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Question 715
Obstetric infection → Viral
Classification
Question
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Antiviral treatment of severe maternal chickenpox
Question Stem
A woman at 31 weeks of gestation with chickenpox develops dyspnoea, increasing respiratory distress and extensive skin lesions. She is admitted to hospital. Which antiviral management is most appropriate?
Options
A
Intravenous aciclovir
B
Varicella-zoster immunoglobulin
C
Oral valaciclovir only
D
Varicella vaccination
E
Withhold antivirals until virological confirmation
Explanation
Intravenous aciclovir should be given to all pregnant women with severe chickenpox. Respiratory symptoms are particularly concerning because varicella pneumonia is an important cause of serious maternal morbidity. Severe disease warrants immediate hospital referral, isolation and appropriate multidisciplinary care.
Option Validity
B) VZIG is not treatment for established chickenpox.
C) severe disease requires intravenous aciclovir rather than routine oral antiviral treatment.
D) vaccination has no therapeutic role in established maternal infection.
E) treatment of severe clinically apparent chickenpox should not be delayed pending virological confirmation.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, sections 5.2–5.3.