She will only need to receive the Tdap vaccine once during pregnancy. All other adolescent and adult family members also should be advised to make sure they are up-to-date with their Tdap vaccine to ensure protection for themselves and the newborn. As part of standard wound management care to prevent tetanus, a tetanus toxoid-containing vaccine is recommended in a pregnant woman if 5 years or more have elapsed since her previous tetanus and diphtheria Td vaccination.
If a Td booster vaccination is indicated in a pregnant woman for acute wound management, the obstetrician—gynecologist or other health care provider should administer the Tdap vaccine, irrespective of gestational age 7.
A pregnant woman should not be revaccinated with Tdap in the same pregnancy if she received the vaccine in the first or second trimester. Example case : An emergency department ED physician calls you about a patient, gravida 4, para 3, at 13 weeks of gestation who is being seen after accidentally stepping on a rusty nail.
The patient cannot remember when she last received a tetanus booster and the ED physician is confused about when to administer the indicated tetanus booster because the Centers for Disease Control and Prevention guidelines recommend the administration of Tdap between 27 weeks and 36 weeks of gestation. How should you advise the ED physician?
Answer : The ED physician should be advised that the appropriate acute wound management strategy for the patient is to receive a dose of Tdap now. This vaccine replaces the solitary tetanus booster vaccine, and administering it now as part of acute wound management is the most important factor.
The patient should be told that getting Tdap now will preclude her getting it again between 27 weeks and 36 weeks of gestation in this pregnancy.
She and her fetus will still receive pertussis prevention benefits from receipt at 13 weeks of gestation. If a Td booster vaccination is indicated during pregnancy ie, more than 10 years since the previous Td vaccination then obstetrician—gynecologists and other health care providers should administer the Tdap vaccine during pregnancy within the 27—weeks-of-gestation window 7.
This recommendation is because of the nonurgent nature of this indication and the desire for maternal immunity. It also will maximize antibody transfer to the newborn. To ensure protection against maternal and neonatal tetanus, pregnant women who have never been vaccinated against tetanus should begin the three-vaccination series, containing tetanus and reduced diphtheria toxoids, during pregnancy.
The recommended schedule for this vaccine series is at 0 weeks, 4 weeks, and 6—12 months. The Tdap vaccine should replace one dose of Td, preferably given between 27 weeks and 36 weeks of gestation 7. The Advisory Committee on Immunization Practices recommends that all adolescents and adults who have or who anticipate having close contact with an infant younger than 12 months eg, siblings, parents, grandparents, child care providers, and health care providers who previously have not received the Tdap vaccine should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission 7.
Ideally, these adolescents and adults should receive the Tdap vaccine at least 2 weeks before they have close contact with the infant 6. The American College of Obstetricians and Gynecologists has identified additional resources on topics related to this document that may be helpful for ob-gyns, other health care providers, and patients. You may view these resources at: www. These resources are for information only and are not meant to be comprehensive.
The resources may change without notice. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Committee Opinion No. American College of Obstetricians and Gynecologists.
Obstet Gynecol ;e—7. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary.
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A single copy of these materials may be reprinted for noncommercial personal use only. This site complies with the HONcode standard for trustworthy health information: verify here. This content does not have an English version. This content does not have an Arabic version. See more conditions. Request Appointment. Healthy Lifestyle Pregnancy week by week. Td1 On first contact with the health care system or as soon as possible during pregnancy Td2 At least 4 weeks after Td1 Td3 6 months to 1 year after Td2 or during the following pregnancy Td4 1 to 5 years after Td3 or during the following pregnancy Td5 1 to 10 years after Td4 or during the following pregnancy.
Type of wound. Td 1 booster dose.
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