Varicella in pregnancy

Question 1

Management of VZV exposure

Answer 1

• Confirm significant exposure
  o Living in same household as person with chicken pox or herpes zoster
  o Face-to-face contact for 5 minutes
  o Present in same room for 1 hour
• Assess immunity
  o Previous maternal chickenpox or VZV immunisation
• Immune and no further action required
  o No or uncertain history of exposure or immunisation
• Urgent serology
  o If serology negative or not available within 96/24 of exposure, treat
• Assess timing of exposure
  o <96/24 earlier
• Varicella zoster immunoglobulin (ZIG)
  o >96/24
• ZIG of no benefit
• Consider post-exposure prophylaxis with oral aciclovir if risk factors
• > 20/40, lung disease, smoker, immunocompromised
• Advise to seek medical attention if develops symptoms of chickenpox

Question 2

Management of confirmed Chicken pox in pregnancy

Answer 2

• Assess for clinical complications
  o Respiratory symptoms
  o Haemorrhagic rash
  o New pocks developing >6 days
  o Persistent fever >6 days
  o Neurological symptoms
• If none present
  o Oral aciclovir 800mg 5x per day if rash present <24/24
  o Outpatient management
• If complications present
  o Admission for IV aciclovir 8 hourly
• Referral to MFM for counselling on fetal risk
  o Varicella Syndrome
• Skin scars
• Eye abnormalities
• Limb abnormalities
• Preterm birth, low birth weight
• Cortical atrophy, intellectual impairment
  o Risk is low in all trimesters
• T1 0.55%
• T2 1.4%
• T3 No cases reported
  o Tertiary ultrasound may detect abnormalities 5 weeks after infection

Question 3

Neonatal management

Answer 3

o Give infant ZIG if maternal infection within 7 days of delivery
o Treat with aciclovir if develops chickenpox