1. IMMUNIZATION Immunization??? Reduce mortality and morbidity of mathernal and baby

2.  Rubella infection in pregnancy is likely to cause fetal infection, which can result in miscarriage, fetal demise, and serious birth defects (e.g., cataracts, heart disease, deafness, intellectual disability).  Influenza infection increases the risk of serious complications in pregnant women and their newborns, as well as the risk of premature labor and delivery.

3. Reduced tetanus toxoid, diphtheria toxoid, and acel-lular pertussis (Tdap) vaccine should be provided during each pregnancy Preferably between 27 and 36 weeks of gestation. This timing recommendation is based on the maternal immune response, which peaks two weeks after administration.

4. If not given during pregnancy (and for the protection of the newborn), The Tdap vaccine should be administered immediately postpartum in any woman who has not previously received it. If Tdap vaccination history cannot be confirmed through written records, the patient should be considered unvaccinated and should receive a Tdap vaccine.

5. 63% received Tdap in the first trimester and 37% after. Tdap was given most commonly as wound prophylaxis. The incidence of spontaneous or elective abortion was no greater in Tdap cases There were no significant differences in preterm delivery, gestational age, or birth weight between groups. One or more congenital anomaly was identified

6. The influenza vaccine is safe in pregnancy, vaccinating all pregnant women during any trimester should be a priority to minimize these risks. They will be pregnant during the flu season (or up to 3 months postpartum during flu season).

7. Although the effects of varicella virus on the fetus are unknown, there are theoretical concerns, and the risk of severe varicella virus infection may be higher in pregnant women. Therefore, vaccinating nonimmune women before pregnancy is recommended.

8. The hepatitis B vaccine has not been shown to cause any harm to the developing fetus. The hepatitis B vaccine should be provided to any pregnant woman at higher risk of exposure to hepatitis B (e.g., multiple sex partners, recent injection drug use). Adequate safety data do not exist for the hepatitis A vaccine, but the theoretical risks are low because it is produced from an inactivated virus. Women who are thought to be at high risk of exposure to hepatitis A should be considered for vaccination during pregnancy (e.g., travel to endemic countries, chronic liver disease ).

9. Human papillomavirus (HPV) and herpes zoster vaccines are not recommended because of a lack of safety data in pregnant women

10. Immunization Live virus vaccines must be avoided during pregnancy because of possible effects on the fetus. These include measles, mumps,rubella (MMR), yellow fever (YF-Vax), and varicella (Varivax) vaccinations. The risks to the fetus from the administration of rabies vaccine (RabAvert, IMOVAX) are unknown.

11. 1. Immediate/early effects include fainting and vasovagal reactions. These are differentiated from anaphylactic shock (see below). Patients who have received the vaccine should be kept in the waiting room for observation for 5 to 10 minutes 2. Local effects are mild and are the most common such as soreness, erythema, and swelling. 3. Systemic effects are less common and include malaise and fever. Side effects

12. 1. Mild allergic reactions can also occur. In general, these will be in reaction to exposure to avian proteins (eggs, such as in yellow fever) or to traces of neomycin/streptomycin (MMR). Anaphylactic reactions are exceedingly rare. They should be recognized immediately and treated following local protocolswith injection of SC epinephrine (1:1000). 2. Long-termcomplications such as Guillain-Barre syndrome can occur but usually at rates lower than that seen for spontaneous disease.

13. The items on this list DO NOT represent contraindications to immunization 1.Mild acute illness with or without low-grade fever 2.Autoimmune disorder, multiple sclerosis 3.Family history of convulsions, epilepsy 4.Recent exposure to an infectious disease 5.Current antimicrobial therapy or convalescence from recent illness 6.Prior reaction to immunization with mild/moderate tenderness, redness, swelling, or fever of less than 40 °C 7.Personal history of allergies, excluding anaphylaxis, to neomycin/streptomycin or egg protein 8.Family history of adverse reaction or allergies to vaccines 9.Positive TB skin test