Varicella in pregnancy

What it is

Chickenpox is caused by primary infection with varicella zoster virus, VZV, human herpes virus 3. Shingles is reactivation of dormant virus in the dorsal root ganglion. The incubation period is 10-23 days. It is the most common exanthematous disease of childhood and is very contagious, above 90% in household contacts.

In pregnancy there is a risk to both the mother and the fetus, a syndrome now termed fetal varicella syndrome. The local protocol puts it this way: varicella in pregnancy may cause maternal mortality or serious morbidity, and it may also cause fetal varicella syndrome and varicella infection of the new born, which includes congenital varicella syndrome and neonatal varicella.

How it presents

The prodrome is 1-2 days of low grade fever, malaise and URI symptoms. The rash is papules and vesicles with surrounding erythema, and pustules at different sites, so that crops of papules, vesicles and crusts are seen at the same time; it spreads central to peripheral. The exanthem is described as vesicular lesions on an erythematous base, the dew drops on rose petals appearance, with lesions present in different stages, papules, vesicles, pustules and crusting, spreading from the trunk to the face, neck and extremities and buttock with pruritus; mucous membranes can be involved.