What are the guidelines for treating chickenpox during pregnancy?

Updated: Nov 30, 2018
  • Author: Kirsten A Bechtel, MD; Chief Editor: Russell W Steele, MD  more...
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The Royal College of Obstetricians and Gynaecologists recently released revised guidelines for treating chickenpox in pregnancy, summarized below. [22, 23]

Clinicians should ask women presenting for antenatal care about previous chicken pox or shingles infection.

Pregnant women who have not had chicken pox, or who are known to be seronegative for chicken pox, should avoid contact with persons who have chicken pox or shingles and should promptly inform their clinician of potential exposure.

Clinicians should confirm potential exposure by careful history to confirm the significance of the contact and the susceptibility of the patient, as well as by blood test to determine VZV immunity or nonimmunity.

Pregnant women may need a second dose of varicella-zoster immunoglobulin if there is further exposure and 3 weeks have elapsed since the last dose.

Pregnant women who develop the characteristic rash should immediately inform their clinician, and they should be isolated from other pregnant women and neonates until the lesions have crusted over (usually about 5 days after rash onset).

Symptomatic treatment and hygiene are helpful to prevent secondary bacterial infection.

Aciclovir is not licensed for use in pregnancy. Clinicians should advise their patients of the risks and benefits.

Clinicians should consider hospital assessment of women at high risk for severe or complicated chicken pox, regardless of clinical status.

Clinicians should refer pregnant women who develop chicken pox to a fetal medicine specialist, virologist, and neonatologist for decision regarding treatment.

Clinicians should individualize the timing and mode of delivery of the pregnant woman with chicken pox.

Women with chicken pox should breast-feed if they so desire and are in sufficiently good health.

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