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Recognising the pregnant woman who needs escalation

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Additional Insight #83

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Most management decisions after maternal chickenpox depend on distinguishing uncomplicated disease from women at increased risk of deterioration.

Respiratory symptoms, neurological features such as photophobia, seizures or drowsiness, haemorrhagic rash or bleeding, and a dense rash with or without mucosal lesions are warning features of potentially severe disease and require hospital referral.

Even without these severe features, hospital assessment should be considered when additional risk is present, including smoking, chronic lung disease, immunosuppression such as systemic corticosteroid use within the previous 3 months, or being in the second half of pregnancy.

Oral aciclovir is used for appropriate uncomplicated presentations, whereas intravenous aciclovir is recommended for severe maternal chickenpox.

The practical distinction is therefore not simply whether chickenpox is present, but whether maternal features or background risk move the woman from outpatient antiviral management to hospital-based assessment and treatment.

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Recognising the pregnant woman who needs escalation

Additional Insight #83

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