EMQ — Extended Matching Question · Review
Question 768
Obstetric infection → Viral
Classification
Question
EEMQQuestion Header
Select the single most appropriate breastfeeding advice.
Question Stem
A woman develops chickenpox shortly before delivery and is well enough to breastfeed. After birth she has active vesicular lesions immediately adjacent to one nipple. What is the most appropriate advice?
Answer Bank
A
Breastfeeding and expressed breast milk are permanently contraindicated
B
Continue direct feeding from the affected breast through the active lesions
C
Express milk from the affected breast until the lesions have crusted; the expressed milk may be given to the baby receiving appropriate neonatal prophylaxis
D
Stop all breastfeeding until maternal VZV IgG becomes negative
E
Discard all expressed milk for 28 days
F
Give varicella vaccine to the neonate before each feed
G
Separate mother and baby permanently
H
Suppress lactation pharmacologically
Correct Answer
C. Express milk from the affected breast until the lesions have crusted; the expressed milk may be given to the baby receiving appropriate neonatal prophylaxis
Explanation
Women with chickenpox may breastfeed if they wish and are well enough. When active lesions are close to the nipple, milk should be expressed from the affected breast until the lesions have crusted. The expressed milk may be fed to a baby who is receiving VZIG and/or aciclovir as appropriate.
Option Validity
A) Maternal chickenpox is not a permanent contraindication to breastfeeding.
B) Direct feeding through active lesions adjacent to the nipple should be avoided.
D) Breastfeeding decisions are not based on loss of maternal VZV IgG.
E) The guideline does not require expressed milk to be discarded for 28 days.
F) Neonatal varicella vaccination before feeds is not recommended.
G) Permanent separation is not recommended.
H) Routine pharmacological suppression of lactation is unnecessary.
Further Reading
RCOG Green-top Guideline No. 13. Chickenpox in Pregnancy. Royal College of Obstetricians and Gynaecologists; January 2015, minor update 2024.