Wound Care for Expectant Mothers: Harmless Pregnancy Rash or Life-Threatening Atypical Wound?
Wound development and management presents a significant clinical challenge to healthcare workers serving older patients, both at home but especially those in long-term care or skilled nursing facilities or a hospital setting. An estimated 2-3% of the population suffer from chronic wounds, and among the elderly, the presence of typical or atypical wounds can have serious effects on their overall health outcomes.
However, atypical wounds are not relegated to long-term care facilities or only brought on by sudden injuries; they can also present serious underlying illnesses and medical complications for younger patients, and wound care specialists should stay informed about the signs, risks, and courses of treatment for these often life-threatening atypical wounds.
One such atypical wound that can present a serious health threat in younger patients is pemphigoid gestationis — a rare yet serious acute atypical wound that can develop in pregnant women and cause risk of premature birth and health complications for both mother and fetus. Pemphigoid gestationis is particularly menacing because, although it develops during pregnancy, the effects can last for both mother and baby even after birth, sometimes for years.
What is Pemphigoid Gestationis?
Pemphigoid gestationis is a rare pregnancy-related autoimmune skin disorder that occurs in only about 1 of every 50,000 pregnancies and typically presents in the second or third trimesters (although it can occur at any time during pregnancy). It causes an itchy rash that often leads to severe blistering of the skin, particularly the abdomen, back, chest, and extremities. The itching (pruritus) can become so severe, in fact, that it interferes with the patient’s daily activities. Although it is still somewhat of a mystery as to what causes this unusual immune response (some reports have suggested the woman’s body initiates an attack against placental tissue) Pemphigoid gestationis is caused by autoantibodies that attack epidermal basal cells, manifesting as severe itching and bullous lesions on the skin.
Common Outcomes Clinicians Can Expect to See
In most (less serious) cases, the condition resolves itself in the mother shortly after she gives birth, although it is possible for symptoms to linger for weeks, months, or even years beyond the pregnancy. Some studies have shown that women who experienced pemphigoid gestationis in one pregnancy are more likely to experience a recurrence in future pregnancies (often more serious with each recurrence), and others have even linked it to a higher risk of developing Graves disease. Some newborns born to mothers with pemphigoid gestationis present a rash or skin lesions, but this typically resolves itself days or weeks after birth.
Why Pemphigoid Gestationis Requires a Fast Response from Wound Care Specialists
Although occurrence is rare, if left untreated pemphigoid gestationis can lead to complications such as premature birth, lower than expected birth weight, transient blistering on the newborn, secondary infection, or, in a smaller number of cases, even death. According to the NIH, “Study of neonatal complications showed that there was morbidity or mortality in 38% of cases of pemphigoid gestationis: premature partus in 23%, neonatal herpes gestationis in 9% and intrauterine death in 7.7%.” But, as one study notes, “prompt recognition and appropriate management may reduce morbidity of this disease.”
Early detection for this atypical wound is key to ensuring good health outcomes for both mother and baby and avoiding the more threatening complications such as preterm birth or morbidity, although preventive wound management practices face a hurdle: pregnancy, in general, can lead to a variety of dermatological skin conditions, most of them relatively harmless, leading many healthcare providers to brush off or ignore the early signs of pemphigoid gestationis.
A primary concern, therefore, for clinicians and wound care specialists when treating pregnant patients is the potential for pemphigoid gestationis to be confused with other more common (and less serious) skin wounds and conditions that can occur throughout a pregnancy. For example, pemphigoid gestationis is often clinically mistaken for other pruritic breakouts and unusual skin pathologies associated with pregnancy, especially the more common “pruritic urticarial papules and plaques of pregnancy” (PUPP). But, ignoring the early signs of pemphigoid gestationis or confusing it with other common “pregnancy rashes” can lead to delayed treatment and, therefore, a higher risk of negative outcomes or complications for mother and baby. 1482898906
How Nurses, Doctors Can Manage This Atypical Pregnancy Wound
If a pregnant patient complains of itching or presents any kind of a rash, early and accurate identification of pemphigoid gestationis is critical to minimizing the risk of further complications such as preterm labor, low birth rate, secondary infections, or even death. The NIH also recommends most patients diagnosed with pemphigoid gestationis to be hospitalized in order to monitor the risk of preterm birth.
The most common course of treatment includes topical or oral corticosteroids or antihistamines to control itch. Patients with a severe case may receive steroid therapy or other clinical treatments, although the risk to mother and baby must be taken into account when considering more aggressive treatments.
Awareness is Key in Wound Care
For any wound care clinician or student of wound care, awareness of typical and atypical wounds that present in populations outside of geriatric care facilities is a vital part of maintaining professional development and increasing positive health outcomes for patients of all ages and demographics. The atypical wound pemphigoid gestationis presents healthcare providers with an unusually challenging approach to wound care identification and management because it is so often confused with other more common and less severe skin pathologies that occur during pregnancy.
And, although this is a rare condition that usually resolves, there is a risk of serious complication or morbidity if misdiagnosed or left untreated, making it all the more important for wound care specialists, nurses, and doctors to monitor the signs and symptoms early and often to avoid the worst outcomes for both mother and baby.
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