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Question 727
Obstetric infection → Viral
Classification
Question
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Neonatal risk after peripartum maternal chickenpox
Question Stem
A woman develops a chickenpox rash 4 days before giving birth. Which management of the newborn is most appropriate according to the guideline?
Options
A
Test neonatal VZV IgG first and treat only if seronegative
B
No neonatal prophylaxis is required because maternal antibodies cross the placenta immediately
C
Give routine varicella vaccination to the neonate
D
Give neonatal prophylaxis as soon as possible with VZIG with or without aciclovir, without waiting for testing
E
Observe only unless the neonate develops vesicles
Explanation
Severe neonatal chickenpox is particularly likely when the baby is born within 7 days of onset of the maternal rash or when the mother develops the rash up to 7 days after delivery. For babies exposed within this interval, neonatal prophylaxis should be given as soon as possible with VZIG with or without aciclovir; testing is not required before prophylaxis.
Option Validity
A) there is no need to test before prophylaxis in this high-risk peripartum interval.
B) birth close to onset of the maternal rash is precisely the setting associated with severe neonatal disease.
C) neonatal varicella vaccination is not the recommended prophylaxis in this situation.
E) prophylaxis should not be delayed until clinical disease develops.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 6.3.