126 Chickenpox 159

Pregnancy Issues

Varicella zoster immunoglobulin (VZIg) should be used to prevent chickenpox in susceptible women who have had significant exposure. It should be given within ten days of exposure for maximal effect12. It has no place in treatment once chickenpox has developed.

Oral aciclovir decreases the duration and severity of symptoms in women who develop chickenpox in pregnancy. To be effective it needs to be given within 24 hours of the rash developing. It may also decrease the risk of serious complications12.

Women with chickenpox in pregnancy should be alerted to the possible complications that may occur and should report any respiratory or neurological symptoms or any bleeding immediately so that hospital admission may be considered. Hospital admission may also be required if the mother is in the latter stages of pregnancy, if she smokes or is taking steroids or is immunosuppressed13.

Neonatology involvement is very important and the mother should be given the opportunity to discuss possible neonatal complications and plans for investigation and treatment of the neonate, post delivery.

Medical Management and Care

• If a mother presents with chickenpox within the first 20 weeks she should be counselled regarding the risks of fetal varicella syndrome (FVS) (1-2%); discuss amniocentesis to determine whether the viral DNA is detectable in the liquor and arrange detailed ultrasound examinations to try to detect features of FVS

• If complications arise the mother should be managed in hospital by a multi-disciplinary team involving obstetrician, virologist and neonatologist12

Midwifery Management and Care

If a women reports contact with chickenpox

• Ask if previous infection - if so, reassure

• If not, check if significant exposure - was the diagnosis definite; did exposure occur when uncrusted lesions were present or 48 hours prior to development of the rash; was there face to face contact with infected person?

• If yes - arrange for booking blood samples to be tested for Varicella zoster virus IgG or send serum for testing

• If IgG negative - arrange for VZIg to be given as soon as possible

• Inform the woman to notify her doctor or midwife if she develops a rash, irrespective of whether she had VZIg or not

If a woman presents with chickenpox in pregnancy:

• Arrange for her to be given oral aciclovir if >20 weeks gestation and if she has presented within 24 hours of the onset of the rash

• Consider whether factors indicating hospital admission are present, and discuss with obstetrician if in doubt

• Inform the woman to report any new symptoms immediately, e.g. chest symptoms, bleeding

• If the woman is less than 20 weeks pregnant, refer to obstetrician for counselling regarding the risks of fetal varicella syndrome

• Counsel her to avoid contact with anyone at risk of developing severe chickenpox, e.g. other pregnant women, including attending ANC

• Advise on use of topical soothing agents and possible use of antihistamines

• Ensure women who remain at home are reviewed regularly

Labour Issues

• Delivery should be avoided during the acute illness

• There is a risk of serious maternal complications including disseminated intravascular coagulation (DIC)

• For the neonate, there is the risk of severe varicella of the newborn, with significant morbidity and possible mortality10

Medical Management and Care

• Supportive treatment should be given if labour occurs in the viraemic period

• Intravenous aciclovir is recommended in this situation12

Midwifery Management and Care

• The woman should be closely observed for the development of the complications of chickenpox, in particular DIC

• Ascertain if the paediatrician is to review the baby post delivery

Postpartum Issues

The highest risk to the neonate is when delivery occurs within five days of maternal infection or if the mother develops chicken-pox within two days of delivery. In this situation the baby should be given VZIg and monitored. If chickenpox does develop then the baby should be treated with aciclovir.12

• Any baby born to a seronegative mother who has significant exposure to chicken-pox in the first seven days of its life should be given VZIg12

• Premature babies (less than 28 weeks gestation) are at risk of chickenpox because of inadequate transfer of maternal antibodies at this gestation; if exposure has occurred VZIg should be given12

Medical Management and Care

• If maternal infection occurred in the first 20 weeks of pregnancy then neonatal blood should be sent for Varicella zoster virus IgM antibody testing12 and the baby should have a neonatal ophthalmic examination soon after birth

• If delivery occurred during the acute maternal illness the neonatologists should be involved to treat and observe the baby appropriately

• If severe maternal complications arise then the woman may require transfer to the intensive care unit for further monitoring and supportive treatment

Midwifery Management and Care

• The woman should continue to be monitored for complications

• If infective, woman and baby should be isolated from other mothers and babies on the ward but not from each other14

• Breast-feeding is not contraindicated and should be encouraged14

0 0

Post a comment