A 33-year-old G3P2 at 38 weeks’ gestation develops flu-like illness and breaks out with a pruritic, vesicular lesions all over her body. Three days later she goes into spontaneous labor and delivers a healthy appearing male infant via vaginal delivery. Her lesions are beginning to heal and she feels well.
What is the most appropriate next step in the management of this patient and her baby?A. Administer intravenous acyclovir to the mother
Varicella, or chicken pox, is usually diagnosed based on the clinical findings of a classic pruritic, vesicular rash. Pregnant women should have varicella immunity documented in early pregnancy by a history of previous infection or varicella vaccination. Pregnant women who have no history of chicken pox or have serology demonstrating lack of immunity should avoid varicella infected individuals until their lesions have crusted over and they are no longer infectious. Neonatal mortality rates are close to 25% when maternal varicella develops around the time of delivery, due to the lack of protective maternal antibodies and the relative immaturity of the fetal immune system. Therefore, if a mother has clinical evidence of varicella infection 5 days before or up to 48 hours after delivery, the newborn should receive varicella-zoster immune globulin. Typically, varicella infection in the mother only requires supportive therapy, but pregnant women have a higher and mortality related to development of pneumonia. If pneumonia is diagnosed, intravenous acyclovir should be given. The newborn should be isolated from the mother if she is infective, and if the neonate develops signs or symptoms of varicella infection, then intravenous acyclovir would be administered. Pregnant women should not receive the live-attenuated varicella vaccine.