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Chickenpox in Pregnancy

Chickenpox in Pregnancy. Max Brinsmead PhD MRCOG July 2012. Varicella. Caused by Herpes zoster Different epidemiology in temperate and tropical climates Causes Chickenpox Shingles Fetal varicella syndrome (FVS)

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Chickenpox in Pregnancy

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  1. Chickenpox in Pregnancy Max Brinsmead PhD MRCOG July 2012

  2. Varicella • Caused by Herpes zoster • Different epidemiology in temperate and tropical climates • Causes • Chickenpox • Shingles • Fetal varicella syndrome (FVS) • In pregnancy maternal risks of pneumonitis (10%) are greater than the fetal risks of FVS (2%)

  3. Fetal Varicella Syndrome • Greatest risk is maternal infection 13 – 20w • Mental retardation 50% • Skin scarring • Eye defects (micropthalmia, chorioretinitis and cataracts) • Limb hypoplasia • Bowel/Bladder dysfunction • Intrauterine diagnosis requires ultrasound or fetal blood sampling for HZV PCR • Consultation recommended

  4. Neonatal Varicella • Risk is greatest if maternal rash occurs 5 days before delivery and up to 2 days after • Transmission rate 20 – 60% • 30% neonatal mortality if untreated • Acyclovir recommended • Consultation recommended

  5. Maternal Varicella in Pregnancy • Pneumonitis 10% • Hepatitis • Encephalitis • Acyclovir required • Consultation recommended

  6. My Recommendations* • Prenatal screening and/or Immunisation • Serum HZV IgG at the 1st antenatal visit* • ZIG for non immune women who come into close contact with Varicella • Prophylactic oral Acyclovir for exposure >20w • Delay delivery >5 days after rash • Neonatal ZIG and Acyclovir for high risk neonate • Immunise health care workers • Exclude those non immune to Varicella from care of pregnant women for 8 – 21days after possible infection

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