Chicken pox in pregnancy Management protocol

 

Maternal Medicine · Clinical Reference

Chickenpox (Varicella)
during Pregnancy

A protocol for prevention, post-exposure prophylaxis, and active infection — for mother and baby.

BASED ON RCOG & ACOG GUIDELINES

1

Initial Assessment & Prevention

Determine Immunity

At the first antenatal visit, take a detailed history of prior chickenpox or shingles infection, or varicella vaccination.

If Non-Immune

• Advise avoidance of contact with anyone with chickenpox or shingles.
• Offer vaccination postnatally — not during pregnancy.
• Delay conception 1 month after vaccination.

2

Management Following Exposure

Step 1

Determine "Significant Exposure"

• Contact type: face-to-face, or same small room for 15+ minutes, with someone who has chickenpox, disseminated shingles, or exposed shingles lesions.
• Infectious window: 24 hours before rash appears → 5 days after.

Step 2

Determine Susceptibility

Urgent VZV IgG blood test for a susceptible woman with significant exposure.

A reliable history of chickenpox, or two vaccine doses, is itself sufficient evidence of immunity in an immunocompetent woman — no further testing needed.

Step 3

Post-Exposure Prophylaxis (PEP)

Offered if VZV IgG negative (non-immune).

First-line

Oral Antiviral Therapy

Aciclovir or valaciclovir — now the recommended first choice. Given Day 7 to Day 14 after exposure.

Second-line

VZIG

Considered if antivirals are contraindicated (e.g. renal impairment) or not tolerated. A blood product giving passive immunity; effective up to 10 days after contact.

3

Management of Active Chickenpox

Immediate Action

Contact the healthcare provider immediately, and isolate from other pregnant women.

Risk Profile

10–20%

Pregnant women who develop pneumonia

0.4–2.0%

Risk of fetal varicella syndrome

1st / early 2nd

Trimester = highest fetal risk window

Maternal risks also include hepatitis and encephalitis. Fetal risk depends on gestational age at infection.

Treatment

Route	When indicated
Oral aciclovir	Presenting within 24 hours of rash onset, ≥20 weeks gestation. Use before 20 weeks should also be considered.
IV aciclovir	All pregnant women with severe chickenpox or signs of complications (e.g. respiratory symptoms).

High-Risk Window: Late Pregnancy

Maternal infection from 5 days before to 2 days after delivery carries a high risk of neonatal death. Requires specialist management in a unit with neonatology expertise.

SOURCES — ROYAL COLLEGE OF OBSTETRICIANS & GYNAECOLOGISTS (RCOG) · AMERICAN COLLEGE OF OBSTETRICIANS & GYNECOLOGISTS (ACOG)
FOR CLINICAL REFERENCE — ALWAYS FOLLOW LOCAL PROTOCOL