chickenpox in pregnancy Flashcards
how is chickenpox spread
droplet and direct contact
What virus causes chickenpox
herpes VZV, DNA virus
What is the prevalence of congenital infection with chickenpox
3/1000
Is chickenpox part of routine antenatal screening
no but vaccination pre-pregnancy or postnatally for seronegative women
Symptoms of chicken pox in a pregnant woman
pneumonia, hepatitis, encephalitis
What are the features of congenital VZV infection
fetal varicella syndrome
What should you ask pregnant women at booking wrt chickenpox
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
What features of exposure to chickenpox warrant significant exposure
being in the same room with a person for >15 mins
face to face contact
how long are individuals infectious
48hrs prior to rash and until vesicles crust over, usualy 5 days
What investigations should be done in a woman with significant contact with chickenpox
VZV IgG. Results come back in 48hrs and virology can compare to booking sample.
How do you manage a non-immune woman exposed to chickenpox
Give VZIG varicella zoster immunoglobulin ASAP. this is effective 10 days after contact
Safety netting for a woman exposed to chickenpox?
come back asap if rash develops
What advice should you give to a pregnant woman with chickenpox
avoid contact with other pregnant women or neonates until the lesions have crusted over
How do you treat a woman with chickenpox >20/40
oral aciclovir 800mg 5 times a day for 7 days if >20/40 and if the rash onset was <24hrs ago
Should you give IVIG to a woman who has chickenpox
no it doesn’t work
when should you asses pregnant women with chickenpox in hospital
if she smokes, has chronic lung disease, is taking corticosteroids or is >20/40
Risks of delivery during viraemic period?
thrombocytopenia, DIC, hepatitis
Features of fetal varicella syndrome FVS
skin scarring in dermatomal distribution
eye defects - microphthalmia, chorioretinitis, cataracts
hypoplasia of limbs
neuro abnormalities
When in gestation is the greatest likelihood of transmission of chickenpox to fetus causing FVS
3-28 weeks, lower risk in first trimester
when should fetal medicine be involved
5 weeks after infection to be able to detect abnormalities
how should pregnant women getting infected with chickenpox at term be managed
delay elective delivery for 5-7 days while rash subsides
organise neonatal ophthalmic exam after birth
if the mother got infected with chickenpox within 7 days of the delivery, how should the neonate be managed?
give neonate IVIG and monitor for signs of infection for 1 month. if neonate has chickenpox, treat with aciclovir
if a women has significant contact with a person with shingles, what is the risk of infection
very low
