Varicella infection in pregnancy

de la Calle, Maria; Omeñaca, Felix; Bartha, Jose Luis

doi:10.1016/j.medcle.2016.04.036

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In pregnant women it increases the risk of complications such as pneumonia and viral encephalitis.<a class="elsevierStyleCrossRefs" href="#bib0050">2,3</a> In the foetus, the risk of vertical transmission through the placenta is low, so most new-borns of mothers with varicella in pregnancy are asymptomatic. This risk is higher in the third trimester of pregnancy.<a class="elsevierStyleCrossRef" href="#bib0060">4</a> However, the risk of foetal infection with the development of congenital varicella syndrome is higher if maternal infection occurs in the first 20 weeks of pregnancy, with an incidence of 1–2%.<a class="elsevierStyleCrossRef" href="#bib0065">5</a> Typical manifestations of congenital varicella syndrome include skin lesions (70%), neurological disorders (62%), eye abnormalities (52%), limb hypoplasia (46%) and low birth weight (23%).<a class="elsevierStyleCrossRef" href="#bib0070">6</a> If a varicella infection in pregnancy is suspected, serological confirmation is recommended with IgM+ and/or PCR+ of a vesicle for varicella zoster virus (VZV). The diagnosis of foetal infection should be done by amniocentesis from week 19 to confirm DNA positivity for VZV in the amniotic fluid. Confirmation of foetal infection does not always indicate that the foetus is anomalous, but these foetuses should be closely monitored with ultrasounds, as sometimes late ultrasound abnormalities may appear. The foetal neurological study should include performing an MRI in the third trimester.We treated six cases of varicella infection in pregnant women in 2014, among 5600 deliveries in the same year at our institution (0.11%). In all cases, the diagnosis was confirmed by IgM+ serology and/or PCR+ of a dermal vesicle. In 5 patients, varicella was diagnosed before week 20 of gestation, and one of them, who was in the eighth week, decided to terminate the pregnancy. In all cases there was both dermal and mucosal involvement, without other clinical manifestations, except for one patient who had respiratory failure or dyspnoea without anomalies in chest radiology. Rupture of membranes occurred in one case, resulting in foetal loss a week after the diagnosis. Three patients with skin involvement in more than two thirds of the body were treated with oral acyclovir for 7 days. Amniocentesis was performed in 3 cases, and the PCR for VZV was positive in one of them, although this case and the remaining 3 who completed gestation had normal deliveries with asymptomatic new-borns. The clinical characteristics for the 6 patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Treatment of mild cases of varicella during pregnancy mainly includes hygienic measures. In highly symptomatic cases, oral antivirals, such as acyclovir, will be administered at doses of 800mg, 5 times a day, between 24 and 72h of the rash onset, for 7 days. In cases of progression to varicella pneumonia, the patient must be admitted and administered intravenous acyclovir at a dose of 10–15mg/kg/8h between 5 and 10 days.<a class="elsevierStyleCrossRef" href="#bib0075">7</a> When varicella occurs within 5 days before delivery or within 2 days the same 2, the risk of vertical transmission is high (>50%) and the neonate may not have protective antibodies of maternal origin, so the risk of severe neonatal varicella is high. For this reason, postponing the delivery with tocolytic drugs for 7 days after the onset of skin rash is recommended. If labour is triggered during that period, neonatologists should be informed so that they can administer the neonate specific immunoglobulin against VZV.If there is a case of varicella contact during pregnancy, IgG serology to VZV should be performed. If the mother is not immunized, she should be administered prophylactically gamma globulin against VZV in the first 72–96h after contact.<a class="elsevierStyleCrossRef" href="#bib0075">7</a>IgG serology to VZV should also be carried out in women with a fertility desire whose medical history of varicella is unknown, and receive the vaccine if negative. Special emphasis will have to be placed on women whose work activity poses a high risk of infection, although a high rate of immunity to VZV has been recently described in this group.<a class="elsevierStyleCrossRef" href="#bib0080">8</a> The varicella vaccine should never be administered during pregnancy." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: de la Calle M, Omeñaca F, Bartha JL. Varicela en la gestación. Med Clin (Barc). 2016;146:40–41." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PCR, polymerase chain reaction; VZV, varicella zoster virus." