Question 750

Pregnant women with chickenpox should be considered for hospital assessment when they have factors associated with an increased risk of severe or complicated disease, even if severe symptoms are not yet present. Chronic lung disease is specifically identified as a high-risk feature. Other high-risk features include smoking, immunosuppression including systemic corticosteroid use within the preceding 3 months, and being in the second half of pregnancy. Assessment should be arranged so that the woman avoids contact with other pregnant women because active chickenpox is infectious. Varicella-zoster immunoglobulin is used for post-exposure prophylaxis in selected susceptible women and has no therapeutic benefit once chickenpox has developed. Immediate delivery, amniocentesis and neonatal prophylaxis are not indicated by this presentation.

A) Chronic lung disease places the woman in a group for whom hospital assessment should be considered despite the absence of severe symptoms.

C) VZIG has no therapeutic benefit once chickenpox has developed.

D) Chickenpox at 18 weeks without maternal deterioration is not an indication for immediate delivery.

E) Immediate amniocentesis is not the next maternal management step and invasive testing should not be performed while maternal skin lesions remain active.

F) Varicella vaccination is not given as treatment for active chickenpox during pregnancy.

G) The presence of chronic lung disease warrants assessment rather than routine review alone.

H) Neonatal prophylaxis is relevant around maternal infection close to delivery, not at 18 weeks.

RCOG Green-top Guideline No. 13. Chickenpox in Pregnancy. Royal College of Obstetricians and Gynaecologists; January 2015, minor update 2024.