Management of Facial Non-Blanching Rash in Pregnancy

Presentation and Differential Diagnosis

The American College of Obstetricians and Gynecologists notes that atopic eruption of pregnancy (AEP) presents with eczematous rash on face, eyelids, neck, antecubital/popliteal fossae, trunk, and extremities—NOT petechiae 1, 2
The American College of Obstetricians and Gynecologists states that polymorphic eruption of pregnancy (PEP) presents with pruritic urticarial papules and plaques on abdomen and proximal thighs in third trimester—NOT at 11 weeks with facial petechiae 1, 2
Pemphigoid gestationis is rare and associated with vesicles and bullae—NOT petechiae, as noted by the American College of Obstetricians and Gynecologists 1, 2
Intrahepatic cholestasis of pregnancy (ICP) presents with pruritus WITHOUT a primary rash in second/third trimester—NOT with visible petechiae at 11 weeks, according to the American College of Obstetricians and Gynecologists 1, 2, 3

Complete blood count with differential and platelet count should be performed, as recommended by the American College of Obstetricians and Gynecologists 4
Peripheral blood smear is necessary, as stated by the American College of Obstetricians and Gynecologists 3
Coagulation studies (PT/INR, aPTT) should be conducted, according to the American College of Obstetricians and Gynecologists 3
Comprehensive metabolic panel including liver function tests is recommended by the American College of Obstetricians and Gynecologists 4
Lactate dehydrogenase (LDH) and haptoglobin should be measured if hemolysis is suspected, as noted by the American College of Obstetricians and Gynecologists 4

If platelets <100,000/μL, refer immediately to maternal-fetal medicine and hematology, as recommended by the American College of Obstetricians and Gynecologists 4
Consider bone marrow evaluation if etiology is unclear, according to the American College of Obstetricians and Gynecologists 4
Assess for bleeding risk and fetal implications, as stated by the American College of Obstetricians and Gynecologists 5
Parvovirus B19 IgM and IgG, rubella IgM and IgG, and CMV IgM and IgG should be tested, as recommended by the American College of Obstetricians and Gynecologists 4
Immediate referral is necessary if platelet count <50,000/μL, active bleeding, systemic symptoms, or signs of hemolysis are present, according to the American College of Obstetricians and Gynecologists 1

Serial platelet counts should be performed if thrombocytopenia is identified, as recommended by the American College of Obstetricians and Gynecologists 1
Fetal ultrasound for growth and anatomy should be conducted if maternal infection is confirmed, according to the American College of Obstetricians and Gynecologists 4