consultation • If infectious exposure always check antibodies and seek specialist advice if no clear history.