Chickenpox in pregnancy
Chickenpox in pregnancy - symptoms
Pathogenesis and clinical picture.The incubation period for chickenpox is 21 days.Infectious patients are for 1- 2 days before the rash and remain so exactly one week.In adults in the prodromal period observed fever and malaise.Then, there is a characteristic vesicular-papular rash.The abundant precipitation, the usually heavier than common manifestations of infection (fever, headache, sleep disturbance).Severe forms of the disease with abundant precipitations, gangrenous, hemorrhagic elements rashes, high fever and visceral occur in children and adults with weakened immune systems.Complications of chickenpox are rare and are mainly related to secondary bacterial infections.Serious complications are varicella pneumonia and CNS as cerebellar ataxia and encephalitis.In adults, varicella pneumonia is observed in 20% of cases of varicella.
Chickenpox in pregnancy - diagnosis
diagnosis of chickenpox is set on the clinical picture.Additionally, you can examine the contents of the vesicles by PCR on DNA WZ.Serological diagnosis is carried out by detection of specific IgG- and of IgM-antibody, IgM appear 4-8 day from the beginning of the disease and are stored up to 3 months.Further there IgG, which are determined by the blood lifetime.Their titer was examined to confirm the presence of immunity to WZ.
All pregnant women who recover from chickenpox in early pregnancy, ultrasound is recommended at 22-23 weeks of gestation to identify typical WZ-infection of fetal malformations.In unusual ultrasound data necessary to identify DNA by PCR in fetal blood and amniotic fluid.To establish fetal infection at 16-20 weeks of gestation can investigate the amniotic fluid.In the case of confirmation of the diagnosis of absolute indications for termination of pregnancy is still there, only in the presence of US data on serious malformation of the fetus is necessary to offer a woman an abortion.
Chickenpox in pregnancy - treatment
On the application of antiviral therapy for varicella in pregnant women is still unknown.As WZ is less sensitive to acyclovir than HSV, it is necessary to increase the dose, and administer the drug parenterally.In severe cases of pneumonia acyclovir administered at 10 mg / kg intravenously every 8 hours for 10 days.In severe herpes zoster during pregnancy acyclovir can be used in the II and III trimester, in very severe - in the I trimester.Introduction of specific VVZ-immunoglobulin during pregnancy is carried out with the purpose of passive immunization, and for the prevention of serious complications of chicken pox as varicella pneumonia.
Activities in childbirth.If you suspect chickenpox should delay delivery 3-4 days to mother-of IgG antibodies, the level of which is increased by approximately 5-6 days after acute varicella, can be transferred to the fetus and newborn, respectively.If you are unable to conduct tocolysis, then immediately after the birth of a child is introduced WZ-immunoglobulin.When massive eruptions varicella elements genital diseased less than 5 days ago, a woman can be a question of cesarean delivery for prevention of intrapartum infection.
After birth, women with chickenpox or shingles are isolated in special boxes observational department.Newborns prescribed prophylactic course of acyclovir and WZ-immunoglobulin.Passive immunization is carried out via intramuscular injection at a dose of 0.2-0.4 varitsellona ml / kg or intravenous dose varitekta 1.2 ml / kg.Child isolated from the mother as long as the danger of infection has passed.These newborns are observed for 14 days even in the absence of symptoms of the infection.With the development of varicella in the newborn prescribed treatment course of acyclovir at a dose of 5 mg / kg intravenously every 8 hours for 5-7 days.Read the quarantine only after covering peel lesions.Recommended mandatory breastfeeding of infants, as breast milk transferred protective en-TH-VVZ-antibodies.
Fetal varicella syndrome includes:
When infecting women on the eve of the birth of the newborn after birth may develop neonatal varicella.This disease is possible if seronegative woman had been in contact with sick chicken pox in the last 3 weeks of pregnancy.Neonatal varicella manifests itself in the first 10 to 12 days of newborn life, because it is transmitted transplacental before birth.If the rash appeared 12 days after birth, then it is more indicative of postnatal infection.This disease has a mild course, since there is in most infants protective maternal immunity.The most difficult runs infection in children whose mothers were ill in the last 5 days of pregnancy and the first 2 days after birth.Mortality among these children is 20-30%.In general, the incidence of severe complications in neonatal varicella is 20-50%.
Laboratory diagnosis of chickenpox
To confirm the diagnosis of congenital varicella syndrome laboratory diagnosis is needed WZ PCR.The following criteria are taken into account to confirm the relationship of maternal varicella and congenital anomalies of the fetus:
Currently WZ-created live vaccine.It is recommended in childhood and seronegative women planning pregnancy.After vaccination, pregnancy is allowed after 3 months.Vaccination prohibited in pregnancy, but pregnant accidental administration of the vaccine is not an indication for termination of pregnancy.
seronegative pregnant women who had contact with a sick chickenpox, no later than 72 hours after contact administered immunoglobulin.Passive immunization is carried out via intramuscular injection at a dose of 0.2-0.4 varitsellona ml / kg or intravenous dose varitekta 1.2 ml / kg.With timely administration and optimum dosage immunoglobulin prevent infection in only 48% of cases.In 6% of pregnant women there is an asymptomatic infection, and in the remaining cases, chickenpox occurs in weak form.
Thus, in contact with WZ necessary during pregnancy following.
should be noted that a favorable perinatal outcome can be expected with a high titer of maternal IgG to WZ;herpes zoster in a pregnant woman is not a threat to the fetus.