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Sender's message: Chicken pox in pregnancy
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Herpes simplex and varicella-zoster virus
infections during pregnancy: current concepts of prevention, diagnosis
and therapy. Part 2: Varicella-zoster virus infections.
Sauerbrei
A, Wutzler
P.
Institute of Virology and Antiviral Therapy, Friedrich-Schiller
University of Jena, Hans-Knoell-Strasse 2, 07745 Jena, Germany.
Andreas.Sauerbrei@med.uni-jena.de
Varicella during pregnancy can be associated with severe illnesses for
both the mother and her neonate. Varicella pneumonia must be regarded
as a medical emergency, since pregnant women are at risk of
life-threatening ventilatory compromise and death. After maternal
chickenpox in the first and second trimesters, congenital varicella
syndrome may occur in nearly 2% of the cases. The characteristic
symptoms consist of skin lesions in dermatomal distribution,
neurological defects, eye diseases and skeletal anomalies. If the
mother develops varicella rashes between day 4 (5) antepartum and day
2 postpartum, generalized neonatal varicella leading to death in about
20% of the cases has to be expected. Normal zoster has not been shown
to be associated with maternal pneumonia, birth defects or problems in
the perinatal period. On the basis of the clinical consequences of
varicella-zoster virus infections during pregnancy, the present paper
summarizes the currently available concepts of prevention, diagnosis
and therapy.
Publication Types:
PMID: 17180380 [PubMed - indexed for MEDLINE]
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Managing varicella zoster infection in pregnancy.
Gardella
C, Brown
ZA.
Department of Obstetrics and Gynecology, Division of Women's Health,
University of Washington Medical Center, Seattle, WA 98195-6460, USA.
cgardel@u.washington.edu
Varicella zoster virus (VZV) infection can be serious for pregnant
women and their babies, although it is rare. The implications of
primary VZV infection vary with the gestational age at infection. For
the mother, the risk of severe illness is greatest after
mid-pregnancy, when she is relatively immunocompromised. For the
fetus, the risk of congenital infection is greatest when maternal
infection occurs in the first or second trimester. Maternal infection
is preventable by preconception vaccination.
Publication Types:
- Research Support, N.I.H., Extramural
- Review
PMID: 17438678 [PubMed - indexed for MEDLINE]
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Chickenpox in pregnancy: revisited.
Tan
MP, Koren
G.
The Motherisk Program, Division of Clinical Pharmacology and
Toxicology, The Hospital for Sick Children, University of Toronto,
Ont., Canada.
Varicella infection during the first and second trimester of pregnancy
may increase the risk for congenital varicella syndrome 0.5-1.5% above
the baseline risk for major malformation. Third trimester infection
may lead to maternal pneumonia which can be life threatening if not
treated appropriately. Varicella-zoster immune globulin (VZIG) should
be administered as soon as possible preferably within 96 h from
exposure to prevent maternal infection or subsequent complications.
Later than 96 h, the effectiveness of VZIG has not been evaluated.
Neonatal varicella is more severe if maternal rash appears 5 days
prior to or 2 days after delivery. The newborn should be given VZIG
immediately. Intravenous acyclovir is recommended for maternal
pneumonia and severely affected neonate. No controlled study has yet
evaluated the effectiveness of acyclovir or valacyclovir for
postexposure prophylaxis to pregnant women or neonates. Unlike primary
varicella infection in pregnancy, herpes zoster has not been
documented to cause complications unless in the disseminated form. The
advent of advanced imaging techniques and molecular biotechniques has
improved prenatal diagnosis. With increase use of vaccination, the
incidence of chickenpox in pregnancy is expected to decline in the
future.
Publication Types:
- Research Support, Non-U.S. Gov't
- Review
PMID: 15979274 [PubMed - indexed for MEDLINE]
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Chickenpox, pregnancy and the newborn: a follow-up.
[No authors listed]
In September 2005, we published an article on Chickenpox, pregnancy
and the newborn. One of the issues it considered was fetal varicella
syndrome, an uncommon but potentially fatal consequence of in-utero
chickenpox infection. We reported evidence suggesting that contracting
maternal chickenpox within the first 28 weeks of pregnancy can lead to
fetal varicella syndrome. This suggestion was questioned after
publication since it was at odds with national guidance in the U.K.
and elsewhere, which has indicated that fetal varicella syndrome
occurs only where maternal chickenpox develops before 20 weeks of
pregnancy. Here we discuss in more detail the basis for our conclusion
and its implications.
