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A suspected viral rash in pregnancy

BMJ 2017; 356 doi: (Published 03 March 2017) Cite this as: BMJ 2017;356:j512
  1. Jack Carruthers, honorary clinical research fellow1,
  2. Alison Holmes, professor of infectious diseases2,
  3. Azeem Majeed, professor of primary care1
  1. 1Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Department of Medicine, Imperial College London, London, UK
  1. Correspondence to J Carruthers jack.carruthers{at}
  • Accepted 19 January 2017

What you need to know

  • Consider country of origin in a woman presenting with a rash in pregnancy and ask for immunisation history.

  • Test for measles and rubella IgM and IgG antibodies, particularly if immunisation history is not clear.

  • Refer women with an active infection to the fetal medicine unit for fetal monitoring.

A pregnant woman at 12 weeks’ gestation seeks help for a red rash covering her back and chest. She is worried that the rash might be caused by a virus. She is originally from Bangladesh and is unsure about her vaccination history.

Viral exanthema can cause rash in a pregnant woman and should be considered even in countries that have comprehensive vaccination programmes. In the UK, for example, three cases of congenital rubella syndrome have been notified in recent years in women born outside the UK.1 This article focuses on viral rashes. For a more general overview of rash in pregnancy, see the review by Vaughan-Jones et al.2

Vaccination coverage for viral infections varies globally. The World Health Organization estimates that adult varicella immunity is greater than 95% in the US but only 75% in India.3 Similarly, global measles and rubella immunisation coverage is only 85% and 44%, respectively.4

These infections have consequences for mother and fetus. Measles and rubella can cause intrauterine death. Intrauterine infection with rubella can lead to congenital rubella syndrome in the liveborn baby, characterised by deafness, eye abnormalities, congenital heart disease, and learning disability.5 6 Meanwhile, the current Zika virus epidemic has garnered international attention for its link to microcephaly and birth …

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