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Re: Chicken Pox exposure 1st trimesterFrom: Ira Mark Bernstein (ibernste@moose.uvm.edu)Fri Oct 25 08:33:05 1996
My comments folow the individual scenarios
>Patient 7w pregnant, non-VZ immune is exposed to daughter with chicken See answer below and I would suggest that the therapy with VZIG is likely to reduce the risk of vertical transmission. I have not seen any data on this point however.
>Second scenario: Say now she doesn't consult Doc when rash breaks out, This one is a little easier. Risk of congenital infection is probably around 2% (combined ref 1 and 2) for the first trimester in the absence of VZIG therapy. Of those children affected with congenital VZ infection there is a high incidence of neurologic injury (75%) (ref 3) and many other potential problems. In reference #2 36 women with first trimester exposure had ultrasound exams at 18-20 weeks to examine for VZ effects. Only one anomaly was seen, an abdominal wall defect in a fetus who was not VZ infected. Of the remaining 35 none had evidence of congenital VZ. Many of the important neurologic findings of congenital VZ infection could well be missed by ultrasound. I would say that the ultrasound is of uncertain value, but probably reduces the risk of congenital VZ slightly. 1. Paryani et al NEJM 1986:314:1542-6. 2. Balducci et al Obstet Gynecol 1992;79:5-6. 3. Enders et al The Lancet 1994;343:1547-50. IRA
-- Ira M. Bernstein M.D. Department of OB\GYN University of Vermont (802) 656-5111 (ph) ibernste@moose.uvm.edu
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