Rashes in Pregnancy
A different approach will be required to crack this virological nugget (imagine that rashes in pregnancy is like trying to serve Fidel Castro with an ASBO!). Here is the HPA* "breakdown":
- All pregnant women with a non-vesicular rash illness should be investigated simultaneously for rubella and parvovirus B19 infection.
- All pregnant women with contact with a non-vesicular illness should be investigated for asymptomatic parvovirus B19 infection, and for asymptomatic rubella infection unless there is satisfactory evidence of past rubella infection (vaccine or natural infection). A significant contact is defined as being in the same room for a significant period of time (>15 minutes) or face-to-face contact.
- Specific investigation to detect asymptomatic rubella reinfection is not advised.
- It is essential to confirm by adequate laboratory investigation all cases of possible rubella and parvovirus B19 infection in pregnancy.
- Management of proven rubella in pregnancy should be based on established risks of adverse outcome.
- Women with proven parvovirus B19 infection in the first 20 weeks of pregnancy should be followed by regular ultrasound scanning, and referred to Regional Units of Fetal Medicine if hydrops fetalis is detected.
- Parvovirus B19 antibody screening in pregnancy is not advised, and consensus has been reached on the procedures to be followed for rubella antibody screening, including the concentration of antibody to be adopted to reflect past infection.
- Oral antiviral treatment (aciclovir or valaciclovir) is advised for pregnant women who present within 24 hours of onset of varicella.
- Referral to hospital and antiviral treatment is indicated for pregnant women with complications and/or risk factors, or whose illness continues for six days or more.
- Pregnant women exposed to varicella or herpes zoster can be reassured as to protection if they themselves have a history of varicella or herpes zoster. If no or uncertain history, susceptibility should be tested, and VZIG offered to those found susceptible if within 10 days of exposure.
- Infants whose mothers develop varicella 7 days before to 7 days after delivery should be given varicella-zoster immunoglobin (VZIG), and aciclovir if onset was 4 days before to 2 days after delivery.
|
|
Rubella |
Parvovirus B19 |
Varicella-zoster |
| Proportion susceptible in young adult females | 1-2% | 40-50% | 10% |
| Infectivity - risk transmission from close contact (household attack rate) | High(90%) | Medium (50%) | High(70-90%) |
| Risk of intrauterine transmission by(gestational age) | <11 weeks - 90% 11-16 weeks - 55% >16 weeks - 45% | <4 weeks - 0% 5-16 weeks - 15% >16 weeks - 25-70%, increasing with gestation | <28 weeks - 5-10% 28-36 weeks - 25% >36 weeks - 50% |
| Risk of adverse fetal outcome | <11 weeks - 90% 11-16 weeks - 20% 16 -20 weeks minimal risk of deafness only >20 weeks - no increased risk | <20 weeks - 9% excess fetal loss; 3% hydrops fetalis, of which about 50% die | Congenital varicella syndrome:<13 weeks- 1%, 13-20 weeks -2% risk. 4 days prior to 2 days post delivery- 20% neonatal varicella |
| Risk of adverse outcome for mother | Arthritis | Arthritis | Pneumonitis. Case fatality rate for mother estimated at 1/1000 infections in pregnancy |
| Available Interventions and benefits | Termination of pregnancy | Fetal hydrops - intrauterine transfusion reduces odds of death to 0.14 | ZIG to mother and neonate attenuatesillness. Aciclovir within24 hrs of rash onset for mother. Aciclovir for infected neonates |
| Incubation period | 14-21 days | 13-18 days | 14-21 days |
| Infectivity period (days pre and post rash onset) | 7 days pre to 10 days post onset of rash | 10 days pre to day of onset of rash | 2 days pre onset of rash until cropping has ceased and all lesions crusted |
| Number of infections in pregnancy | Currently rare | 1 in 400 pregnancies (ref 18) or seroconversion of 1.5 -13% per annum among susceptible | Exposure use of VZIG- 590-785 women per year, 1996-1999, England and WalesEstimate 2-3 infections per 1000 pregnancies or 2000 maternal infections per year |
| Terminations of pregnancy | 1995-96 - 18 1997 - 2 | Unknown - not recommended | Unknown |
| Babies with congenital infection (proven) | 1994-96 - 20 1997 to date* - 1 | Unknown | Unknown |
| Babies with congenital damage (proven) | 1994-96 - 19 1997 to date* - 1 | Unknown | Unknown |
| Babies with congenital infection (estimate) | Rare (see text) | See below | 30 neonates at risk of severe neonatal infection per year in UK |
| Babies with congenital damage (estimate) | Rare (see text) | 2-8 fetal hydrops per 100,000 pregnancies (14-56 cases per year in UK ) 12-48 per 100,000 spontaneous abortion (84-336 cases per year in UK ) | 10 per year, England and Wales |
*This method is based on 'Health Protection Agency (2007):
"Investigation of erythrovirus (parvovirus) B19 in pregnant women exposed to rash illness.
National Standard Method VSOP 30 Issue 3."
http://www.hpa-standardmethods.org.uk/documents/vsop/pdf/vsop30.pdf
which was developed, reviewed and revised by the National Standard Methods Working Group
for Virology (http://www.hpa-standardmethods.org.uk/wg_virology.asp)
under the auspices of the Health Protection Agency in England. The contributions of many
individuals in clinical virology laboratories and specialist organisations who have
provided information and comment during
the development of this document, and final editing by the Medical Editor are
acknowledged.
AMH.
I guarantee. You'll be fine.
I guarantee. You'll be fine. I guarantee.Bad influence (on the kids). I don't want you to hang out with him anymore. He's such a bad influence on the children.Pass4sure 310-065 Give in! Give in! You won't have a chance.Cisco 642-691 So that's how it is.P4S 642-591 certification Don't believe a word he says.
Think it over.You wanna
Think it over.You wanna die?CompTIA-Linux+ XK0-002 Don't rush me. I'm on it! Don't rush me.Pass4sure 132-S-911 certification No wonder.310-202 What's the big deal!