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Question 743
Obstetric infection → Viral
Classification
Question
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Role of VZIG after chickenpox develops
Question Stem
A non-immune woman at 24 weeks of gestation develops a typical chickenpox rash after a recognised exposure. She did not receive post-exposure prophylaxis. What is the role of VZIG now that clinical chickenpox has developed?
Options
A
It should be given immediately to shorten the maternal illness
B
It should be given only if the rash has been present for less than 24 hours
C
It should be combined routinely with oral aciclovir
D
It should be reserved for women with pneumonia
E
It has no therapeutic benefit once chickenpox has developed
Explanation
VZIG is a post-exposure prophylactic intervention and is not treatment for established clinical chickenpox. Once a pregnant woman has developed the chickenpox rash, VZIG has no therapeutic benefit and should not be used for treatment. Antiviral treatment is considered according to gestation, timing of presentation and severity, with intravenous aciclovir indicated for severe disease.
Option Validity
A) VZIG does not shorten established maternal chickenpox.
B) development of the rash, rather than a 24-hour therapeutic window for VZIG, determines that it is no longer useful as treatment.
C) VZIG is not routinely combined with aciclovir to treat established disease.
D) severe chickenpox requires antiviral and supportive management; VZIG is not therapeutic treatment.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 5.2.