Should a planned induction be postponed in a patient with hand, foot, and mouth disease (HFMD) until they are no longer contagious?

Management of Labor Induction in a Patient with Hand, Foot, and Mouth Disease

The planned induction should be postponed until the patient is no longer contagious with hand, foot, and mouth disease to prevent transmission to healthcare workers and potentially to the newborn.

Understanding Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease is a highly contagious viral illness primarily affecting young children but can also affect adults, including pregnant women. Key characteristics include:

• HFMD is caused by various enteroviruses, most commonly Coxsackievirus A16, Enterovirus 71, and increasingly Coxsackievirus A6 and A10 1, 2
• The disease is marked by fever, oral ulcers, and skin manifestations affecting the palms, soles, and buttocks 3
• Symptoms typically last less than one week, with the disease being self-limiting in most cases 3, 4
• Transmission occurs through direct contact with nose and throat secretions, saliva, fluid from blisters, or stool of infected persons 5

Infection Control Considerations

When managing a patient with an active infectious disease such as HFMD, several infection control principles apply:

• Persons with moderate or severe acute illness should have elective procedures postponed until they have recovered from the acute phase of the illness 6
• This precaution helps avoid superimposing adverse effects on the underlying illness and prevents transmission to healthcare workers 6
• Elective operative procedures on patients who have transmissible infections should be delayed until the patient is no longer infectious 6

Specific Recommendations for Labor Induction

For the 38-week pregnant patient with HFMD planning for induction:

• Postpone the planned induction until the patient is no longer in the contagious phase of HFMD 6
• The contagious period for HFMD typically lasts about 7-10 days from symptom onset 2
• This delay helps protect:
  • Healthcare workers from potential infection 6
  • The newborn from potential viral exposure during or after delivery 2
  • Other patients in the labor and delivery unit 6

When to Proceed with Induction

The induction can be rescheduled when:

• The patient's acute symptoms have resolved 6
• Skin lesions have crusted over or healed 2
• At least 7 days have passed since symptom onset 2, 4

Special Considerations

• If there are urgent maternal or fetal indications for delivery that outweigh infection control concerns, proceed with induction using appropriate isolation precautions 6
• In such cases, implement:
  • Contact precautions with appropriate personal protective equipment for healthcare workers 6
  • Isolation of the mother-baby dyad to prevent transmission to other patients 6
  • Enhanced hand hygiene protocols for all healthcare workers 6

Potential Complications to Consider

• While HFMD is typically self-limiting, rare complications can include meningitis and encephalitis 1
• Monitor for any neurological symptoms that might indicate complications requiring immediate medical attention 2
• Be aware that vertical transmission to the newborn is possible, though uncommon 4

By postponing the induction until the infectious period has passed, the risks of transmission to healthcare workers and potentially to the newborn are minimized, while still maintaining appropriate obstetric care for the mother and baby.