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Question 718
Obstetric infection → Viral
Classification
Question
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Timing of planned delivery after maternal chickenpox
Question Stem
A woman at 39+0 weeks develops chickenpox. Four days later she remains clinically stable and there is no maternal, fetal or obstetric indication for immediate birth. An elective caesarean had previously been planned for that day. What is the most appropriate approach?
Options
A
Proceed with delivery because maternal antibodies are already fully protective
B
Proceed with delivery and administer maternal VZIG
C
Postpone planned delivery until at least 7 days after onset of the maternal rash, provided maternal and fetal circumstances remain satisfactory
D
Postpone delivery until 28 days after the rash irrespective of maternal or fetal condition
E
Proceed immediately because neonatal risk decreases when birth occurs during active maternal infection
Explanation
Maternal chickenpox occurring in the last 4 weeks of pregnancy carries a significant risk of neonatal infection. Where clinically safe, planned delivery should normally be avoided for at least 7 days after onset of the maternal rash to allow passive transfer of maternal antibodies to the fetus. This is not an absolute reason to defer a clinically necessary delivery; timing and mode of birth must be individualised.
Option Validity
A) four days does not provide the recommended interval for passive antibody transfer.
B) maternal VZIG is not treatment for established chickenpox.
D) there is no mandatory 28-day postponement irrespective of clinical circumstances.
E) delivery during active maternal infection may expose the newborn to substantial risk.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, sections 5.4 and 6.3.