VZV in pregnancy (Complete)

Question 1

What are severe complications of VZV in pregnancy?

Answer 1

Foetus: Congenital varicella syndrome

Mother: Pneumonitis

Question 2

Define congenital varicella syndrome

Answer 2

A congenital condition which can occur when a non-immune pregnant woman contracts VZV during first trimester of preganncy

Question 3

Congenital varicella syndrome is more likely to occur during which part of pregnancy?

Answer 3

First trimester (<20 weeks)

1% if less than 20 weeks, NO cases found in >28 weeks

Question 4

What other complications of VZV can occur if infected in second and third trimester?

Answer 4

Shingles in infancy

Severe neonatal varicella

• Occurs if mother presents with rash 5 days before - 2 days after pregnancy
• 20% mortality rate

Question 5

What are the main clinical features of congenital varicella syndrome

Answer 5

Skin scarring

Low birth weight

Limb hypoplasia

Microcephaly

Eye defects (micropthalmia)

Learning disabilities

Question 6

What investigations should be conducted in pregnant women with suspected VZV infection

Answer 6

Clinical diagnosis

Bloods:

VZV IgG: Check for previous infection if unsure history

• > 1000 IU/ml : Previous exposure/immunity

Can check for previous exposure status whilst waiting for 7-14 days post-exposure period

Question 7

How are non-immune pregnant woman managed?

Answer 7

Medicine: Post-exposure prophylaxis (PEP)

Oral aciclovir

• Given at 7-14 days after exposure NOT immediately
• Given within 24 hours of onsent of rash occurs and > 20 weeks gestation

Question 8

When is oral aciclovir given as prophylaxis?

Answer 8

If woman has been in contact with someone with suspected chicken pox or shingles and at 7-14 days post-exposure

Question 9

What time window is oral aciclovir given in symptomatic pregnant women presenting with rash?

Answer 9

Within 24 hours of onset of rash

Give in women > 20 weeks gestation