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20 Cards in this Set
- Front
- Back
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Recommendation:
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1) Prenatal VZV immunity should be assessed:
a) Hx of Chickenpox b) Hx of vaccination c) VZV IgG 2) Varicella immunization for non-immune women is recommended >=28 days prior to conception 3) VZV vaccination in pregnancy is not recommended. 4) If VZV vaccination in pregnancy occurs, termination is NOT recommended. |
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Varicella belongs to which family of viruses?
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Herpesviridae (HHV3)
(DNA virus) |
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Varicella virus (VZV) causes which two clinical presentations?
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Primary varicella = chickenpox
Latent varicella reactivation = Zoster or "Shingles" |
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What percentage of the antenatal population are seropositive for VZV IgG?
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>90%
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What is the incidence of primary VZV (chickenpox) in pregnant women in Canada?
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2-3 / 1000
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Is Herpes Zoster (Shingles) in pregnancy associated with adverse fetal outcomes?
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No
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What are the possible sequelae of maternal VZV infection in pregnancy?
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Varicella pneumonia (10%)
Most commonly uncomplicated (i.e. just have characteristic rash) Rare encephalitis |
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What is/are:
1) RFs for Varicella pneumonia 2) mortality from Varicella penumonia |
1)
a) Smoking b) > 100 cutaneous vesicles 2) 5-10% |
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What trimester poses the greatest risk for death from Varicella pneumonia?
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3T
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What two adverse presentations are possible for fetuses exposed to varicella in utero?
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1) Congenital Varicella Syndrome
2) Neonatal Varicella (chickenpox) |
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Describe the U/S findings of congenital Varicella syndrome
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FGR
Polyhydramnios Hydrops IUFD/stillbirth MSK asymmetric limb malformations chest wall malformation intestinal/hepatic echogenic foci CNS ventriculomegaly hydrocephalus microcephaly w/ polymicrogyria porencephaly Eye cataract microophthalmos |
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Congenital Varicella syndrome occurs in what percentage of:
a) 1T fetuses b) 2T fetuses c) 3T fetuses |
a) 1%
b) 2% c) 0% |
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When is development of maternal chickenpox (primary Varicella) worrisome for possible neonatal chickenpox?
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5 days before delivery
2 days after delivery |
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When should neonatal VZV Ig (immunoglobulin) be administered?
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If maternal infection occurs within +/-5 days of delivery
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Describe clinical features of a neonate with congenital Varicella syndrome
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Low birth weight
Cutaneous scarring CNS MR microcephaly seizures Horner's sydnrome MSK hypoplasia atrophy Occular cataracts chorioretinitis nystagmus GI GERD bowel atresia/stenosis |
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If a gravida is exposed to chickenpox and is seronegative or has a negative history, what should be offered?
Does it reduce the risk for: a) maternal varicella sequelae b) fetal CVS/neonatal varicella |
Varicella Immunoglobulin (VZIG)
a) yes b) yes |
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1) When should VZIG be given? (Within how many days of exposure?)
What is the dose? |
1) 3-4 days
2) 12.5U/kg, <= 625U |
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What percentage of neonates will still develop neonatal varicellla/chickenpox despite maternal VZIG?
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30-40%
(but severity of disease is significantly reduced) |
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1) When should acyclovir be used?
2) What is the dose? 3) When should IV therapy be considered? 4) What is the safety profile for the fetus? |
1) best if used within 24h of developing rash; use if developing symptoms of varicella pneumonia
2) 400-800 mg PO q8-q5h (higher dose for resp symptoms) 3) Worsening varicella pneumonia 4) Excellent safety profile, used in thousands of registered pregnancies and no adverse fetal effects above baseline reported. |
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List the tests/steps to be taken if a women is exposed to varicella in pregnancy?
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Determine immune-status
if previous infection/documented antibodies, assume immunity and reassure if not immune/not infected: a) VZIG w/i 3-4 days b) Acyclovir w/i 1 day depending on symptoms c) Monitor for Varicella pneumonia d) U/S or MFM referral to follow fetal well-being *** if -5 or +2 days of delivery, consult neonatology for possible neonatal acyclovir |
