A patient who works as a nurse in the surgery intensive care unit at a local community hospital comes to see you for her annual gynecologic exam. She tells you that she plans to go off her oral contraceptives because she plans to attempt pregnancy in the next few months. This patient has many questions regarding updating her immunizations and whether or not she can do this when pregnant. All of the following statements are true regarding immunizations and pregnancy except

A. The patient should be checked for immunity against the rubella (German measles) virus prior to conception because the rubella vaccine is a live virus and should not be given during pregnancy

B. The patient should be given the tetanus toxoid vaccination prior to becoming pregnant because it is a live virus that has been associated with multiple fetal anomalies when administered during pregnancy

C. The Centers for Disease Control and Prevention recommends that all pregnant women should be vaccinated against the influenza virus after the first trimester

D. If the patient does not have a history of having chickenpox in the past, she should be screened for immunity because most people without a history of the infection are immune; if the patient is nonimmune, she should be given the vaccine prior to achieving pregnancy because the vaccine is a live virus

Correct Answer: The patient should be given the tetanus toxoid vaccination prior to becoming pregnant because it is a live virus that has been associated with multiple fetal anomalies when administered during pregnancy

Description: Immunizations in pregnancy with toxoids (tetanus) or killed bacteria or viruses (influenza, hepatitis B) have not been associated with fetal anomalies or adverse outcomes. The varicella, rubella, measles, mumps, and polio vaccines consist of attenuated live viruses and should not be administered during pregnancy because of a theoretic risk to the fetus. The Centers for Disease Control recommends that women wait 3 months to conceive after receiving immunization with a live attenuated virus, and that all women receive the influenza vaccine after the first trimester of pregnancy.

Category: Gynaecology & Obstetrics

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