Varicella Infection In Pregnancy

Clinical description

Highly contagious, varicella zoster virus (VZV) is transmitted by infected secretions from the nasopharynx, by direct contact with vesicular fluids or by air borne spread.

The most infectious period spans from 48hours before rash appears until vesicles have crusted over which is 5-7 days after onset of rash.

Maternal complications Bacterial superinfection Fetal risks Varicella Pneumonia Congenital varicella syndrome, if maternal infection Arthritis between 8 and 20 weeks (neurological abnormalities, Glomerulonephritis ocular abnormalities, limb abnormalities, cutaneous Myocarditis scars, low birth weight) Ocular disease Neonatal varicella (born to mothers who are infected Adrenal insufficiency within 2weeks of delivery Encephalitis

Signs and symptoms

History/Exam Fever, malaise, pruritic and appears in successive crops of vesicles on the face, trunk and extremities.

The lesions begin as macules that become papules followed by vesicles, then it forms the crusted papules Investigations Send VZV IgG only if needed.

US findings suggestive of fetal varicella syndrome include: hydrops, hyperechogenic foci in the liver and bowel, cardiac malformations, limb deformities, microcephaly, and/or IUGR.

Treatment

For pregnant women with VZV infection:

• Any suspicious rash should be seen immediately.
• Avoid contact with susceptible individuals for 5-7 days after onset of rash.
• Treat symptoms and practice clean hygiene.
• Treat with acyclovir 800 mg oral 5x daily for 7 days (treatment is most effective if within the first 24

hours); give intravenous acyclovir at 10mg/kg every 8 hours in cases of pneumonia and CNS involvement

• Postpone delivery until 5-7 days after onset of rash, even at term.
• For the infant born to a woman with VZV:
• Notify pediatricians of maternal infection- Neonatal ophthalmic exam soon after birth
• Treat with varicella zoster immunoglobulin (VZIG) if birth and onset of maternal rash occur

within 7 days of each other+- intravenous acyclovir.

• Monitor for infection until 28 days after the onset of maternal rash; treat neonatal infection with

acyclovir.

For susceptible pregnant women with known exposure:

• Send blood for VZV IgG.
• If significant exposure and seronegative for VZV IgG, treat with VZIG within 10 days of contact and

manage as infectious for 8-28 days after.