Management of Varicella in Pregnant Women: Observation, Admission, or IVIG? - Obstetrics and Gynecology

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The management of varicella (chickenpox) in pregnant women is a critical concern due to the potential risks to both the mother and the fetus. When a pregnant woman presents with skin lesions consistent with varicella, the approach to management should be guided by the timing of the infection in relation to the gestational age, the mother's vaccination history, and the presence of any complications.

Firstly, it is essential to assess the gestational age of the pregnant woman. Varicella infection acquired during the first trimester is generally associated with a lower risk of severe complications compared to infections acquired later in pregnancy. However, infections that occur close to delivery (within 5 days) pose a significant risk to the newborn, including the potential for severe neonatal varicella, which can lead to disseminated disease and even death. The risk of severe disease in the neonate is particularly high if the mother develops varicella within 4 days of delivery.

In cases where the mother is diagnosed with varicella during pregnancy, the following management strategies may be considered:
1. Observation (OBS): If the mother is otherwise healthy, has no complications, and is beyond the critical period of 5 days before delivery, observation may be appropriate. This involves monitoring the mother for any signs of complications and ensuring that she receives supportive care, such as hydration and antipyretics for fever.

2. Admission: If the pregnant woman presents with severe symptoms, such as pneumonia, encephalitis, or other complications, or if she is within 5 days of her due date, hospitalization may be necessary. This allows for close monitoring and management of any potential complications that may arise.

3. Intravenous Immunoglobulin (IVIG): For pregnant women who are at high risk of severe disease, particularly those who are immunocompromised or who have been exposed to varicella within 4 days of delivery, the administration of varicella-zoster immune globulin (VZIG) may be indicated. This can help reduce the severity of the disease and protect the neonate if the mother is infected close to delivery.

4. Do Nothing: In cases where the mother is not symptomatic and is beyond the critical period, a "watchful waiting" approach may be appropriate. However, it is crucial to provide education about the signs and symptoms of complications that may require immediate medical attention.

In summary, the management of varicella in pregnant women requires a careful assessment of the timing of the infection, the mother's health status, and the potential risks to the fetus. Close monitoring and appropriate interventions, such as IVIG for high-risk cases, can help mitigate the risks associated with this infection. It is also essential for healthcare providers to educate pregnant women about the importance of vaccination prior to pregnancy, as this can significantly reduce the incidence of varicella and its associated complications. Pregnant women should also be advised to avoid exposure to individuals with active varicella or shingles to minimize their risk of infection.