Synopsis
Offer the current maternal vaccination programme at the correct gestation, distinguish safe inactivated vaccines from live-vaccine precautions, and respond promptly to infectious exposure or illness that could threaten the pregnant person or fetus.
- Offer one inactivated influenza vaccine at any stage of pregnancy during the seasonal programme; do not delay it to combine with a later antenatal vaccine.
- Offer one pertussis-containing Tdap vaccine in every pregnancy from 16 weeks, ideally between 20 and 32 weeks and commonly around the fetal anomaly scan.
- Offer one RSV vaccine in every pregnancy from 28 weeks, ideally in week 28 or soon afterwards; eligibility continues until birth although very late vaccination may protect the infant less well.
- Influenza, pertussis and RSV vaccines are inactivated and may be given at the same visit or at any interval from one another, each at its recommended gestation.
- Pregnancy alone is not an indication for the spring 2026 COVID-19 campaign; give COVID-19 vaccine during pregnancy when the person meets the current programme eligibility, including relevant immunosuppression criteria.
- Do not give MMR or live varicella vaccine routinely during pregnancy; arrange indicated vaccination before conception or after birth and seek expert advice after inadvertent administration rather than predicting fetal harm.
- Ask about vaccine history, allergies, immunosuppression, occupational or travel exposure and infection contacts at booking, then recheck uptake at later appointments.
- Use hand hygiene, food-safety advice, safe management of animal or occupational exposure and prompt assessment after significant contact; vaccination does not prevent every important infection in pregnancy.
Key red flags
Breathlessness at rest, hypoxia, chest pain, confusion, hypotension or rapidly worsening fever in pregnancy requires same-day emergency assessment for severe respiratory infection or sepsis.
A vesicular rash or significant varicella or shingles exposure in a person without a reliable history of immunity needs urgent specialist risk assessment because time-sensitive post-exposure measures may be indicated.
A measles-like febrile rash, rubella exposure, parvovirus exposure or new rash illness in pregnancy should be discussed promptly with maternity and infection specialists before the patient enters a shared waiting area.
Fever with uterine tenderness, fluid loss, contractions, vaginal bleeding or reduced fetal movement requires urgent obstetric assessment alongside infection management.
Anaphylaxis after vaccination is treated immediately with intramuscular adrenaline and standard resuscitation; pregnancy is not a reason to withhold lifesaving treatment.
A laboratory or public-health notification requirement never replaces direct clinical escalation when the pregnant person or fetus may be acutely unwell.
Investigation priorities
Confirm which maternal vaccines were given, on what date and in which pregnancy before repeating or omitting a dose.
Management branches
A booking or later antenatal contact identifies an eligible pregnancy.
- Check gestation, vaccine record, current programme, contraindications and whether a dose has already been given in this pregnancy.
- Offer inactivated influenza during the season, pertussis from 16 weeks and RSV from 28 weeks, using co-administration rather than delay when convenient.
- Record product, batch, route, site, date and consent or decline, then reoffer any missed maternal vaccine at subsequent appropriate contacts.