Chickenpox in pregnancy

Question 1

what is the risk to both mother and foetus known as?

Answer 1

fetal varicella syndrome

Question 2

main risk to mother

Answer 2

5 times greater risk of pneumonitis

Question 3

when does fetal varicella syndrome occur

Answer 3

before 20 weeks

Question 4

what are the features of foetal varicella syndrome

Answer 4

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

Question 5

other risks to foetus?

Answer 5

shingles in infancy

severe neonatal varicella

Question 6

Mx of chickenpox exposure in pregnancy

Answer 6

1. doubt if mother has already had chicken pox - varicella antibodies should be checked
2. if the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible
3. if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

Question 7

Mx of chicken pox in pregnancy

Answer 7

1. specialist advice
2. women > 20 weeks and presents with in 24 hours of onset of rash - oral aciclovir
3. <20 weeks - acyclovir should be considered with caution