Update in vzv in preg.

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Information about Update in vzv in preg.

Published on November 7, 2016

Author: HashemYassin

Source: slideshare.net

1. UPDATE IN “CHICKENPOX IN PREGNANCY” Hashem Yaseen MD, 4th year OG

2. GENERAL BACKGROUND  VZV is a DNA virus of the herpes family  Primary: varicella (chickenpox)  secondary: herpes zoster (shingles)  The incubation period is between 1 and 3 week  Seroprevelance: ~ 95 % of UK & USA women immune  Incidence of 1ry infection in pregnancy ~ 3:1000 Hashem Yaseen MD, 4th year OG 31/10/2016

3. TRANSMISSION Hashem Yaseen MD, 4th year OG 31/10/2016  Person to person 1. respiratory droplets 2. direct personal contact with vesicle fluid 3. indirectly via fomites (e.g. skin cells, hair, clothing and bedding).  Mother to infant 1. Intrauterine → transplacental transmission 2. Postnatal → respiratory droplets or direct contact with someone with varicella  Passage of varicella zoster virus to the fetus during zoster is rare, except?!

4. TRANSMISSION ’2 Hashem Yaseen MD, 4th year OG 31/10/2016    the disease is infectious 48 hours before the rash appears and continues to be infectious until the vesicles crust over. The vesicles usually crust over within 5 days.

5. SYMPTOMS Hashem Yaseen MD, 4th year OG 31/10/2016  The primary infection - Uncomplicated varicella : 1. Fever 2. Malaise 3. Maculopapular pruritic rash that develops into crops, which become vesicular and crust over before healing  Maternal risks -Complicated infection: Varicella in pregnancy is often more sever and may be life threatened as a consequence of: 1. Varicella pneumonia 2. Encephalitis 3. hepatitis

6. FETAL EFFECTS OF VZV INFECTION Hashem Yaseen MD, 4th year OG 31/10/2016  ~ 25% in all trimester.  ≤ 20 wks -> 2% risk for Congenital varicella syndrome: 1. Cutaneous scars in a dermatomal pattern 2. Neurological abnormalities (eg, mental retardation, microcephaly, hydrocephalus, seizures, Horner’s syndrome) 3. Ocular abnormalities (eg, optic nerve atrophy, cataracts, chorioretinitis, microphthalmos, nystagmus) 4. Limb abnormalities (hypoplasia, atrophy, paresis) 5. Gastrointestinal abnormalities (gastroesophageal reflux, atretic or stenotic bowel) 6. Low birth weight a mortality rate of 30 percent in the first few months of life and a 15 percent risk of developing herpes zoster in the first four years of life

7. Neonatal VZV infection Hashem Yaseen MD, 4th year OG 31/10/2016  results from VZV transmission from a mother to the fetus just prior to delivery  disease within five days before to two days after delivery are at the greatest risk for severe disease and poor outcome.  VZIG as soon as possible

8. Fetal Neonatal Varicella

9. Congenital Varicella

10. Again Hashem Yaseen MD, 4th year OG 31/10/2016

11. Hashem Yaseen MD, 4th year OG 31/10/2016

12. Varicella prevention Hashem Yaseen MD, 4th year OG 31/10/2016  live attenuated vaccine  In two separate doses 4–8 weeks apart.  Varicella vaccination prepregnancy or postpartum is an option.  should be advised to avoid pregnancy for 4 weeks after completing the two-dose vaccine schedule  Routine antenatal testing is not recommended  It is safe to breastfeed.

13. Varicella-zoster contact Hashem Yaseen MD, 4th year OG 31/10/2016 •Significant contact is defined as contact in the same room for 15 minutes or more, face-to-face contact or contact in the setting of a large open ward ~Varicella: the green book, chapter 34. London: Public Health England; 2012

14. Varicella-zoster contact Hashem Yaseen MD, 4th year OG 31/10/2016

15. Varicella-zoster contact Hashem Yaseen MD, 4th year OG 31/10/2016

16. Presents with chickenpox Hashem Yaseen MD, 4th year OG 31/10/2016

17. Presents with chickenpox Hashem Yaseen MD, 4th year OG 31/10/2016

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