The prevalence of congenital varicella syndrome after a maternal infection, but before 20 weeks of pregnancy: a prospective cohort study

Sánchez, María Ángeles; Bello-Muñoz, J.; Cebrecos, Isaac; Sanz, T. Higueras; Martínez, Juan; Carreras, Elena; Cabero, L.

doi:10.3109/14767058.2010.497567

Cited by 29 publications

(11 citation statements)

References 20 publications

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“…In this review, the incidence of FVS was 0.55% in the first trimester, 1.4% in the midtrimester, and 0 in the third trimester. In another cohort study only 1 case of FVS was documented in 276 exposed pregnancies (0.4%), but details were lacking concerning gestational age and follow‐up. The period at highest risk of FVS is between 8 and 20 weeks.…”

Section: Fetal Varicella Syndromementioning

confidence: 99%

“…Amniocentesis is clearly indicated in case of structural, growth or amniotic fluid anomalies following maternal varicella, to establish the diagnosis. The anomalies that can be seen are nonspecific, and even a pattern of birth defects highly suggestive of FVS can be due to other causes, including herpes simplex or genetic causes such as MIDAS (microphthalmia, dermal aplasia, sclerocornea) or MLS (microphthalmia with linear skin defects) syndrome, while the presence of malformations in a fetus following maternal varicella can be coincidental …”

Section: Prenatal Diagnosis Of Fetal Varicellamentioning

confidence: 99%

“…Many of the severe manifestations of FVS are accessible to prenatal ultrasound diagnosis. However, only a few case reports and small series have been published, as summarized (Table 2), 1,6,10,37,[39][40][41]46,47,[53][54][55]57,[63][64][65][66][67][68][69][70][71] such as limb atrophy, microcephaly, cataract, microphthalmia, cerebellar dysplasia. Nonspecific findings, such as intrauterine growth retardation, polyhydramnios, oligohydramnios, hydrops and/or calcifications in the abdominal cavity may be due to VZV fetopathy, and various other « TORCH » infections.…”

Section: Ultrasound Findingsmentioning

confidence: 99%

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Fetal varicella – diagnosis, management, and outcome

Mandelbrot

2012

Prenatal Diagnosis

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Fetal varicella syndrome (FVS) is due to transplacental infection by the Varicella zoster virus following maternal infection. The risks for the fetus and neonate depend on the timing. When varicella occurs around delivery, it often leads to disseminated neonatal varicella. When varicella occurs during pregnancy, transmission can occur, but is usually asymptomatic; some infants develop zoster postnatally and a few have FVS. Before 20 weeks' gestation, FVS can occur, with an incidence of about 1%. The lesions can affect the skin, limbs, central and autonomous nervous systems, eyes, cause calcifications, and growth retardation; mortality is high. Lesions typically follow one or several nerve territories, suggesting that damage results from in utero zoster following primary fetal infection. There has been little study of prenatal diagnosis of FVS. Serial ultrasound examination can detect various anomalies, magnetic resonance imaging can be of use to investigate for microphthamia and cerebral lesions, and amniocentesis can diagnose viral transmission. Prevention strategies include vaccination and post-exposure prophylaxis with immune globulin and/or antivirals. Perspectives for treating infected fetuses in utero require further research.

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Section: Fetal Varicella Syndromementioning

confidence: 99%

Section: Prenatal Diagnosis Of Fetal Varicellamentioning

confidence: 99%

Section: Ultrasound Findingsmentioning

confidence: 99%

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Fetal varicella – diagnosis, management, and outcome

Mandelbrot

2012

Prenatal Diagnosis

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“…The risk of CVS with maternal chickenpox occurring during gestational weeks 2 to 12 is 0.4% to 0.6%; weeks 13 to 28 is 1.4% to 2.0%; and the risk beyond 28 weeks is essentially 0. [5][6][7] The period of highest risk seems to be during gestational weeks 13 to 20. When maternal varicella occurs during the third trimester, fetal infection can occur despite passively acquired maternal antibody, but the outcome is usually good with no associated birth defects.…”

Section: Congenital and Neonatal Varicellamentioning

confidence: 99%

Varicella-Zoster Virus

Gnann

2012

Clinical Obstetrics &Amp; Gynecology

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Widespread use of varicella vaccine in the United States has drastically changed the epidemiology of the disease. Although chickenpox is no longer a ubiquitous childhood infection, varicella-zoster virus continues to circulate in the community and nonimmune pregnant women remain at risk. Varicella can cause severe infection in pregnant women, often complicated by viral pneumonia. Maternal varicella occurring in the first half of pregnancy can cause the rare but devastating congenital varicella syndrome, whereas infection in the late stages of pregnancy may cause neonatal varicella. The best approach to avoiding the morbidity and mortality associated with chickenpox in pregnancy is to screen and vaccinate susceptible reproductive-age women.

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“…Some authors recommend following-up mothers who have contracted varicella during pregnancy by means of ultrasonography, and then searching for viral DNA in the case of malformations [19,159] , insisting on always searching for VZV DNA because other micro-organisms such as Coxsackie B and HSV can cause congenital lesions similar to those of CVS [502][503][504] . There is a report of a case of fetal malformations due to HSV2 and not VZV in a mother who contracted varicella during pregnancy [502] , and conditions such as microphthalmia dermal aplasia scleroderma (MIDAS) or microphthalmia with linear skin defects (MLS) may also lead to malformations, with maternal varicella being just a coincidence [505,506] . There are few and unconvincing data concerning chorionic villi as the PCR-detected presence of viral DNA is not necessarily associated with an infected fetus, but may due to false positivity caused by maternal contamination or a placental infection not transmitted to the fetus [169,506,507] .…”

Section: Prenatal Infection and The Diagnosis Of Cvsmentioning

confidence: 99%

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Paschale

Clerici

2016

WJV

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Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn. Core tip: Although varicella during pregnancy is infrequent and congenital varicella syndrome (CVS) is rare, every available means should be used to prevent and diagnose them. Microbiology laboratories can be crucial in these situations: Evaluating a mother's immune status with sensitive and specific tests for the detection of antibodies; allowing a rapid diagnosis with molecular biology tests when a clinical manifestation may be due to different etiologies; following pregnant women with varicella for the prenatal diagnosis of CVS with close collaboration between molecular biology investigators and specialists in imaging diagnostics.De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World

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The prevalence of congenital varicella syndrome after a maternal infection, but before 20 weeks of pregnancy: a prospective cohort study

Abstract: The fetal infection rate in this cohort was 0.8%, but the best expected prevalence of CVS, according to our findings, should be 0.39% among infected women. This data should be considered and used during parental counselling.

Cited by 29 publications

References 20 publications

Fetal varicella – diagnosis, management, and outcome

Fetal varicella – diagnosis, management, and outcome

Varicella-Zoster Virus

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

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