Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 2139  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
REVIEW ARTICLE
Year : 2010  |  Volume : 55  |  Issue : 4  |  Page : 313-315
Chicken pox in pregnancy : An obstetric concern


Wiwanitkit House, Bangkhae, Bangkok 101 60, Thailand

Date of Web Publication4-Jan-2011

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok 101 60
Thailand
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.74527

Rights and Permissions

   Abstract 

Chicken pox is a common viral infection presenting with fever and discrete vesicular lesions. This infection can be widely detected in developing countries, especially for those tropical countries. The pregnant can get chicken pox, and this becomes an important obstetrical concern. In this specific paper, the author hereby details and discusses on chicken pox in pregnancy. Clinical presentation, diagnosis, treatment, and prevention are briefly summarized. In addition, the effects of chicken pox on pregnancy as well as the vertical transmission are also documented.


Keywords: Chicken pox, pregnancy, obstetric


How to cite this article:
Wiwanitkit V. Chicken pox in pregnancy : An obstetric concern. Indian J Dermatol 2010;55:313-5

How to cite this URL:
Wiwanitkit V. Chicken pox in pregnancy : An obstetric concern. Indian J Dermatol [serial online] 2010 [cited 2020 Jul 8];55:313-5. Available from: http://www.e-ijd.org/text.asp?2010/55/4/313/74527



   Introduction Top


Chicken pox is a viral infection. This infection has its clinical presentations as high fever with generalized vesicular lesions. [1],[2] This is a highly contagious disease. This disease is considered as an important infectious disease in surveillance program. In the past, the disease usually occurred in the pediatric population. [1],[2] However, due to the improved sanitation in this day, the epidemiology of disease changes and the disease hits the higher aged group. [3]

In tropical country, chicken pox is common. [4] However, it is also detectable in the developed nontropical countries. The problem on infection in pediatric cases is not as much as that of non-pediatric case. In adult infection, the patients might suffer from many complications of chicken pox, especially for lung complications [3],[5] Similar to other population, the chicken pox among the pregnant subjects can be seen, and this becomes the concern in obstetrics.


   Clinical Presentation of Chicken Pox in Pregnancy Top


Similar to general population, there is no difference in clinical presentation of chicken pox in pregnancy. [6],[7],[8],[9],[10],[11],[12],[13] The pregnant subjects who get chicken pox will develop the high fever and can last for 7 days due to the nature of viral infection. Chicken pox is classified as a respiratory infection. [1],[2] This viral infection is highly contagious. The skin lesions usually help clinical diagnosis of the disease. Usually, the pruritic skin lesions start after 1-2 days of fever. [6] The vesicular skin lesion is the hallmark of the disease. The vesicles can be easily ruptured and serous fluid can be detectable. The contact with skin fluid can be another mode of disease transmission. Similar to general adult population, the pregnant can develop chicken pox pneumonia. Focusing on chicken pox pneumonia in pregnancy, there is no difference in clinical outcome or presentation. [14]


   Diagnosis of Chicken Pox in Pregnancy Top


As earlier mentioned, the diagnosis of chicken pox, either in pregnant or non-pregnant subjects can be easily performed on the basis of clinical history and clinical classical signs-symptoms. [6],[7],[8],[9],[10],[11],[12],[13] There is no need for laboratory diagnostic tool. [15] However, there are also some available laboratory diagnostic tools including virus/viral antigen detection, virus isolation, and identification or serological diagnosis. These tools might be useful for atypical cases. [16] The cost utility of those laboratory diagnostic tools is still not approved.


   Treatment of Chicken Pox in Pregnancy Top


In pediatric population, chicken pox can be self-limited without any specific antiviral drug treatment. [1],[2] There is no need for this scenario. However, the use of specific antiviral drug, acyclovir, is recommended in non-pediatric group since this group gets higher risk of complication. [17],[18],[19] The dosage form of acyclovir is 800 mg per oral for five times per day for continuous 7 days. [17] For the pregnant subject, the treatment by acyclovir is recommended for special precautions. [20] However, there are many reports confirming the effectiveness and safety of acyclovir for treatment of chicken pox among the pregnant. Nevertheless, there is still a need for systematic assessment on the risk-benefit of using acyclovir in this scenario. [20] However, use of acyclovir in pregnancy seems to be acceptable similar to general population. Frenkel et al reported that the administration of acyclovir, 400 mg every 8 h, appears appropriate for use in an efficacy and safety study regarding suppression of herpes simplex virus recurrences during the last weeks of pregnancy. [21] Another problem to be concerned is the management of the presumed susceptible chicken pox exposed gravid. Rouse et al gave an opinion on this issue that from a cost-effectiveness/cost-benefit standpoint, management based on immune testing is preferable to universal varicella-zoster immune globulin administration when caring for the varicella-exposed gravida with a negative or indeterminate infection history. [22]


