- What to do
The Royal College of Obstetricians and Gynaecologists (RCOG) has issued the revision, the fourth edition of the Green-top guideline on chicken Pox (primary infection from varicella zoster virus VZV) in pregnancy on January 21.
The new recommendations describe prevention of chicken pox in pregnancy, management and treatment of pregnant women with chickenpox, the modeà of childbirth, the risks for children and advice about breastfeeding. What follows is a summary.
The Chickenpox può be a serious health issue during pregnancy, and there can be complications, ” says Professor Patricia Crowley, MB, FRCOG, University College Dublin.
it is vital that pregnant women with symptoms of the virus to contact their general practitioners as soon as possible, and avoid contact with individuals who may be susceptible to contracting the disease such as other pregnant women and children.
The infection from VZV is very common and usually the infection during childhood results in a immunityà persistent.
However, the infection from VZV are interested in three pregnancies per 1000.
chickenpox is very contagious, and then it is important that women are aware of the symptoms and the needà to require quickly medical care, says the RCOG Guidelines Committee Co-Chair Dr. Manish Gupta.
women may be concerned about the passage of the virus to their child, however this is very rare and it depends on the period of pregnancy in which the virus is transmitted to the mother.
it is also vital that clinicians are aware of the increase in the morbidityà associated with chickenpox in the pregnant women, and ensure that women receive the best possible care.
The best practice recommendations specific are (best practice):
- physicians should ask women who present for the visit preconcezionale if they have had chickenpox or the herpes zoster virus.
- pregnant women who does not had chickenpox, or who know they are seronegative, they should avoid people with chickenpox or herpes zoster (shingles) and shall promptly inform the health care provider of possible exposure to the contagion.
doctors must confirm that the possible exposure to the contagion with a careful assessment to confirm the value of the contact, the usedà of the patient, and ask for the research of antibodies to VZV.
If the expectant mother is not; immune to VZV and she has had a significant exposure, should be offered the immnuoglobulina VZIG as soon as possible. the VZIG is effective if taken within 10 days of contact (in the case of continuous exposure, this is defined as ten days after the appearance of the rash).
expectant mothers are not immune who have been exposed to chickenpox should be considered as potentially infected from 8 to 28 days after exposure, is that they receive the administration of VZIG or not receive.
When the resources are limited, the outputs of pregnant women must be restricted and the doctors recommended to see the availabilityà of VZIG before you plan to pregnant women.
women who have been exposed to chickenpox or shingles (regardless of the fact that both had been administered immunoglobulin specific) should notify their doctor or midwife the first appearance of skin rash. Pregnant women who develop the rash of chickenpox must be isolated from other pregnant women when you are in the waiting room and in general in the health services.
chickenpox is contagious for two days prior to the first of the appearance of the rash and for the duration of the disease as lesions are active, and stops being contagious when the lesions are all scabbed dry. Herpes Zoster can be contagious through contact with an area of the body (e.g. the eye) or with the contact with immunocompromised individuals in which the issue of the virus can; be massive.
The risk of transmission by coming in contact with patients suffering from herpes zoster in areas that are not exposed (for example toracolombare) is remote, but not impossible.
significant contact you intend to stay in the same room for about 15 minutes or more, face-to-face, or a contact in the environment as a lane.
The usedà of the woman should be determined by the medical history compared to chickenpox or herpes zoster. If there is a history clear of chickenpox is reasonable to determine that the woman is immune.
What to do
If thereà of the woman is unknown, or if there are doubts, or it is sure that not c’è thereà è need to take the antibodies. This usually può be made within 24 to 48 hours and often even in a few hours if the laboratory has parades the serum of the blood tests preconcezionali.
About 80% of the women può be reassured becauseé has antibodies.
- pregnant women may need a second dose of immunoglobulin anti-VZV if there is a further exposure and three weeks have passed from previous dose.
- To prevent secondary bacterial infections should be used in treatment symptomatic and hygiene care.
- Aciclovir non è authorized for use in pregnancy. Physicians should warn their patients about the risks and benefits.
- doctors must consider the possibilityà of a shelter for women at high risk for chickenpox, severe or complicated, regardless of their state at the time.
- The doctors have to send pregnant women with varicella to specialists in fetal medicine, virologists, and neonatologists, for treatment decisions.
- physicians should individualize the timing of childbirth, and the way, for pregnant women with chickenpox.
- women with chickenpox should breastfeed if they wish and if they are well enough to do so.
This is a summary of Chickenpox in Pregnancy RCOG, published online on 21 January 2015. Review of the guidelines on chickenpox in pregnancy from the Royal College of Obstetricians and Gynaecologists.
Faq about the risks of chicken pox contracted in pregnancy
The varicella zoster in pregnancy
For further clarification or requests for help you can call the Association the Life of the Woman number 333 9856046
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1 February 2015