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Varicella in Pregnancy > Varicella in pregnancy > Flashcards

Varicella in pregnancy Flashcards

1
Q

how is varicella transmitted

A

repiratory droplets and direct contact with vesicular fluids

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2
Q

What is the incubation period

A

10-21 days Infectious 48hrs prior to rash infectious until vesicles crust over

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3
Q

Maternal VZV complicated how many pregnancies

A

2-3 per 1000

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4
Q

True or false ? shingles is not assoc w viremia and does not cause fetal sequale

A

TRUE

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5
Q

What is the maternal fatality rate by age group?

A

15-19 yo : 2.7 per 100 000 30-39 yo : 25.2 per 100 000

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6
Q

What usually causes maternal death

A

Respiratory complications; 5-10% will have pneumonitis

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7
Q

What are risk factors for varicella pneumonitis

A

Smoker More than 100 lesions

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8
Q

What is strongest correlate with maternal death

A

Onset of disease in 3rd trimester

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9
Q

What are fetal manifestations of varicella infection

A

Congenital varicella ( embryopathy) Neonatal varicella (no embryopathy) in 1st 10 days of life

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10
Q

What are manifestations of congenital varicella

A

Chorioretinitis Cerebral cortical atrophy Hydronephrosis Cutaneous and bony leg defects partial limb reduction

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11
Q

What are rate of fetal infection prior to 13 weeks and between 13-20 wks?

A

0.4% 2%

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12
Q

what is the risk of fetal congenital varicella in 1st, 2nd and 3rd trimester

A

0,7% 2% 0%

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13
Q

list US findings of congenital varicella

A

MSK abn (assymetric limbs, shortening of limbs, malformations)

chest wall deformation

intestinal and hepatic echogenic foci

IUGR

polyhydramnios

hydrops

demise

Ventriculomegaly

Hydrocephalus

microcephaly

polymicrogyra

Porencephaly

Congenital cataract

microphtalmos

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14
Q

What ar ethe 2 most common ocular lesions related to varicella

A

congenital cataracts

microphtalmos

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15
Q

When (what GA) is neonatal infection more likely to happen ?

A

5 days before delivery to 2 days after

(period when maternal IgG are formed and it too short to provide transplacental passive immunization to fetus)

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16
Q

When varicella zoster immune globulin is given to mother, what % of newborns still develop infection

What does the vaccine help reduce?

A

30-40%

Number of complications

17
Q

What medication is given to mother to treat varicella ?

A

oral Acyclovir

(shown to reduce duration of fever and sx of varicella infection in immunocompromised children and immunocompetent adults if started within 24hrs of developmment of rash)

18
Q

Who should be treated with antivirals?

A

Children at high risk

adults with substansive varicella infection ( more than 100 lesions)

and or respiratory co-factors

Pregnant women with varicella pneumonitis

(if levels warrants, give IV antiviral)

19
Q

What is the definition of direct contact exposure, substansial expsure and brief contact expsoure, continuous exposure?

A

Direct contact that lasts an HOUR or longer with infectious person while indoors

SUbstantial exposure for hospital contacts ex: sharing hospital room with infectious patient or prolonged, direct, face-to-face contact with infectious person

Brief contact: brief contact with infectious person (ex : x-ray tech or hskg personel)

Continuous exposure: ex: living with household member who have varicella (at greatest risk for infection)

20
Q

How is the varicella vaccine given ?

What is the seroconversion rate ?

Should termination of pregnancy be recommended if vaccinated durign pregnancy?

A

2 doses 4-8 weeks apart for children more than 13yp when no hx of varicella.

97%

Not recommended in pregnancy or within 1 month of pregnancy

NO; study of 362 vaccine-exposure with NO cases of congenital varicella syndromes or congenital malformation.

21
Q

VZIG (Varicella zoster immunoglobulin) lowers infection rates if administered within how long after exposure ?

A

72-96 hrs after exposure

22
Q

Protection with VZIG last how long ?

What is the indication of VZIG?

What is the dose of VZIG ?

A

3 weeks

to reduce maternal risks of varicella infection and its complications

125 units per 10kg IM, max dose 625units.

Recommended for all susceptible pregnant women.

23
Q

What testing should be done if hx reveals no prior varicella infection and no varicella antibody testing in early pregnancy or previous vaccination, after an exposure ?

A

antibody testing with enzyme-linked immunosorben assay OR

Fluorescent antibody to membrane antigen

Should precede use of VZIG

24
Q

What is most frequent adverse rx following VZIG ?

A

local discomfort at injection site (pain, redness, swelling) 1%

less frequent: GI sx, 0,2%

severe: angioneurotic edema & anaphylactic shock (less than 0,1%)

25
Q

What is required from patient before giving VZIG ?

A

consent. since its a blood product.

26
Q

What is Acyclovir ?

A

synthetic nucleoside analogue that inhibits replication of human herpes virus

Crosses the placenta, found in fetal tissue, cord blood and AF

May inhibit viral replication during maternal viremia limiting transplacental passage of the virus.

27
Q

Varicella immunization is recommended for who ?

A

all non-immune women as part of pre-pregnancy and postpartum care

28
Q

Varicella immunity status can be document by what ?

A

history of previous infection

varicella vaccination

varicella zoster immunoglobulin G serology

29
Q

IN a case of possible exposure to varicella in pregnant women with unknown immune status, serum testing should be performed. If serum results are negative or unavailable within ____ hrs from exposure, varicella zoster immunoglobulin should be administered.

A
30
Q

Women with significant (ex: pneumonitis) varicella infection should be treated with what ?

A

oral antivirals ( acyclovir 800mg 5 times daily)

31
Q

What is the dose of IV acyclovir, used for severe complications ?

A

10-15mg /kg of BW or 500mg/m2 IV q8h for 5-10 days for varicella pneumonitis, should be started within 24-72 hrs of onset of rash.

32
Q

When should neonatal zoster immunoglobulin should be given ?

A

if onset of maternal disease is between 5 days before and 2 days after delivery.

Varicella in Pregnancy (1 decks)

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