There is a wide differential diagnosis for a rash in pregnancy. However, rubella, parvovirus B19 and syphilis are all infections that may present with a rash and should be considered in the investigation. Pregnant women with a rash or those who have been in contact with patients with confirmed infections (rubella, PVB19, etc) should be referred for medical management.
Information and advice concerning rashes should be given to all pregnant women. At booking, midwives should:
- enquire if the woman has previously had chickenpox or shingles and, if not, advise that they seek urgent medical attention if they develop chickenpox-type vesicles in pregnancy or have contact with chickenpox or shingles
- advise women to inform their midwife, GP or obstetrician urgently if they develop a rash in pregnancy
- advise women that they should inform their midwife, GP or obstetrician if they have 'contact' in pregnancy with someone who has a rash
- women should be provided with unbiased information regarding screening and diagnostic tests, the meaning and consequences of both, what to expect in terms of results, and further options for management. Women should feel free to exercise whatever options they choose
Minimum standards of information prior to any screening or diagnostic tests should include:
- informing the woman that all tests to establish the initial diagnosis will be on blood samples obtained by phlebotomy and that more invasive tests such as amniocentesis may be necessary
- informing the women that all tests may give inconclusive results and further testing may be necessary
- how long the results will take (consult local laboratory)
- who will give the test results?
- who will discuss future management of the pregnancy?
- who they can contact if they have any unanswered queries or concerns?
- written information should be provided to back up verbal advice or information given
- advice and care management plans should be documented
- all pregnant women with rash illness, or contact with rash illness, should be referred for medical management.
Care must be taken when assessing women with dark skin, as the appearance of a rash may not be the same as that seen in those with lighter skin.
The use of an interpreter for women who do not speak English and the use of audiotapes to reiterate verbal discussions indicates good practice, and all discussions, advice and care management plans should be documented. See our Communication Skills tutorial for more information.