Chickenpox in pregnancy is a serious condition which must be treated, Pregnant Patients present to outpatient or emergency department with chickenpox lesions, so the health care practitioner must know how to deal with such condition, as if untreated, it may cause fetal anomalies. So let’s start step by step, what should we do if a pregnant woman comes to you with the complaint of exposure to chicken pox or with active lesions of chickenpox.
If a pregnant female comes to you, and tell you that she was exposed to another person or child who had chickenpox. Now the first question you must ask her is;
Have you ever got chickenpox before? In childhood or recently?
If she answers, yes she has got chickenpox once before, then you don’t have to do anything, just wait, as there are more than 95% chance that she will not develop chickenpox.
If she answers that she doesn’t know, or she doesn’t remember, then, in this case, check the serum varicella zoster antibody level, if antibodies are present then it means patient has got chickenpox previously, so in this case, don’t start any treatment and start the treatment only if lesions appear.
If you don’t find any antibody against Varicella zoster, then give the varicella immunoglobulins as soon as possible. but you may give the varicella immunoglobulins up to 10 days after exposure. Varicella immunoglobulins greatly reduce the severity of chickenpox infection. Closely monitor the patient for chickenpox rash for 2 weeks after exposures, as the incubation period of varicella zoster is 2 weeks, so the first lesion may appear after 2 weeks of exposure, start the treatment as soon as the first lesion appears. Only Varicella immunoglobulins must be used in case of exposure and if patient presents within 10 days of exposure.
If treatment of chickenpox is indicated in a pregnant woman, then you must first tell the patient that although the drug that you are going to use to treat the chickenpox is category B drug, it is relatively safer in pregnancy. The chickenpox, if untreated, is associated with greater harm, it may cause fetal anomalies, such as undeveloped limbs, corneal inflammation, incomplete development of brain, if chickenpox appears in later stages of pregnancy, that is close to delivery then the fetus is at risk of developing a life-threatening condition called Newborn Varicella Syndrome. So in this case drug must be given.
The best time of starting the treatment is within 24 hours of the appearance of the first lesion of chickenpox. But you may start the lesion if new lesions are continued to be appearing. Once crust formation occurs then there is no role of antibiotic (Acyclovir) therapy.
The Drug of Choice is Acyclovir
Its dose in pregnancy is 15mg/kg every 6h hours for 7 days minimum (10 days maximum).
Monitor for side effects such as dizziness, anemia, thrombocytopenia, elevated liver enzymes, malaise, rash or hives, alopecia, agitation and nausea or vomiting.
Steroids which are used previously and topical acyclovir has no definite role.
Written By:
Dr. Adil Ramzan, MBBS, MD (Internal Medicine)
Resident, Department of Internal Medicine, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University PIMS, Islamabad Pakistan
