Podcast Summary

Podcast: Dr. Chapa’s OBGYN Clinical Pearls
Host: Dr. Chapa
Episode: More Measles Material
Date: November 17, 2025

Overview

This episode delivers a concise, evidence-based update on measles (rubeola) in pregnancy in response to a recent narrative review just published by ACOG, “Measles in Pregnancy: Clinical Considerations and Challenges.” Dr. Chapa reviews key clinical pearls, updates listeners with the newest literature, and emphasizes actionable steps for clinicians, especially relevant as the US faces the largest measles outbreak in Texas in three decades. Expect a rapid-fire, engaging recap with practical highlights, ideal for busy medical students, residents, and providers.

Key Discussion Points and Insights

1. The Current Measles Outbreak & Why This Episode Now

• Largest outbreak in Texas in 30 years, nearly 100 cases nationally (00:38)
• Dr. Chapa stresses the importance of staying ahead of the curve with timely, evidence-based info, explaining,

  "We do a lot of work to keep our finger on the pulse of what's coming out... we covered that February 24th because of the then big worry about measles in Texas and New Mexico..." (02:05)

• New ACOG narrative review (published Nov 14, 2025) closely matches what was previously covered — listeners are encouraged to revisit the “Measles 101: What to Know” Feb 24, 2025 episode for foundational knowledge (03:35)

2. Measles Immunity: Rubella vs. Rubeola

• Key distinction emphasized:

  "Proof of rubella immunity does not always mean proof of immunity to measles." (05:02)

• Dr. Chapa highlights clinical examples where patients were rubella-immune but rubeola (measles)-nonimmune, underscoring the need to check specifically for rubeola in high-risk populations (05:55, 24:57)

3. Virology & Clinical Presentation: Rapid Review

• Organism: Measles (rubeola) is a single-stranded, negative-sense RNA virus (09:03)
• Incubation: 7–21 days after exposure (09:16)
• Prodrome: Classic "3 Cs":
  • Cough
  • Coryza (runny nose)
  • Conjunctivitis
  • Often includes fever and sometimes photophobia

  "It doesn't have to be all three. It's just one of the three Cs with fever... in a susceptible patient." (10:24)

• Pathognomonic sign: Koplik spots — bluish-white spots on a red base in the buccal mucosa, present in ~70% of patients, appearing before the rash and lasting ~48 hours after rash onset (11:08)

4. The Rule of Four: Infectious Period

• Patients are infectious:
  • Four days before rash onset
  • Through four days after rash appears

  "That's the rule of four...four days before the rash, and then four days after its appearance." (13:54)

5. Rash Characteristics

• Measles rash spreads “top down”: starts on the face/head, then spreads caudally to trunk and extremities (12:26)

6. Risks and Outcomes in Pregnancy

• Measles during pregnancy increases risks for mothers:
  • Pneumonia (up to 18%)
  • Hepatitis (around 11%)
  • Maternal mortality (up to 4.3%)

  "Measles in pregnancy is bad... it is bad. It's bad for mom, bad for baby." (16:42)

• For fetus/infant:
  • Preterm birth
  • Low birth weight
  • Fetal growth restriction
  • First trimester: risk of fetal loss; possible increased stillbirth rates (17:20)
• Teratogenicity: No consistent association with patterns of congenital anomalies (18:25)

  "Measles is not a known teratogen. That's good news." (18:28)

7. The Rule of Ten: Congenital Measles

• Key Clinical Pearl:
  • Neonate with a rash within 10 days of life whose mother had measles during pregnancy = suspect congenital measles

  "Appearance of the measles rash at birth or within the first 10 days in a child whose mother had measles during pregnancy is congenital measles. And it's bad." (19:12)

• Outcomes: can include hearing loss, death, subacute sclerosing panencephalitis, even years later (19:52)
• Perinatal transmission:
  • "Appears to be rare, but tends to be worse if infection in the third trimester or within 10 days before delivery." (20:54, quote from narrative review)

8. Breastfeeding Considerations

• Measles is not transmitted through breast milk; breastfeeding generally allowed
  • Must use shared decision-making, especially if the mother has active breast lesions
  • Direct nursing requires N95 mask and hand hygiene
  • Baby should remain quarantined for 21 days after exposure (24:15)

