A 28-year-old woman, gravida 1 para 0, at 29 weeks gestation comes to the office in the fall for routine prenatal care. She has had no vaginal bleeding, abdominal pain, or leakage of fluid. Fetal movements have been normal. The patient has no chronic medical conditions. Medications include a daily prenatal vitamin. She does not use alcohol, tobacco, or illicit drugs. She works as a kindergarten teacher.
Vital signs are normal; fetal heart rate is 140/min. Fundal height is 29 cm.
Prenatal laboratory results showed a lack of immunity to rubella. Ultrasounds have been normal.
Which of the following vaccines is recommended for this patient during pregnancy?

Question

A 28-year-old woman, gravida 1 para 0, at 29 weeks gestation comes to the office in the fall for routine prenatal care.  She has had no vaginal bleeding, abdominal pain, or leakage of fluid.  Fetal movements have been normal.  The patient has no chronic medical conditions.  Medications include a daily prenatal vitamin.  She does not use alcohol, tobacco, or illicit drugs.  She works as a kindergarten teacher.
Vital signs are normal; fetal heart rate is 140/min.  Fundal height is 29 cm.
Prenatal laboratory results showed a lack of immunity to rubella.  Ultrasounds have been normal.
Which of the following vaccines is recommended for this patient during pregnancy?

Quizplus · Accepted Answer

11ec193a_98a3_5027_853d_b9e26397462b_MD0002_00 The incidence of pertussis in the United States has increased due to waning immunity. Pertussis in infants age <3 months, who are at highest risk of acquiring the infection from affected adults, is associated with high rates of morbidity and mortality. Therefore, Tdap vaccination (tetanus toxoid-reduced diphtheria toxoid-acellular pertussis) is recommended for women during each pregnancy, regardless of previous vaccination history. The Tdap vaccine is safe during every trimester; however, vaccination during the third trimester is preferred as it both facilitates the maternal antibody response and provides passive immunity to the neonate. Tdap vaccination is also recommended for family members who have not been recently vaccinated and will be in close contact with the newborn. vaccination history (Choice A) The intramuscular influenza vaccine, an inactivated vaccine, is safe during every trimester of pregnancy and is administered as soon as it becomes available. In contrast, the intranasal influenza vaccine, a live attenuated vaccine, is contraindicated during pregnancy due to the risk of fetal infection. (Choice B) The measles-mumps-rubella vaccine is a live attenuated vaccine and is contraindicated during pregnancy; vaccination is delayed until the immediate postpartum period. (Choice C) The pneumococcal vaccine is safe in pregnancy; however, it is recommended only for patients who have risk factors for invasive pneumococcal infection (eg, chronic lung disease, immune deficiency). (Choice E) The varicella-zoster vaccine is a live attenuated vaccine and is contraindicated during pregnancy. Due to risks of maternal (eg, pneumonia, encephalitis) and congenital fetal (eg, cataracts, chorioretinitis) complications, nonimmune pregnant patients exposed to varicella are treated with prophylactic varicella-zoster immunoglobulin. Educational objective: Patients should receive the tetanus toxoid-reduced diphtheria toxoid-acellular pertussis (Tdap) during each pregnancy regardless of prior vaccination history. Vaccination in the third trimester is preferred as it provides passive immunity to the infant. __________ References: ACOG Committee Opinion No. 566: update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. (http://www.ncbi.nlm.nih.gov/pubmed/23812487) Committee opinion no. 608: influenza vaccination during pregnancy. (http://www.ncbi.nlm.nih.gov/pubmed/25162283) Effectiveness of vaccination during pregnancy to prevent infant pertussis. (http://www.ncbi.nlm.nih.gov/pubmed/28557752)

A 28-Year-Old Woman, Gravida 1 Para 0, at 29 Weeks