chicken pox

1. CHICKEN POX IN PREGNANCY
BY
DR.HAFSA

2. DEFINITION:
 Chicken pox is a viral illness caused by
varicella zoster virus.
 VZV is a DNA virus of herpes family.

3. ROUTE OF TRANSMISSION:
 VZV is a highly contagious virus.
 It is transmitted by
-respiratory droplets
-direct personal contact with vesical fluid

4. PREVELANCE:
 90% adults are immune to chickenpox.
 Approximately one in 200 women will contract
chickenpox during their pregnancy.

5. MATERNAL RISKS:
1:Pneumonia
2:Hepatits
3:Enchepalitis
4:Rarely death

6. FETAL RISKS:
Fetal varicella syndrome (FVS)
 can complicate maternal chickenpox that
occurs as early as 3 weeks and upto
28week of gestation.
 It occurs in 1% of fetuses.
 Risk of spontaneous miscarriage is less in
first trimester ,if chickenpox occurs.

7. FEATURES OF FVS:
 FVS is characterized by one or more of the
following:
1:skin scarring in a dermatomal origin.
2:Eye defects
(micro-opthalmia,chorioretinits,cataracts)
3:Hypoplasia of limb
4:Neurological abnormalities
(microcephaly,cortical atrophy,developmental
delay & dysfunction of bowel and bladder
sphincters)

8. PRENATAL DIAGNOSIS OF FVS:
 Women who have chickenpox in
pregnancy should be referred to fetal
medicine specialist, at 16-20 week or 5
weeks after infection for detailed
ultrasound examination and discussion.
 Amniocentesis should not be performed
before the skin lesion is completely
healed.

10. IMMUNIZATION:
 Varicella vaccination pre pregnancy or postpartum is an
option for women who are sero-negative forVZV IgG.
 It is not given during pregnancy.

11. ANTENTAL MANAGEMENT
 Women booking for antenatal care should be asked
about previous chickenpox history.
 Women with no previous history/sero negative should be
advised to
1. avoid contact with chickenpox .
2. to inform healthcare worker of a potential exposure
without delay.

12. PREVENTION IN SERONEGATIVE
PREGNANT WOMEN
 When contact occurs a careful
history must be taken to
confirm the significance of
contact . (contact in same room for 15
minutes)
 Blood test to determine VZV
immunity or non immunity.
 This test can be performed
within 24-48hrs.

14. IMMUNE WOMEN:
 Women who are immune and have VZ
IgG should be reassured.

15. NON IMMUNE:
 If a pregnant women is not immune toVZV
and she has a significant exposure she should
be given varicella zoster
immunoglobulins(VZIG) as soon as possible.
 VZIG is effective when given upto 10 days
after contact.
(In case of continuous exposure this is defined
as 10 days from the appearance of rash in the
index case)

16.  Non-immune pregnant women who have
been exposed to chickenpox should be
managed as potentially infectious from 8-
28 days after exposure if they receive
VZIG and from 8-21 days after exposure if
they do not receive.
 VZIG has no benefit once the chickenpox
has developed.

17. WOMEN WITH CHICKENPOX
 Avoid contact with susceptible individuals
(neonates and other pregnant women) until the lesion
have crusted over. This is usually about 5
days after the onset of rash.
 Symptomatic treatment and hygiene is
advised to prevent secondary bacterial
infection of the lesion.

18. ACICLOVIR:
 Oral aciclovir 800mg 5times/day for 7 days
should be prescribed for pregnant women with
chickenpox if they present within 24hrs of onset
of rash and if they are more than 20 week of
gestation.
 Use of aciclovir before 20 week of gestation
should also be considered.
 Aciclovir is not licensed for use in pregnancy.
 Risks and benefits of its use should be discussed
with the women.

19.  Women hospitalized forVaricella should be
nursed in isolation.
 If a women smokes cigarette ,has chronic
lung disease or taking corticosteroid or is in
later half of pregnancy, a hospital assessment
should be considered even in the absence of
complication.

20. TIME AND MODE OF DELIVERY:
 Timing and mode of delivery must be invidualised.
 Delivery during the veremic period may be extremely
hazardous.
 Elective delivery should normally be avoided until 5-7
days after the onset of maternal rash.
 Delivery may precipitate hemorrhage and/or
coagulopathy due to thrombocytopenia or hepatitis.

21.  Supportive treatment and intravenous
aciclovir is therefore desirable allowing
resolution of rash and transfer of protective
antibodies from mother to fetus.
 Delivery may be required in women to
facilitate assisted ventilation in cases where
Varicella pneumonia is complicated by
respiratory failure.
 Mode of delivery will be according to
obstetric indication.

22. ANESTHESIA:
 When epidural/spinal anesthesia is
undertaken in women with chickenpox, a
site free of cutaneous lesion should be
chosen for needle placement.

23. NEONATES:
 Neonatal ophthalmic examination should be organized
after birth.
 If birth occurs within 7 day period following the onset of
maternal rash or if mother develops chickenpox rash
within 7 day period after birth, the neonate should be
givenVZIG.
 Infant should be monitored for signs of infection until 28
days after the onset of rash.
 Neonate infection should be treated with aciclovir.

24. BREASTFEEDING:
 Women with chickenpox should breastfeed if they wish
to and are well enough to do so.
 If there are active chickenpox lesion close to nipple, they
should express breast milk from the affected breast until
the lesions have crusted away.
 The expressed breast milk may be fed to baby who is
receiving treatment withVZIG and/or aciclovir.

27. VARICELLA ZOOSTER
CONTACT
PAST
HISTORY
Present
No past
history/women
from tropical or
subtropical
region
Presents with
chickenpox
REASSURANCE
Check forVZV
IgG
yes no
Avoid contact
Symptomatic treatment
Aciclovir
Avoid delivery until 7
daysGiveVZVIG within
10 days
Discuss
postpartum
immunization