Varicella zoster in pregnancy

Question 1

What is the risk of VZV to mothers in pregnancy?

Answer 1

Varicella pneumonitis
Hepatitis
Encephalitis

Question 2

What are the risks of VZV to baby?

Answer 2

Fetal varicella syndrome
Neonatal varicella syndrome
Shingles in infancy

Question 3

What are the symptoms of fetal varicella syndrome?

Answer 3

Fetal growth restriction
Microcephaly
Learning disability
Skin scarring
Limb hypoplasia
Cataracts

Question 4

What is the treatment of chicken pox infection during pregnancy?

Answer 4

Oral acyclovir if more than 20 weeks and presents in less than 24 hours

Question 5

What is the management of VZV exposure in a woman who has had chicken pox?

Answer 5

Reassure - no action needed

Question 6

What is the management of VZV exposure in a woman who is not sure if she’s had chicken pox?

Answer 6

Test for VZV antibodies (IgG)
- If has antibodies - reassure
- If no antibodies - treat

Question 7

What is the management of VZV exposure in a woman who has not had chicken pox?

Answer 7

If < 20 weeks, should be given VZIG (immunoglobulins) within 10 days of exposure

If > 20 weeks, VZIG or acyclovir should be given 7-14 days after exposure

Question 8

Why is the varicella zoster vaccine not given in pregnancy?

Answer 8

It is a live attenuated vaccine and can cause fetal infection

Question 9

What are the features of congenital varicella syndrome?

Answer 9

Atypical skin scarring
IUGR
Cataracts
Cerebral cortical atrophy
Global developmental delay
Limb hypoplasia