Varicella zoster exposure in pregnancy

Question 1

how would you manage a pregnant lady who was exposed to chicken pox and she didn’t know if she had it when she was younger?

Answer 1

test maternal blood for antibodies

give varicella zoster immunoglobulin (VZIG) as soon as possible (effective up to 10 days after exposure)

Question 2

how would you manage a pregnant woman who caught the chicken pox whilst pregnant?

Answer 2

seek specialist advice!

if she is < 20 weeks pregnant then consider acyclovir with caution

if > 20 weeks and presents within 24 hours of onset of rash then give acyclovir

Question 3

what are the maternal risks of varicella zoster exposure during pregnancy?

Answer 3

severe varicella zoster infection

5x increased risk of pneumonitis

Question 4

what risk to the foetus does maternal varicella zoster exposure create ?

Answer 4

foetal varicella syndrome (1% risk if exposed < 20 weeks gestation)

Question 5

what are the features of foetal varicella syndrome?

Answer 5

microcephaly 
eye disorder (microphthalmia)
limb hypoplasia 
learning difficulties 
skin scarring

Question 6

when is exposure of varicella during pregnancy the risk greatest for foetal varicella syndrome?

Answer 6

< 20 weeks

Question 7

what risk to the neonate does maternal varicella zoster infection create?

Answer 7

severe neonatal varicella

shingles in infancy

Question 8

when during pregnancy does maternal exposure to varicella increase risk of severe neonatal varicella and shingles in infancy?

Answer 8

if rash develops within 5 days before or 2 days after delivery then risk of severe neonatal varicella which can be fatal to 20%

1-2% risk of neonatal shingles if maternal infection in 2nd or 3rd trimester