A 20-year-old woman, gravida 1 para 0, at 12 weeks gestation comes to the office for routine prenatal care during the fall season. She has mild nausea, which she controls with vitamin B supplementation, but no abdominal pain or vaginal bleeding. The patient has no chronic medical conditions or previous surgeries. She takes a daily prenatal vitamin. She is currently in a monogamous relationship and has had 1 partner previously. The patient does not use tobacco, alcohol, or illicit drugs. She did not receive any routine childhood vaccinations but does not object to vaccination. She plans to start taking college courses in the next few years. The patient has no known allergies. Blood pressure is 120/70 mm Hg and pulse is 65/min. BMI is 23 kg/m². The fetal heart rate is 150/min by bedside Doppler ultrasonography. Initial prenatal laboratory results are as follows: Which of the following preventive vaccines is most appropriate for this patient at this visit?

Question

Quizplus · Accepted Answer

Explanation: 11ec2b69_c03e_6dcf_8f63_8534033e8998_MD0005_00 Maternal vaccination is beneficial to both mother and fetus, and the optimal time for administration is prior to conception. However, vaccination during pregnancy is indicated if the likelihood of disease exposure is high, if the disease has significant maternal or fetal risks, and if the risks of the vaccination are low. Vaccination prevents fetal disease by decreasing vertical transmission rates and by providing passive immunity for the infant via transplacental passage of maternal antibodies (IgG). Inactivated vaccines (eg, tetanus toxoid-reduced diphtheria toxoid-acellular pertussis [Tdap], injectable influenza virus), toxoids (eg, tetanus), and immunoglobulins (eg, Rho(D) immunoglobulin) are safe during pregnancy. Live attenuated vaccines (eg, intranasal influenza) are contraindicated during pregnancy due to a theoretical risk of congenital infection. Pregnant women are at increased risk for morbidity (eg, pneumonia) and mortality from the seasonal influenza virus. Influenza may also increase the risk for spontaneous abortion, congenital anomalies, fetal growth restriction, and preterm delivery. All pregnant women without contraindications (eg, allergic response to prior vaccination) should receive the influenza vaccination as soon as it becomes available. The seasonal inactivated influenza vaccine is safe during every trimester of pregnancy and during breastfeeding. Vaccination prevents maternal influenza-related illness and provides passive neonatal immunity, thereby decreasing the risk of influenza-related illness in newborns. (Choice A) Although the human papillomavirus vaccine is an inactivated vaccine, vaccination during pregnancy is avoided due to lack of information regarding its safety. (Choices C and E) The measles-mumps-rubella and varicella vaccines are live attenuated vaccines. They are typically administered in the immediate postpartum period to susceptible mothers, to decrease the risk of congenital infection in subsequent pregnancies. (Choice D) The Tdap vaccine, an inactivated vaccine, is indicated during each pregnancy regardless of vaccination history. Tdap vaccination during the third trimester (>28 weeks gestation) is preferred as it facilitates both the maternal antibody response and the transfer of maternal antibodies through the placenta, providing passive immunity to the fetus. Educational objective: Vaccines that are safe during pregnancy include inactivated influenza, tetanus toxoid-reduced diphtheria toxoid-acellular pertussis, and Rho(D) immunoglobulin. The seasonal inactivated influenza vaccine is safe during every trimester of pregnancy and should be administered to pregnant patients as soon as it becomes available. References: Committee opinion no. 608: influenza vaccination during pregnancy. (http://www.ncbi.nlm.nih.gov/pubmed/25162283)

A 20-Year-Old Woman, Gravida 1 Para 0, at 12 Weeks