SBA — Single Best Answer · Review
Question 710
Obstetric infection → Viral
Classification
Question
SSBAQuestion Header
Post-exposure prophylaxis after chickenpox exposure
Question Stem
A woman at 18 weeks of gestation has significant household exposure to chickenpox. She has no previous history of chickenpox or varicella vaccination, and VZV IgG testing confirms that she is non-immune. What is the most appropriate first-line post-exposure prophylaxis?
Options
A
Oral aciclovir or valaciclovir
B
Varicella vaccination immediately
C
Intravenous aciclovir immediately
D
Varicella-zoster immunoglobulin routinely as first-line prophylaxis
E
No prophylaxis unless a rash develops
Explanation
A non-immune pregnant woman who has had significant exposure to chickenpox should be offered post-exposure prophylaxis. Oral antiviral therapy with aciclovir or valaciclovir is recommended as the first choice for PEP. VZIG may be considered when antivirals are contraindicated or associated with adverse effects. Varicella vaccination is not given during pregnancy, and waiting for a rash would miss the opportunity for prophylaxis.
Option Validity
B) varicella vaccination is not given during pregnancy.
C) intravenous aciclovir is used for severe established chickenpox, not routine PEP.
D) VZIG is an alternative when antiviral PEP cannot be used.
E) significant exposure in a confirmed non-immune pregnant woman warrants PEP.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 4.3.