chickenpox in pregnancy

Question 1

how is chickenpox spread

Answer 1

droplet and direct contact

Question 2

What virus causes chickenpox

Answer 2

herpes VZV, DNA virus

Question 3

What is the prevalence of congenital infection with chickenpox

Answer 3

3/1000

Question 4

Is chickenpox part of routine antenatal screening

Answer 4

no but vaccination pre-pregnancy or postnatally for seronegative women

Question 5

Symptoms of chicken pox in a pregnant woman

Answer 5

pneumonia, hepatitis, encephalitis

Question 6

What are the features of congenital VZV infection

Answer 6

fetal varicella syndrome

Question 7

What should you ask pregnant women at booking wrt chickenpox

Answer 7

have you had chicken pox before?
avoid contact with chickenpox if you haven’t had it before
tell doctor as soon as you come into contact with chickenpox

Question 8

What features of exposure to chickenpox warrant significant exposure

Answer 8

being in the same room with a person for >15 mins

face to face contact

Question 9

how long are individuals infectious

Answer 9

48hrs prior to rash and until vesicles crust over, usualy 5 days

Question 10

What investigations should be done in a woman with significant contact with chickenpox

Answer 10

VZV IgG. Results come back in 48hrs and virology can compare to booking sample.

Question 11

How do you manage a non-immune woman exposed to chickenpox

Answer 11

Give VZIG varicella zoster immunoglobulin ASAP. this is effective 10 days after contact

Question 12

Safety netting for a woman exposed to chickenpox?

Answer 12

come back asap if rash develops

Question 13

What advice should you give to a pregnant woman with chickenpox

Answer 13

avoid contact with other pregnant women or neonates until the lesions have crusted over

Question 14

How do you treat a woman with chickenpox >20/40

Answer 14

oral aciclovir 800mg 5 times a day for 7 days if >20/40 and if the rash onset was <24hrs ago

Question 15

Should you give IVIG to a woman who has chickenpox

Answer 15

no it doesn’t work

Question 16

when should you asses pregnant women with chickenpox in hospital

Answer 16

if she smokes, has chronic lung disease, is taking corticosteroids or is >20/40

Question 17

Risks of delivery during viraemic period?

Answer 17

thrombocytopenia, DIC, hepatitis

Question 18

Features of fetal varicella syndrome FVS

Answer 18

skin scarring in dermatomal distribution
eye defects - microphthalmia, chorioretinitis, cataracts
hypoplasia of limbs
neuro abnormalities

Question 19

When in gestation is the greatest likelihood of transmission of chickenpox to fetus causing FVS

Answer 19

3-28 weeks, lower risk in first trimester

Question 20

when should fetal medicine be involved

Answer 20

5 weeks after infection to be able to detect abnormalities

Question 21

how should pregnant women getting infected with chickenpox at term be managed

Answer 21

delay elective delivery for 5-7 days while rash subsides

organise neonatal ophthalmic exam after birth

Question 22

if the mother got infected with chickenpox within 7 days of the delivery, how should the neonate be managed?

Answer 22

give neonate IVIG and monitor for signs of infection for 1 month. if neonate has chickenpox, treat with aciclovir

Question 23

if a women has significant contact with a person with shingles, what is the risk of infection

Answer 23

very low