Case 2: Unexplained Rash Develops in the Third Trimester
Mrs. U, a 36 year old G1, P0 at 32 weeks gestation presents for a routine prenatal visit. She complains, however, of a new “itchy rash all over my chest.”

HISTORY OF PRESENT ILLNESS
Mrs. U first noticed the rash upon awakening. It is just on her trunk and does not involve the hands. 

EXAMINATION
Mrs. U’s vital signs were: BP 124/64mm Hg, pulse 88bpm. On physical exam, small papules were present on the chest, erythemic, pruritic. No fever, adenopathy, or any other symptoms. Mrs. U reports consistent, good fetal movement.


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Fundal height: 32cm
FHT:  140 sets

ASSESSMENT & TREATMENT PLAN
The likely diagnosis for Mrs. U’s rash is PUPPS (pruritic urticarial papules and plaques of pregnancy). PUPPS is a chronic hive-like rash that generally begins appearing on the abdomen and can often spread to the chest, legs, and underarms. This condition more frequently occurs in first pregnancies during the third trimester.

Mrs. U is reassured that PUPP has no long-term effects to the health and safety of both mother or fetus. She is prescribed Benadryl to alleviate the rash. A mild topical corticosteroid (e.g., clobetasol or betamethasone) is reocmmended to help with the itching.