  "Short answer is yes, they can either express breast milk...or they can engage in breastfeeding. As long as there's no lesions in the way because the virus is not transmitted in breast milk." (25:05)

9. Neonatal Prophylaxis

• All neonates born to women with suspected/confirmed measles: Receive IM immunoglobulin ASAP (0.5 mL/kg up to 15 mL, within 6 days of exposure) (25:36)

  "AAP... all babies...born to women with suspected or confirmed measles...should have immunoglobulin...as soon as possible or within 6 days of exposure." (25:36)

10. Maternal Post-Exposure Prophylaxis

• Non-immune, exposed pregnant patient:
  • IVIG (400 mg/kg IV) within 6 days of exposure (26:32)

  "For the mom, if she's been exposed and...she's non immune...the treatment...is post exposure prophylaxis...400 milligrams per kilo of intravenous IVIG..." (26:32)

• MMR vaccine contraindicated in pregnancy. For non-pregnant, MMR ideally within 72 hours of exposure; for pregnant, IVIG only. (29:17)
• 28-day avoidance of conception after MMR for nonpregnant women due to live-attenuated virus (29:30)

11. Rubella vs Rubeola Immunity – Practical Testing

• MMR vaccine is highly effective, but seroconversion to all three viruses is not guaranteed (28:10)
• Dr. Chapa’s recommendation:

  "If you have a patient population who likely is at risk for measles...consider a check for Rubiola immunity with IgG. That's what we do." (28:30)

• Cited directly from review:

  "A positive test for rubella immunity is likely insufficient to predict measles immunity in obstetric patients, although the data is equivocal." (28:55)

Memorable Quotes & Notable Moments

• On staying current:

  "We're telling you stuff sometimes really ahead of the curve. I mean, ahead of, of the game. Okay. Like it's the pregame show and I know it's coming out." (02:30)

• On infectious period:

  "That's why in anybody who is rubiola negative...even though ACOG says yes, we check for rubella, I've advocated for...we also check for rubiola immunity." (10:50)

• On classical signs:

  "Coplik spots are a big deal. They are pathognomonic for measles....look inside." (11:08)

• On clinical outcomes:

  "Measles in pregnancy is bad. The good news...it doesn't seem to be a known teratogen." (18:19)

• On immunoglobulin for neonates:

  "Even if they have congenital measles, giving them immunoglobulin, 'may modulate disease in neonates with congenital measles.'" (25:52)

• Straightforward Paraphrase:

  "Measles is not transmitted in breast milk. Breastfeeding is not contraindicated, but use shared decision making and appropriate precautions." (24:12)

Important Segment Timestamps

• Background & ACOG Update: 00:38–07:55
• Immunity Nuances: 05:02–06:15; 24:57–25:15
• Virology & Clinical Course: 09:03–12:26
• Rule of Four (Infectious Window): 13:54–15:18
• Pregnancy Outcomes: 16:23–18:25
• Rule of Ten (Congenital Measles): 18:55–21:10
• Breastfeeding/Infant Management: 24:12–25:52
• Post-Exposure Prophylaxis: 26:32–29:30
• Rubella/Rubeola Immunity Notes: 28:55–29:15

Final Clinical Pearls

• Measles in pregnancy is associated with increased maternal and fetal morbidity and mortality—be vigilant.
• Routinely check rubeola (measles) immunity separately in high-risk populations; rubella immunity does not guarantee protection.
• IVIG is the only post-exposure prophylaxis in pregnancy; MMR vaccine is contraindicated during pregnancy but can be used in non-pregnant patients within 72 hours of exposure.
• Congenital measles is rare but serious—look for rash in neonates within 10 days of birth if maternal measles present.
• Breastfeeding is allowed with precautions; measles is not transmitted via breast milk.

Episode in a Sentence:
Dr. Chapa delivers a rapid, practical, and timely review of the latest on measles in pregnancy, with a focus on clinical risk, accurate immunity assessment, and evidence-based management, tailored for practicing OBGYNs and learners.