Publication Types:
PMID: 16375201 [PubMed - indexed for MEDLINE]
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Chickenpox, pregnancy and the newborn.
[No authors listed]
In the UK, chickenpox (primary varicella virus infection) is usually a
mild, self-limiting disease of childhood. It is more severe in adults.
For example, of every 100,000 people who contract chickenpox, around
4-9 die from it, of whom 81-85% are adults. Chickenpox infection in
pregnant women can lead to a severe maternal illness and it appears
five times more likely to be fatal than in non-pregnant women.
Although most women who have chickenpox in pregnancy give birth to
healthy children, in other cases, the baby is harmed by in-utero
infection or severe varicella of the newborn. Here we review the risks
and key aspects of diagnosis and further management of varicella
infection in pregnancy and the neonatal period.
Publication Types:
PMID: 16176000 [PubMed - indexed for MEDLINE]
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Varicella infection in pregnancy.
McCarter-Spaulding
DE.
Boston College, School of Nursing, Chestnut Hill, MA 02467-3812, USA.
mccartdw@bc.edu
Varicella (chickenpox) is a common childhood illness. Most adults are
immune to the virus because of previous exposure. Pregnant women who
contract varicella risk complications such as pneumonia. Varicella may
be transmitted from mother to fetus and could cause congenital
varicella syndrome or perinatal infection. Susceptibility to varicella
should be determined before pregnancy. Varicella zoster immune
globulin may be considered for the mother or newborn if exposure
occurs. Acyclovir may decrease the risk of maternal complications from
infection.
Publication Types:
PMID: 11724203 [PubMed - indexed for MEDLINE]
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A rash of exanthems. How they affect children and
pregnant women.
Starr
M.
Department of Microbiology and Infectious Diseases, Royal Children's
Hospital, Victoria. starrm@cryptic.rch.unimelb.edu.au
BACKGROUND: Viral exanthems are a common problem for children,
particularly during preschool years. Many of these infections have a
dramatic impact on siblings, parents and other contacts. There may
also be particular ramifications for pregnant contacts. OBJECTIVE: To
discuss some of the most common viral exanthems affecting children, in
terms of the epidemiology, clinical features, diagnosis, and the
management of both the patient and the contacts. DISCUSSION:
Recommendations are made for measles, rubella, parvovirus and
varicella regarding immunisations, use of immunoglobulin, serological
diagnosis and management of pregnant contacts.
Publication Types:
PMID: 10914446 [PubMed - indexed for MEDLINE]
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Varicella in pregnancy.
Chapman
SJ.
Center for Women's Medicine, Division of Maternal-Fetal Medicine,
Greenville Hospital System, SC 29605, USA.
Varicella-zoster virus may cause serious infection, particularly
pneumonia, in adult women. Women of child-bearing age should be
questioned about immunity to varicella preconceptually, and offered
serological testing, and VARIVAX vaccine if indicated. All pregnant
patients should be questioned about immunity to varicella during their
first prenatal appointment. Susceptible patients should be counseled
to avoid contact with individuals who have chickenpox. If exposure
occurs, VZIG should be administered within 96 hours in an attempt to
prevent maternal infection. Varicella embryopathy may occur as a
result of maternal infection particularly in the first half of
pregnancy with an incidence of 1% to 2%. Varicella of the newborn is a
life-threatening illness that may occur when a newborn is delivered
within 5 days of the onset of maternal illness or after postdelivery
exposure to varicella. Susceptible neonates should receive VZIG.
Acyclovir is active against the varicella-zoster virus, and treatment
is indicated in seriously ill adults and neonates.
Publication Types:
PMID: 9738999 [PubMed - indexed for MEDLINE]
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Varicella infections in pregnancy and the newborn.
A review prepared for the UK Advisory Group on Chickenpox on behalf of
the British Society for the Study of Infection.
Nathwani
D, Maclean
A, Conway
S, Carrington
D.
Dundee Teaching Hospitals, King's Cross Hospital, UK.
