Chickenpox exposure in pregnancy

Question 1

what is chickenpox caused by?

Answer 1

primary infection with VZV

Question 2

what is shingles caused by?

Answer 2

reactivation of dormant virus in dorsal root ganglion

Question 3

what is the risk of chickenpox to the mother?

Answer 3

5x greater risk of pneumonitis

Question 4

what is the risk of chickenpox to the fetus?

Answer 4

fetal varicella syndrome

• skin scarring
• eye defects (microphthalmia)
• limb hypoplasia
• microcephaly
• learning disabilities

shingles in infancy

severe neonatal varicella (of mum develops rash between 5 days before and 2 days after birth) - can be fatal

Question 5

how do you manage chickenpox exposure in pregnancy i.e. post-exposure prophylaxis (PEP)?

Answer 5

1. if doubt mum previously having chickenpox –> urgently check for varicella antibodies
2. if pregnant woman <=20 weeks gestation + not immune to varicella –> give VZIG asap
3. if pregnant woman >20 weeks gestation + not immune to varicella –> either VZIG / antivirals (aciclovir) given days 7-14 after exposure

Question 6

how do you manage chickenpox in pregnancy?

Answer 6

• seek specialist advice
• oral aciclovir if >=20 weeks pregnant and present within 24 h of onset of rash
• <20 weeks, aciclovir considered with caution