Case #1 FRCPath Microbiology Part 2

A 24-week pregnant woman presents with a two-day history of severe chickenpox.

What is the management?

Chickenpox Rash

Answer

1. Recognition

• Adult varicella is more severe → ↑ risk of pneumonia, encephalitis, hepatitis.

• Pregnancy increases severity; second trimester = high maternal risk.

• Fetal risk: congenital varicella syndrome (if <20 weeks), neonatal varicella (if near delivery).

2. Immediate Actions

• Urgent hospital referral — severe varicella in pregnancy is a medical emergency.

3. Antiviral Therapy

• IV aciclovir 10 mg/kg every 8h × 7 days.

• Oral antivirals insufficient for severe disease.

4. Supportive Care

• Analgesia: paracetamol (avoid NSAIDs).

• Adequate hydration.

• Monitor: vital signs, respiratory status.

• Airborne isolation.

5. Obstetric Management

• Obstetric review → fetal wellbeing assessment (USS if indicated).

• Counselling on maternal/fetal risks.

6. Additional Points

• VZIG: for non-immune pregnant women after varicella exposure (within 10 days) — not for established disease.

• Document severity, gestational age, and management plan.