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Practice Practice Pointer

Investigating the pregnant woman exposed to a child with a rash

BMJ 2012; 344 doi: (Published 26 March 2012) Cite this as: BMJ 2012;344:e1790
  1. Eithne MacMahon, consultant and honorary senior lecturer12
  1. 1Department of Infectious Diseases, Directorate of Infection, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London SE1 7EH, UK
  2. 2Department of Infectious Diseases, King’s College London School of Medicine
  1. Correspondence to: E MacMahon eithne.macmahon{at}

The author explains what action to take after exposure of a pregnant woman to a child with a rash, to reduce the risk of adverse outcomes for mother and child

A 21 year old woman attending a routine antenatal appointment 38 weeks into her pregnancy mentions that her child, a toddler, has been ill. He was diagnosed with chickenpox nearly a week ago when his father took him to the emergency department with an itchy rash and high temperature. He is now better and the spots have all dried up and crusted over. On questioning, the patient is unsure if she herself has ever had chickenpox or shingles, or if she has received any doses of varicella vaccine. She is not aware of the risks of varicella to herself or to her unborn child. Her child has received all the recommended immunisations, but this does not include varicella vaccine in the area where they live.

What is the challenge?

When a pregnant woman is exposed to a child with a rash, the situation requires rapid assessment. The rash could be due to any one of several infectious or non-infectious causes, but the initial approach needs to focus on those infections that pose risks to the mother and fetus or neonate, and for which intervention can improve the outcome.1 These infections are measles, rubella, parvovirus B19, and varicella zoster virus (table 1).

View this table:
Table 1

 Risk of maternal infection to the mother and to the fetus or neonate 1-3 5-7 9 10 13 14

Measles warrants consideration in endemic regions (such as Europe and Africa) or in association with an imported outbreak.2 Even minimal exposure to a putative case warrants careful assessment in view of the notorious transmissibility of measles.3 Congenital rubella continues to be reported from countries with measles, mumps, and rubella …

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