This policy describes the background to rash illness in pregnancy and sets out the response of the Cumbria and Lancashire Health Protection Unit to a case or cluster.
- Causes
- Clinical and Epidemiological issues
- Laboratory Investigation
- Prevention and Control
- Response to a Case
- Response to a Cluster
- Relevant Factsheets etc. elsewhere on the site
- References
Causes (back to top)
Most rashes during pregnancy are non infectious in origin and include drug reactions and allergies. The important differentiating feature is the presence or absence of a fever. Although relatively uncommon, infectious causes are important because of the potential effects on the fetus. The following can all present with a rash in pregnancy and may have implications for the developing fetus.
|
Viral Infections
|
Bacterial Infections (uncommon)
|
Clinical and Epidemiological issues (back to top)
Viral infections in pregnancy are often mild or inapparent with minimal or absent fever - the exceptions to this being measles or varicella. Bacterial infections are usually more severe and usually feature a fever. Bacterial infections are now uncommon, as are many vaccine-preventable viral infections. The most common infections in pregnancy are Parvovirus B19 (1 in 400 pregnancies) and the enteroviruses.
Laboratory Investigation (back to top)
Where a viral infection is suspected it is important to exclude varicella, parvovirus B19 and rubella. Varicella can usually be diagnosed by the characteristic vesicular rash but where there is doubt, serology should be performed. Rubella and parvovirus B19 can both be diagnosed by detection of IgM in saliva or serum (usually quicker).
The investigation of a pregnant woman who has been in contact with someone with a rash illness is more complex. The aim of the investigation is to determine (a) whether the contact case has varicella, rubella or parvovirus B19 and (b) whether the pregnant patient is susceptible to these infections. The following diagrams summarise the recommended approach.
 Fig 1. Investigation of a pregnant patient in contact with a rash illness |
 Fig 2. Investigation for rubella of a pregnant women exposed to a rash illness |
 Fig 3. Investigation for parvovirus B19 of a pregnant women exposed to a rash illness |
Prevention and Control (back to top)
Rubella infection in pregnancy can be prevented (a) directly, by vaccination of susceptible women of childbearing age and (b) indirectly, by universal rubella vaccination. Pregnant women should be screened for rubella in each pregnancy and offered vaccine postpartum - rubella vaccine is a live preparation and should not be given during pregnancy.
Varicella vaccine is only available on a named-patient basis in the UK, but VZIG is available for post-exposure prophylaxis of susceptible women exposed in the first 20 weeks of pregnancy or within 21 days of the estimated date of delivery.
No specific measures are available for prevention of parvovirus B19 in pregnancy, other than avoiding outbreak situations. Healthcare workers who have been in contact with B19 infection should avoid contact with pregnant women for 15 days from the last contact or until a rash appears.
Response to a Case (back to top)
Laboratory investigations are described above. Pregnant women with confirmed varicella, parvovirus B19 or rubella should be counselled about the risks to the fetus and managed accordingly by the obstetrician.
Response to a Cluster (back to top)
Consideration should be given to community-wide vaccination in the case of clusters of rubella or measles.
Relevant Factsheets etc. elsewhere on the site (pdf) (back to top)
- Chickenpox
- Measles
- Rubella
- Parvovirus (ncbugs)
References (back to top)
- Hawker J. et al. Communicable Disease Control Handbook. Blackwell Oxford; 2001 ISBN 0-632-05649-5