   Prevention of Chicken Pox in Pregnancy Top


The routine infection control process can be useful in prevention of chicken pox. [1],[2] Specific vaccine for chicken pox is available. However, the cost-effectiveness of this new vaccine is assessed in many countries. In the endemic country, there is still evidence that the chicken pox vaccine is not cost-effective for general population and should be considered for the risk groups such as medical personnel. [23],[24] For the pregnant subject, there is no routine recommendation for vaccination for chicken pox in case with or without clear previous history of infection. The safety in case of vaccine is used is also a big concern. Wilson et al noted data collected in the pregnancy registry to date do not support a relationship between the occurrence of congenital varicella syndrome or other birth defects and varicella vaccine exposure during pregnancy. [25]


   Effect of Chicken Pox on Pregnancy Top


The effect of chicken pox on pregnancy is not well defined. It is still a query whether chicken pox can lead to abortion or preterm labor. Focusing on the effect on fetus, there is no report on congenital anomaly due to maternal chicken pox. However, the infection, which can be confirmed by amniotic fluid or fetal blood test for viral DNA, and fetal histopathological change, as miliary calcified necroses in fetal organs, are confirmed. [26] Prenatal diagnosis on the problem can be presently done. Nevertheless, it is confirmed that chicken pox can have vertical transmission mode. [27],[28] Sauerbrei noted that intrauterine death or severe diseases (congenital or fetal varicella syndrome) may ensue depending on the time of maternal infection. [9]


   Vertical Transmission of Chicken Pox Top


The vertical transmission of chicken pox is confirmed. Auriti et al mentioned for the need for expert medical counseling for women who contacted chickenpox at any time during pregnancy. [28] Auriti et al also raised for the importance of immunizing susceptible women of childbearing age before they became pregnant. [28] There are some sporadic reports on this mode of transmission. [25]Usually, the mother gets the infection at term and the infant present with specific vesicular skin lesion confirming the appearance of congenital chicken pox. [26],[27] Acyclovir treatment of the affected neonate with congenital chicken pox is also recommended. [26],[27] Indeed, the serious congenital infection might be preventable with passive antibody prophylaxis and antiviral therapy. [29]

 
   References Top

1.Asano Y. Clinicopathologic understanding and control of varicella-zoster virus infection. Vaccine 2008;26:6487-90.   Back to cited text no. 1
    
2.Tunbridge AJ, Breuer J, Jeffery KJ; British Infection Society. Chickenpox in adults - clinical management. J Infect 2008;57:95-102.  Back to cited text no. 2
    
3.Gershon AA. Varicella-zoster virus infections. Pediatr Rev 2008;29:5-10.  Back to cited text no. 3
    
4.Lee BW, Tan AY. Chickenpox in the tropics. BMJ 1995;310:941.  Back to cited text no. 4
    
5.Conti JA, Karetzky MS. Varicella pneumonia in the adult. N J Med 1989;86:475-8.  Back to cited text no. 5
    
6.Karel DJ. Pruritic rash in pregnancy. Varicella virus. Am Fam Physician 2009;79:405-6.   Back to cited text no. 6
    
7.Daley AJ, Thorpe S, Garland SM. Varicella and the pregnant woman: prevention and management. Aust N Z J Obstet Gynaecol 2008;48:26-33.  Back to cited text no. 7
    
8.Mirlesse V, Lebon P. Chickenpox during pregnancy. Arch Pediatr 2003;10:1113-8.  Back to cited text no. 8
    
9.Sauerbrei A. Varicella-zoster virus infections in pregnancy. Intervirology 1998;41:191-6.  Back to cited text no. 9
    
10.Sauerbrei A, Wutzler P. Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections. Med Microbiol Immunol 2007;196:95-102.  Back to cited text no. 10
    
