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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Varicella in Pregnancy
13. ACOG Resources
What is the latest A.C.O.G. statement on this?
Perinatal Viral and Parasitic Infections. ACOG Practice Bulletin No. 20.
September 2000 American College of Obstetricians and Gynecologists.
Int J Gynaecol Obstet. 2002 Jan;76(1):95-107
Summary
The following recommendations are based on limited and inconsistent
scientific data (Level B):
- Pregnant women who are seronegative for VZV and exposed to
chickenpox should receive VZIG. - Pregnant women who develop chickenpox should be treated with oral
acyclovir to minimize maternal symptoms; if pneumonia develops, they
should be treated with intravenous acyclovir. - Pregnant women who have acute parvovirus B19 infection during
pregnancy should be monitored with serial ultrasound examinations for at
least 10 weeks following infection for the presence of hydrops fetalis. - Fetuses with evidence of hydrops should undergo fetal blood sampling
and transfusion as needed. - Pregnant women who acquire toxoplasmosis should be treated with
spiramycin. When diagnosed, fetal toxoplasmosis should be treated with a
combination of pyrimethamine, sulfadiazine, and folinic acid, alternating
with spiramycin.
The following recommendations are based primarily on consensus and
expert opinion (Level C):
- Routine serologic screening of all pregnant women for CMV and
toxoplasmosis is not recommended. - Nonpregnant women of reproductive age who have no history of varicella
infection should be offered varicella vaccine. - The diagnosis of toxoplasmosis should be confirmed by a reliable
reference laboratory. - Pregnant women exposed to parvovirus B19 should have serologic
screening performed to determine if they are at risk for seroconversion. - Pregnant women should be counseled about methods to prevent
acquisition of CMV or toxoplasmosis during pregnancy.
Perinatal Viral and Parasitic Infections. ACOG Practice Bulletin No. 20.
American College of Obstetricians and Gynecologists
Int J Gynaecol Obstet. 2002 Jan;76(1):95-107
* ACOG Evidence grading system
The MEDLINE database, the Cochrane Library, and ACOG's own internal
resources and documents were used to conduct a literature search to locate
relevant articles published between January 1985 and October 2000. The search
was restricted to articles published in the English language. Priority was given to
articles reporting results of original research, although review articles and
commentaries also were consulted. Abstracts of research presented at symposia
and scientific conferences were not considered adequate for inclusion in this
document.
Guidelines published by organizations or institutions such as the National
Institutes of Health and the American College of Obstetricians and Gynecologists
were reviewed, and additional studies were located by reviewing bibliographies
of identified articles. When reliable research was not available, expert opinions
from obstetrician–gynecologists were used. Studies were reviewed and
evaluated for quality according to the method outlined by the U.S. Preventive
Services Task Force:
- I Evidence: obtained from at least one properly designed randomized
controlled trial. - II -1 Evidence obtained from well-designed controlled trials without
randomization. - II -2 Evidence obtained from well-designed cohort or case–control analytic
studies, preferably from more than one center or research group. - I I-3 Evidence obtained from multiple time series with or without the
intervention. Dramatic results in uncontrolled experiments also could be
regarded as this type of evidence. - III Opinions of respected authorities, based on clinical experience,
descriptive studies, or reports of expert committees.
Based on the highest level of evidence found in the data, recommendations are
provided and graded according to the following categories:
- Level A—Recommendations are based on good and consistent scientific
evidence. - Level B—Recommendations are based on limited or inconsistent scientific
evidence. - Level C—Recommendations are based primarily on consensus and expert
opinion.
