Varicella Infection in Pregnancy Flashcards
How is Varicella transmitted?
Respiratory, Direct contact
What is the infectious period with Varicella?
one day before the outbreak until lesions crust over
What is the incubation period for acute varicella infection?
10 - 14 days
What are the main manifestations of Varicella infection?
Fever, malaise, rash (Macules–> papules –>vesicles–>crusts)
What is the mortality associated with adult varicella infection?
5 - 20%
What are the 4 long term complications associated with Varicella encephalitis?
Reye syndrome, Gillain Barre, Transverse Myelitis, Aseptic meningitis
What percent of pregnant women with chicken pox will get pneumonia?
20%
When does Varicella pneumonia usually occur in relation to the rash?
3-5 D following appearance of skin lesions
What is the mortality associated with Varicella pneumonia?
5%
What is the treatment for Varicella in pregnancy?
800 mg PO Acyclovir within 24 hrs of developing 5 times daily for 10 days
What is the treatment for Varicella Pneumonia?
IV acyclovir 500 mg/m2 q 8 hrs until symptoms resolve and lesions crust over
What test should be ordered with maternal exposure to VZV in pregnancy?
VZV IgG if not ordered in prenatal labs
What should be given to a patient with exposure to VZV in pregnancy who is VZV IgG negative?
Give VZIG immune globulin best within 96 hrs of exposure, give up to 10 days following exposure
What is the risk of fetal infection with maternal VZV infection?
1-2%
When is the risk for fetal loss the greatest with VZV infection?
Risk is greatest between 13 - 20 weeks Gestation
What are the ultrasound findings associated with fetal VZV infection?
Polyhydramnios, Hydrops, Liver calcifications, limb deformities, microcephaly, IUGR
If there are positive findings for fetal VZV on US, what is the next step in management?
Amniocentesis
What time period of maternal VZV infection surrounding delivery puts the fetus most at risk of neonatal infection?
Rash outbreak 5 days before delivery until 2 days following delivery
What is the risk of neonatal transmission at delivery if evidence of maternal infection during critical time period?
10 - 20%
When do neonatal symptoms of VZV appear following delivery?
5 - 7 days following delivery
What is the most common life threatening complication associated with neonatal VZV?
Pneumonia
In a patient with new onset rash associated with VZV, what is the recommended delivery plan?
Delay delivery 5-7 days from symptom onset if possible
What is the prevention of neonatal transmission at delivery if evidence of maternal infection during critical time period?
Give VZIG to the neonate following delivery, Isolate from mother until lesions crust over
Is VZV transmitted in the breast milk?
No
