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Maternal chickenpox and the fetal pathway

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Maternal chickenpox before 28 weeks creates a small risk of fetal varicella syndrome, but maternal infection does not mean that fetal damage has occurred.

The fetal pathway therefore centres on structured surveillance rather than assuming an affected fetus. Women who develop chickenpox or seroconvert during the first 28 weeks should be referred to a fetal medicine specialist.

Detailed ultrasound is arranged at 16–20 weeks or approximately 5 weeks after maternal infection, allowing time for abnormalities such as limb deformity, microcephaly, hydrocephalus, soft-tissue calcification or fetal growth restriction to become apparent.

Fetal MRI may provide additional information when ultrasound identifies morphological abnormalities.

Amniotic-fluid VZV PCR can demonstrate fetal infection, but its strong negative predictive value contrasts with poor positive predictive value for fetal damage. A positive PCR therefore does not itself diagnose fetal varicella syndrome.

Assessment must integrate gestational timing, expert imaging and cautious interpretation of virological testing.

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Maternal chickenpox and the fetal pathway

Additional Insight #84

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