chicken pox in pregnancy presentation by HMC resident of OBGYNE

1. By Dr. Tarek Rabiei
PGY 3 -OBGYN
Supervised by Dr Moone
Consultant – OBGYN

2. varicella zoster virus is one of eight herpes
viruses.
Varicella infection in children is generally a
mild disease.
in adults: it can be more sever
During pregnancy:
mother :varicella pneumonia
Fetus :congenital anomalies

3.  Varicella zoster virus :
varicella (chickenpox)
herpes zoster (shingles)

4.  Primary VZV infection :
 Age :less than 2 %
mortality increases with age 25%
 early gestational period (weeks 8 to 20),
 Maternal varicella during pregnancy is also
associated with the subsequent development
of herpes zoster during infancy
 Herpes zoster — Endogenous reactivation of
latent VZV not associated with risk of
congenital anomalies

5.  TRANSMISSION — is higher with exposure to varicella
compared with zoster.
 Persons are not considered infectious once lesions have
crusted over.
 Duration of infection start 2-3 days before fever till lesion
has crusted over
 Mode of transmission :
a) droplet
b) direct contact with vesicular fluid
c) very rare airborne virus
 Mother to infant : prenatal
postnatal
intrauterine
.

6.  Congenital varicella :
Less than 2 % of women who have acquired
varicella infection during the first 20 weeks of
pregnancy has baby with congenital varicella
syndrome

7.  Uncomplicated varicella — rash, fever
crops of vesicles. New vesicle formation generally
stops within four days
macules then pustule followed by crusted papules.
Most lesions have fully crusted by day six. Crusts
falls one to two weeks .
 Complicated infection —more common in adults
 Most common complication in pregnancy
varicella pneumonia
meningitis, encephalitis, cerebellar ataxia,
pneumonia, glomerulonephritis, myocarditis, ocular
disease, adrenal insufficiency, Secondary bacterial
and death

9.  Cutaneous scars
 Neurological
 Ocular abnormalities
 Limb abnormalities
 Low birth weight
Congenital varicella syndrome is associated
with a mortality 30% in the first few months of
life,15% risk herpes zoster in the first four
years of life

11.  The diagnosis clinical.
 If there is doubt, VZV viral DNA by PCR
testing of skin scrapings from the base of the
vesicle, vesicular fluid or through the
detection of VZV antigen by
immunofluorescence

12.  Prenatal diagnosis : PCR fetal blood or
amniotic fluid usually between 17 –21 weeks
+ ultrasonography after 5 weeks from
maternal infection

13.  Postnatal diagnosis — The diagnosis of
congenital varicella syndrome requires the
following criteria :
◦ History
◦ fetal abnormalities consistent with congenital
varicella syndrome
◦ Evidence of intrauterine VZV infection :
detection of VZV DNA in the newborn
IgM antibodies in cord blood
VZV IgG beyond seven months of age
clinical zoster infection during early infancy.

14.  Canadian guide lines
In the case of a exposure to varicella in a
pregnant woman with unknown immune status
serum testing should be performed. If the
serum results are negative or unavailable within
96 hours from exposure, varicella zoster
immunoglobulin should be administered.

15.  Uncomplicated varicella infection
 the efficacy of acyclovir within 72 hours of
symptom onset . faster healing of skin lesions
and a shorter duration of fever, if initiated
within 24 hours of symptom onset .
 However acyclovir therapy (20 mg/kg PO four
times daily for five days) for all pregnant
women with uncomplicated varicella

16.  Varicella pneumonia — medical emergency;
the mortality rate n the era prior to antiviral
therapy approximated 36 to 40 percent in
case series reports
 It is recommended
intravenous acyclovir (10 mg/kg every eight
hours).

17.  Varicella zoster virus has 2 form of disease
chicken pox and herpes
 Incidence in adult is very low but very sever
 Transmission droplet , vesicle fluid ,airborne
 Most severe complication pneumonia
 Early during pregnancy can cause congenital
varicella syndrome
 Antiviral treatment benefit over weight the
risk
 On exposure for sero negative mother IG is
recommended