Publication Types:
- Guideline
- Practice Guideline
- Research Support, Non-U.S. Gov't
- Review
PMID: 9514109 [PubMed - indexed for MEDLINE]
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Varicella infection and toxoplasmosis in pregnancy.
Grant
A.
Varicella occurring in pregnancy can be dangerous for the fetus, the
mother, and the newborn. The fetus may experience multiple system
damage. The mother and newborn are at increased risk for varicella
pneumonia with a 9% and 20% fatality rate, respectively. The recent
introduction of the varicella vaccine will affect the occurrence of
gestational infection. Toxoplasmosis is rarely dangerous for the
pregnant woman, yet the fetus and newborn may be at risk for
chorioretinitis, hydrocephalus, intracranial calcifications, and
convulsions. The greatest challenge in the management of toxoplasmosis
in pregnancy is diagnosis of the asymptomatic newborn before damage
occurs. Strategies to prevent toxoplasmosis should be taught to every
pregnant woman as part of parental care.
Publication Types:
PMID: 8868624 [PubMed - indexed for MEDLINE]
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Chickenpox in pregnancy: how dangerous?
Venkatesan
P.
Department of Infection, Birmingham Heartlands Hospital.
Publication Types:
PMID: 8762292 [PubMed - indexed for MEDLINE]
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Varicella in pregnancy.
Chapman
S, Duff
P.
Division of Maternal-Fetal Medicine, University of Florida College of
Medicine, Gainesville 32610-0294.
Publication Types:
PMID: 8160024 [PubMed - indexed for MEDLINE]
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Comment in:
Varicella in pregnancy, the fetus, and the newborn:
problems in management.
Brunell
PA.
Ahmanson Pediatric Center, Cedars Sinai Medical Center, Los Angeles,
California 90048.
As many as 9000 pregnancies annually may be complicated by varicella,
which creates management problems for the woman and her fetus or
newborn. Estimates on risk to the fetus and to neonates vary widely,
making counseling difficult. Likewise, the efficacy of passive
immunization of pregnant women or their exposed newborns is not
precisely known. In addition to these problems in clinical management,
questions remain about the developmental immunology of varicella-zoster
virus infection. For example, why do infants exposed in utero to the
virus get zoster at an early age and why does passive immunization of
newborns appear to be less effective than immunization of older
individuals?
Publication Types:
PMID: 1624811 [PubMed - indexed for MEDLINE]
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Use of acyclovir for varicella pneumonia during
pregnancy.
Smego
RA Jr, Asperilla
MO.
Section of Infectious Diseases, West Virginia University Health
Sciences Center, Morgantown.
Twenty-one cases (five new and 16 literature) of varicella pneumonia
of pregnancy were retrospectively reviewed to evaluate the benefits
and risks of intravenous acyclovir on maternal and fetal outcomes. All
women were in their second (12 cases) or third (nine cases) trimester.
Mean gestational ages at the onset of pneumonia and time of delivery
were 27 and 36 weeks, respectively. Twelve patients required
mechanical ventilation. The mean duration of treatment was 7 days. No
definite adverse drug effects were noted. Three women (14%) died of
uncontrolled infection or complications. Two infants died (whose
mothers also died): One was stillborn at 34 weeks' gestation, and the
other died from prematurity shortly after birth at 26 weeks. No child
was born with features of congenital varicella syndrome, and none
developed active perinatal varicella infection. Onset of pneumonia
during the third trimester was a risk factor associated with fatal
maternal outcome. Intravenous acyclovir may reduce maternal morbidity
and mortality associated with varicella pneumonia occurring during
pregnancy, and appears to be safe for the developing fetus when given
during the latter trimesters.
Publication Types:
PMID: 1945218 [PubMed - indexed for MEDLINE]
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Treatment with acyclovir of varicella pneumonia in
pregnancy.
Broussard
RC, Payne
DK, George
RB.
Department of Medicine, Louisiana State University School of Medicine,
Shreveport.
Varicella pneumonia during pregnancy carries a significant mortality
for both mother and fetus. The antiviral drug, acyclovir, appears to
have decreased mortality in reported cases. We present a case report
and review of the literature summarizing the experience to date with
acyclovir in the treatment of varicella pneumonia during pregnancy.
Publication Types:
PMID: 2009766 [PubMed - indexed for MEDLINE]
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