Rashes in Pregnancy

Question 1

What are the risks of Measles infection in pregnancy?

Answer 1

Can lead to encephalitis and pneumonia in pregnancy as well as foetal loss and preterm delivery but does not cause congenital deformity.

Question 2

What are the symptoms of measles in a mother?

Answer 2

Symptoms include fever, rash, Koplik’s spots, cough, coryza and conjunctivitis as well as corneal scaring.

Question 3

How should suspected measles in a mother be managed?

Answer 3

Check MMR status
If maternal rash appears 6 days pre or post-delivery then give IgG immediately after birth or exposure to prevent neonatal subacute sclerosing panencephalitis.

Question 4

What are the risks of rubella infection in pregnancy?

Answer 4

Foetus is most at risk in the first 16 weeks of gestation.

Can lead to foetal deafness, cataracts, stillbirth, miscarriage, reduced IQ cerebral palsy.

Question 5

Can you vaccinate for rubella during pregnancy?

Answer 5

Should avoid pregnancy for 1 month after vaccination as it is a live vaccine.

Question 6

What options should the mother be given for management of rubella during pregnancy?

Answer 6

Offer TOP if infection confirmed in 1st trimester.

Question 7

How is Rubella infection tested for

Answer 7

Confirm infection by testing antibodies at 4-5 weeks from incubation and 10 days apart.

Question 8

What risk does primary maternal varicella zoster infection confer to the mother and foetus?

Answer 8

Risks to the mother
• 5 times greater risk of pneumonitis

Fetal varicella syndrome (FVS)
Risk of FVS following maternal varicella exposure is around 1% if occurs before 20 weeks gestation. There is a very small number of cases occurring between 20-28 weeks gestation and none following 28 weeks

Features of FVS include skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

Also risk of neonatal varicella if mother develops a rash between 5 days before and 2 days after birth. This can be fatal.

Question 9

How should chicken pox exposure in pregnancy be managed?

Answer 9

If there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies.

If the pregnant women is not immune to varicella and is <20 weeks pregnant she should be given varicella zoster immunoglobulin (VZIG) as soon as possible.

But note VZIG is only effective up to 10 days post exposure.

If not immune and >20 weeks then VZIG or aciclovir should be given 7-14 days after exposure.

Guidelines suggest oral Aciclovir should be given if pregnant women with chickenpox presents within 24 hours of onset of the rash.

Question 10

What are the risks of cytomegalovirus infection in a pregnant mother?

Answer 10

Causes more motor and cognitive impairment that rubella in the UK.

Defects to foetus include IUGR, microcephaly, encephalitis/seizures, pneumonitis, anaemia, jaundice, cerebral palsy, hepatosplenomegaly, thrombocytopenia, motor and cognitive impairment and sensorineural deafness.

Question 11

How does cytomegalovirus infection present in pregnancy?

Answer 11

Maternal infection will be mild with just lymphadenopathy, rash and sore throat may even be symptomatic.

Question 12

How can cytomegalovirus transmission to the foetus be detected

Answer 12

Test mother for antibodies, both IgM and IgG

Amniocentesis after 20 weeks and shell viral culture can detect foetal transmission. Also do throat, swab, urine culture and foetal serum after birth.

Question 13

How can a mother avoid cytomegalovirus exposure?

Answer 13

Avoid toddler’s urine

Question 14

How does toxoplasmosis infection in a pregnant woman present?

Answer 14

Symptoms similar to glandular fever, including rash and fever as well as eosinophilia. If symptomatic CNS prognosis is poor.

Question 15

How is a diagnosis of maternal toxoplasmosis made?

Answer 15

Antibody tests.

Question 16

When does toxoplasmosis cause the most damage?

Answer 16

The earlier in pregnancy it occurs the more damage it can do to the foetus but also the lower the rates of transmission.

Question 17

How should toxoplasmosis infection in pregnant mothers be treated?

Answer 17

Start Spiramycin promptly in infected mothers and consider amniocentesis to look if the foetus is also infected. If foetus is infected then give mother pyrimethamine as loading dose on day 1 then sulfadiazine and calcium folinate twice weekly until delivery.

Question 18

How should a baby born to a mother infected with toxoplasmosis be treated after delivery?

Answer 18

Affected babies treat with 4 weekly courses of pyrimethamine, sulfadiazine and calcium folinate x 6 separated by 4 weeks of Spiramycin.

Question 19

How can a pregnant mother prevent exposure to toxoplasmosis?

Answer 19

To prevent infection avoid eating raw meats, wear gloves when touching raw meat, cat litter or gardening and avoid sheep during lambing time.

Question 20

What effect can parvovirus B19 have on the foetus?

Answer 20

Causes foetal suppression of erythropoiesis, and cardiac toxicity resulting in cardiac failure and foetal hydrops.

Question 21

How does parvovirus B19 infection present in the mother?

Answer 21

Completely self-limiting to the mother and 50% of UK women are immune. Causes slapped cheek rash, fever and arthralgia.

Question 22

How is parovirus B19 diagnosed in pregnant women?

Answer 22

Diagnosis made by paired samples of antibodies.