Varicella Infection in Pregnancy

Question 1

How is Varicella transmitted?

Answer 1

Respiratory, Direct contact

Question 2

What is the infectious period with Varicella?

Answer 2

one day before the outbreak until lesions crust over

Question 3

What is the incubation period for acute varicella infection?

Answer 3

10 - 14 days

Question 4

What are the main manifestations of Varicella infection?

Answer 4

Fever, malaise, rash (Macules–> papules –>vesicles–>crusts)

Question 5

What is the mortality associated with adult varicella infection?

Answer 5

5 - 20%

Question 6

What are the 4 long term complications associated with Varicella encephalitis?

Answer 6

Reye syndrome, Gillain Barre, Transverse Myelitis, Aseptic meningitis

Question 7

What percent of pregnant women with chicken pox will get pneumonia?

Answer 7

20%

Question 8

When does Varicella pneumonia usually occur in relation to the rash?

Answer 8

3-5 D following appearance of skin lesions

Question 9

What is the mortality associated with Varicella pneumonia?

Answer 9

5%

Question 10

What is the treatment for Varicella in pregnancy?

Answer 10

800 mg PO Acyclovir within 24 hrs of developing 5 times daily for 10 days

Question 11

What is the treatment for Varicella Pneumonia?

Answer 11

IV acyclovir 500 mg/m2 q 8 hrs until symptoms resolve and lesions crust over

Question 12

What test should be ordered with maternal exposure to VZV in pregnancy?

Answer 12

VZV IgG if not ordered in prenatal labs

Question 13

What should be given to a patient with exposure to VZV in pregnancy who is VZV IgG negative?

Answer 13

Give VZIG immune globulin best within 96 hrs of exposure, give up to 10 days following exposure

Question 14

What is the risk of fetal infection with maternal VZV infection?

Answer 14

1-2%

Question 15

When is the risk for fetal loss the greatest with VZV infection?

Answer 15

Risk is greatest between 13 - 20 weeks Gestation

Question 16

What are the ultrasound findings associated with fetal VZV infection?

Answer 16

Polyhydramnios, Hydrops, Liver calcifications, limb deformities, microcephaly, IUGR

Question 17

If there are positive findings for fetal VZV on US, what is the next step in management?

Answer 17

Amniocentesis

Question 18

What time period of maternal VZV infection surrounding delivery puts the fetus most at risk of neonatal infection?

Answer 18

Rash outbreak 5 days before delivery until 2 days following delivery

Question 19

What is the risk of neonatal transmission at delivery if evidence of maternal infection during critical time period?

Answer 19

10 - 20%

Question 20

When do neonatal symptoms of VZV appear following delivery?

Answer 20

5 - 7 days following delivery

Question 21

What is the most common life threatening complication associated with neonatal VZV?

Answer 21

Pneumonia

Question 22

In a patient with new onset rash associated with VZV, what is the recommended delivery plan?

Answer 22

Delay delivery 5-7 days from symptom onset if possible

Question 23

What is the prevention of neonatal transmission at delivery if evidence of maternal infection during critical time period?

Answer 23

Give VZIG to the neonate following delivery, Isolate from mother until lesions crust over

Question 24

Is VZV transmitted in the breast milk?

Answer 24

No