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Question 746
Obstetric infection → Viral
Classification
Question
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Delivery during active maternal varicella
Question Stem
A woman at 38 weeks has active chickenpox vesicles and is clinically stable. There is no obstetric indication for immediate delivery. Why should delivery during this viraemic phase be avoided when possible?
Options
A
It invariably causes fetal varicella syndrome
B
It prevents subsequent maternal antiviral treatment
C
It makes regional anaesthesia absolutely contraindicated
D
It may precipitate maternal haemorrhage or coagulopathy and exposes the neonate to a high risk of varicella infection
E
It causes permanent maternal VZV viraemia
Explanation
Delivery during the viraemic period while chickenpox vesicles remain active may be extremely hazardous. It can precipitate maternal haemorrhage or coagulopathy associated with thrombocytopenia or hepatitis and is associated with a high risk of neonatal varicella with significant morbidity and mortality. When clinically safe, supportive treatment and intravenous aciclovir can allow maternal recovery and transfer of protective antibodies before delivery.
Option Validity
A) fetal varicella syndrome relates to maternal infection earlier in pregnancy and is not an inevitable consequence of delivery during active infection.
B) antiviral treatment is not prevented by delivery.
C) regional anaesthesia is not absolutely contraindicated; a lesion-free needle site should be selected.
E) delivery does not cause permanent maternal viraemia.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 5.4.