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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Varicella in Pregnancy
7. Varicella pneumonia
Varicella pneumonia is seen in up to 20 percent of adult chickenpox cases.
Retrospective studies suggest that varicella pneumonia may be more severe,
although not more frequent, in pregnant compared to nonpregnant women. A
case-control study of 18 pregnant women with varicella pneumonia and 72
pregnant controls with varicella but no pneumonia found that smoking and the
occurrence of 100 skin lesions were risk factors for the development of
pneumonia.
The predominant signs and symptoms of varicella pneumonia in pregnancy are
cough, dyspnea, fever and tachypnea. The pneumonia usually develops within
one week of the rash. The clinical course is unpredictable and may rapidly
progress to hypoxia and respiratory failure. The chest x-ray findings include a
diffuse or miliary/nodular infiltrative pattern often in the peribronchial distribution
involving both lungs.
Varicella pneumonia in pregnancy is a medical emergency. The mortality rate in
untreated pregnant women is in excess of 40 percent. Prompt supportive care
and acyclovir are the mainstays of therapy. In one retrospective review of 21
cases of varicella pneumonia in pregnant women treated with acyclovir, the
mortality rate was 14 percent, a value lower than expected in untreated women.
In the case-control study cited above, all 18 patients were treated with acyclovir
and all survived. (Harger) Twelve patients required intubation and mechanical
ventilation.
The dose of acyclovir with pneumonia in pregnancy that is recommended during
the 3rd trimester pregnancy (when respiratory symptoms develop within 10 days
of exposure) is 800mg po 5 times daily or 10mg/kg IV Q8h x 5 days.
Extracorporeal membrane oxygenation (ECMO) may be beneficial in pregnant
women with varicella pneumonia and severe hypoxia, but its efficacy in this and
other settings remains unproven.