11.Tan MP, Koren G. Chickenpox in pregnancy: revisited. Reprod Toxicol 2006;21:410-20.   Back to cited text no. 11
    
12.Sauerbrei A, Wutzler P. Varicella during pregnancy. 1: Epidemiology and clinical aspects. Dtsch Med Wochenschr 2004;129:1983-6.  Back to cited text no. 12
    
13.Sauerbrei A, Wutzler P. Varicella during pregnancy. 2. Diagnosis, prevention and therapy. Dtsch Med Wochenschr 2004;129:2045-7.  Back to cited text no. 13
    
14.Martνnez Segura JM, Gutiιrrez Oliver A, Maravν Poma E, Jimιnez Urra I. Severe chickenpox pneumonia. Rev Clin Esp 2003;203:591-4.   Back to cited text no. 14
    
15.Hendrik HJ, Enders M. Infections in pregnancy. MMW Fortschr Med 2004;146:39-41, 43.  Back to cited text no. 15
    
16.Cvjetkoviζ D, Jovanoviζ J, Hrnjakoviζ-Cvjetkoviζ I. Primary varicella-zoster virus infection-current knowledge, diagnostic and therapeutic approaches. Med Pregl 2000;53:272-6.  Back to cited text no. 16
    
17.Swingler GH. Chickenpox. Clin Evid (Online) 2007;2007. pii: 0912.   Back to cited text no. 17
    
18.Klassen TP, Belseck EM, Wiebe N, Hartling L. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev 2004;2:CD002980.   Back to cited text no. 18
    
19.Dorsky DI, Crumpacker CS. Drugs five years later: acyclovir. Ann Intern Med 1987;107:859-74.  Back to cited text no. 19
    
20.Brown ZA, Baker DA. Acyclovir therapy during pregnancy. Obstet Gynecol 1989;73:526-31.   Back to cited text no. 20
    
21.Frenkel LM, Brown ZA, Bryson YJ, Corey L, Unadkat JD, Hensleigh PA, et al. Pharmacokinetics of acyclovir in the term human pregnancy and neonate. Am J Obstet Gynecol 1991;164:569-76.  Back to cited text no. 21
    
22.Rouse DJ, Gardner M, Allen SJ, Goldenberg RL. Management of the presumed susceptible varicella (chickenpox)-exposed gravida: a cost-effectiveness/cost-benefit analysis. Obstet Gynecol 1996;87:932-6.  Back to cited text no. 22
    
23.Wiwanitkit V. New respiratory virus (chicken pox, influenza and respiratory syncytial virus) vaccines: efficacy, necessity and policy for the tropical world at present. Hum Vaccin 2009;5:621-2.  Back to cited text no. 23
    
24.Chiu SS, Lau YL. Review of the Varilrix varicella vaccine. Expert Rev Vaccines 2005;4:629-43.  Back to cited text no. 24
    
25.Wilson E, Goss MA, Marin M, Shields KE, Seward JF, Rasmussen SA, et al. Varicella vaccine exposure during pregnancy: data from 10 Years of the pregnancy registry. J Infect Dis 2008;197:S178-84.  Back to cited text no. 25
    
26.Hartung J, Enders G, Chaoui R, Arents A, Tennstedt C, Bollmann R. Prenatal diagnosis of congenital varicella syndrome and detection of varicella-zoster virus in the fetus: a case report. Prenat Diagn 1999;19:163-6.  Back to cited text no. 26
    
27.Pattanasuttinont S. Maternal chickenpox in peripartum period: a case report and review. J Med Assoc Thai 2008;91:110-6.  Back to cited text no. 27
    
28.Auriti C, Piersigilli F, De Gasperis MR, Seganti G. Congenital varicella syndrome: still a problem? Fetal Diagn Ther 2009;25:224-9.  Back to cited text no. 28
    
29.Smith CK, Arvin AM. Varicella in the fetus and newborn. Semin Fetal Neonatal Med 2009;14:209-17.  Back to cited text no. 29
    




 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (496 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Clinical Present...
    Diagnosis of Chi...
    Treatment of Chi...
    Prevention of Ch...
    Effect of Chicke...
    Vertical Transmi...
    References

 Article Access Statistics
    Viewed5435    
    Printed241    
    Emailed5    
    PDF Downloaded315    
    Comments [Add]    

Recommend this journal