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Weeks of gestation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maternal clinical data \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Amniocentesis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obstetric results \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skin involvement in more than two thirds of the body. Mucosal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir 800mg/5 times a day/7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Premature rupture of membranes in week 15 with foetal loss \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skin involvement in more than two thirds of the body. Mucosal involvement. Dyspnoea without respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir 800mg/5 times a day/7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (week 19), PCR+ for VZV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Delivery week 39+5. Asymptomatic new-born \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skin involvement in a third of the body. Mucosal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hygiene measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Elective termination of pregnancy in week 9+4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skin involvement in a third of the body. Mucosal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hygiene measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (week 19+4), PCR- for VZV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Delivery in week 40+2. Asymptomatic new-born \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skin involvement in a third of the body. Mucosal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hygiene measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Delivery in week 38+3. Asymptomatic new-born \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skin involvement in more than two thirds of the body. Mucosal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir 800mg/5 times a day/7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (week 20), PCR- for VZV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Delivery week 37+6. Asymptomatic new-born \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1053355.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chickenpox during pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Mirlesse" 1 => "P. Lebon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Pediatr" "fecha" => "2003" "volumen" => "10" "paginaInicial" => "1113" "paginaFinal" => "1118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14643554" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Varicella infection in pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.E. McCarter-Spaulding" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Obstet Gynecol Neonatol Nurs" "fecha" => "2001" "volumen" => "30" "paginaInicial" => "667" "paginaFinal" => "673" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors and outcome of varicella-zoster virus pneumonia in pregnant women" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.H. Harger" 1 => "J.M. Ernest" 2 => "G.R. Thurnau" 3 => "A. Moawad" 4 => "V. Momirova" 5 => "M.B. Landon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/338832" "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "2002" "volumen" => "185" "paginaInicial" => "422" "paginaFinal" => "427" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11865393" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prenatal sonographic diagnosis of congenital varicella syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Tongsong" 1 => "K. Srisupundit" 2 => "K. Traisrisilp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jcu.21891" "Revista" => array:6 [ "tituloSerie" => "J Clin Ultrasound" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "176" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22323269" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Varicella in the fetus and newborn" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.K. Smith" 1 => "A.M. Arvin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.siny.2008.11.008" "Revista" => array:6 [ "tituloSerie" => "Semin Fetal Neonatal Med" "fecha" => "2009" "volumen" => "14" "paginaInicial" => "209" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19097954" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital varicella syndrome: still a problem?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Auriti" 1 => "F. Piersigilli" 2 => "M.R. de Gasperis" 3 => "G. Seganti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000220602" "Revista" => array:6 [ "tituloSerie" => "Fetal Diagn Ther" "fecha" => "2009" "volumen" => "25" "paginaInicial" => "224" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19478488" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of varicella infection (chicken pox) in pregnancy" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Maternal Fetal Medicine Committee" "etal" => false "autores" => array:4 [ 0 => "A. Shrim" 1 => "G. Koren" 2 => "M.H. Yudin" 3 => "D. Farine" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Obstet Gynaecol Can" "fecha" => "2012" "volumen" => "34" "paginaInicial" => "287" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22385673" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Susceptibilidad a la varicela en personal sanitario. Aceptación y respuesta a la vacunación" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.L. García-Basteiro" 1 => "J.M. Bayas" 2 => "M. Campins" 3 => "M. Torres" 4 => "C. Serra" 5 => "P. Varela" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2011" "volumen" => "137" "paginaInicial" => "340" "paginaFinal" => "345" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014600000001/v3_201605230108/S2387020616300614/v3_201605230108/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014600000001/v3_201605230108/S2387020616300614/v3_201605230108/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616300614?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

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Vol. 146. Issue 1.

Pages 40-41 (January 2016)

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