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Chickenpox in Pregnancy

Chickenpox in Pregnancy. Dr Bindu Singh. Background. VZV is a DNA Virus Highly contagious & transmitted by respiratory droplets & by direct personal contact with vesicle fluid. C/P- Fever, malaise, pruritic rash (maculopapular -- vesicular -- crust).

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Chickenpox in Pregnancy

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  1. Chickenpox in Pregnancy Dr Bindu Singh

  2. Background • VZV is a DNA Virus • Highly contagious & transmitted by respiratory droplets & by direct personal contact with vesicle fluid. • C/P- Fever, malaise, pruritic rash (maculopapular -- vesicular -- crust). • Incubation period-10-21 days. Infectious 48 hrs before the rash - vesicle crust over. • Chicken pox is common childhood disease usually mild.

  3. Varicella zoster virus (VZV) is 25 times more serious in adults than in children. • >90% antenatal population are seropositive & primary VZV infection is uncommon. • Chickenpox complicates 3 in every 1000 pregnancies. • Following primary infection, virus remain dormant in sensory nerve root ganglia but can be reactivated to cause herpes zoster.

  4. Varicella in pregnancyMaternal risk • Greater morbidity- Pneumonia, Hepatitis, Encephalitis • Pneumonia- • In up to 10% of pregnant women. • Severity of this complication seems increased in later gestation. • Case fatality rate is <1% with antiviral drugs.

  5. Fetal Risk<20 Weeks • No increased in spontaneous miscarriage in first trimester. • Fetal Varicella Syndrome- -In 1-2% of maternal varicella infection. -Characterised by skin scarring, eye defects, hypoplasia of limbs & neurological abnormalities ( microcephaly, cortical atrophy, mental retardation, bladder & bowel sphincters dysfunction).

  6. Fetal varicella syndrome • Pathogenesis unclear- possibly VZV reactivation in utero • Prenatal diagnosis - Detailed USG, Detection of VZV DNA by PCR in amniotic fluid • No treatment

  7. Infant with fatal varicella

  8. Infant with congenital varicella syndrome

  9. Maternal infection20-36 Wks of Gestation • Not associated with adverse fetal effect. • May present as shingles in the first few years of life due to reactivation of virus after a primary infection in utero.

  10. Maternal infection>36 weeks of gestation • Causes varicella infection of newborn. • If maternal infection occurs 1-4 weeks before delivery,up to 50% of babies are infected and 23% of these develop clinical varicella. • Severe chickenpox is most likely if infant is born within 7 days of onset of mother’s rash.

  11. Can varicella be prevented • In non-immune adult who plans to become pregnant - Live attenuated varicella vaccine is safe & effective in preventing chickenpox but it is not available in the UK for this indication. Advise to avoid contact with chickenpox. • At initial antenatal visit – Enquire about H/O chickenpox.If no such history –advised to avoid contact & to inform health care worker of a potential exposure. In case of uncertainty may check serum VZV IgG.

  12. Can varicella be prevented Pregnant woman with H/O contact with chickenpox - • Definite past H/O chickenpox- Reassure • No H/O or any doubt - Do Test for VZ IgG • If nonimmune - Give VZIG within 10 days of exposure • If rash develops - contact doctor

  13. Management of pregnant woman who develops chickenpox Initial management • Avoid contact with susceptible individual. • Symptomatic treatment. • Oral acyclovir reduces the duration of symptoms if started within 24 hours of development of rash. • No adverse fetal or neonatal effects have been reported with the use of acyclovir.

  14. Management of pregnant woman who develops chickenpox Indications for referral to the hospital • Development of chest symptoms • Extensive or haemorrhagic rash • Smoker • Chronic lung disease • Immunosuppressed (On steroids) • Second half of pregnancy

  15. Management of pregnant woman who develops chickenpox • Delivery during viraemic period may be extremely hazardous. • Maternal risk- bleeding, thrombocytopenia, DIC, hepatitis. • High risk of Varicella of the newborn with significant morbidity & mortality. • IV Acyclovir is recommended

  16. Can the neonatal effects of varicella be prevented or ameliorated If maternal infection occurs at term- • If practical delivery should be delayed by 5 days after onset of illness. • If delivery within 5 days of infection - Give VZIG to neonate. • If mother develops chickenpox within 2 days of delivery- Give VZIG to neonate. • VZIG does not prevent neonatal infection but lowers mortality rate. • Monitor baby for signs of infection for 14-16 days. • If neonatal infection occurs, it should be treated with acyclovir.

  17. Contact with chickenpox in the first 7 days of life • If mother is immune - no intervention • If mother is not immune or if neonate delivered prematurely. - Give VZIG

  18. Vaccination of health care workersagainst chickenpox • Varicella vaccination is now recommended for non-immune healthcare workers (JCVI). • Pregnancy should be avoided for 3 months following vaccination. • VZIG is not available for exposed non-immune healthcare worker unless they are considered at ‘high risk’ of complications of infection.

  19. Thank you

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