Chickenpox Exposure in Pregnancy

Casebank History
1

Where you are:
You are an FY2 in GP surgery

Who your patient is:
Emily Pearson, aged 30, has made an appointment to see you.

Other information you have about the patient:
None

What you must do:
Talk to the patient and address the concerns

Patient information

  • You are 37 weeks pregnancy
  • You have got a 3 year old boy called Joshua who was diagnosed with chicken pox yesterday.
  • Child had had fever and generally feeling unwell and yesterday your husband took him to the GP who diagnosed with chicken pox.
  • Your 3-year old boy is doing quiet ok.
  • You are worried that your baby may catch chicken pox.
  • You are generally fit and well.
  • You have not had any problems in this pregnancy
  • You had chicken pox yourself as a child.
  • Your 3-year old boy is up to date with all immunisations.

Questions:

  • Is it going to affect my baby?
  • Can I touch my Josh ?

Emotions: Worried

Approach

GRIPS

  • How can I help?

History of Chicken Pox in the son

  • What symptoms does he have?
  • Did he go to see the doctor?
  • And was the diagnosis of chickenpox made by the GP here?
  • When did he start feeling unwell?
  • Does he have a rash?
  • How is he doing now?

History of exposure

  • Does he live with you at home?
  • Has he been with you for the last 7 days?

Symptoms of chickenpox in a patient

  • Are you running any temperature?
  • Do you have any rash on your body?
  • Any headaches?
  • Any nausea or vomiting?

History of chickenpox in a mother

  • Have you ever had chickenpox before?

History of pregnancy

  • How many weeks is your pregnancy?
  • Have you had any problems so far in this pregnancy?
  • Are you feeling the kicks of the baby?

Ask about General Health

  • Any past medical problems?

Management

  • Explain that since she has chickenpox in childhood, she is unlikely to suffer from chickenpox again
  • Reassure that the chickenpox is unlikely to affect her pregnancy
  • She can play and touch her 3 year old boy without problems
  • Even if the baby was to be affected, the baby would be born with chickenpox and then need treatment.
  • The baby would not have any abnormalities because the pregnancy is more than 36 weeks of gestation.

Safety netting: Advice her to come back if:

  • Any fever
  • Any rash
  • Or if she becomes unwell

Offer a leaflet

  • Offer a leaflet about chickenpox in pregnancy

Note: If the woman has no history of chickenpox or shingles and has significant contact

  • Establish the stage of gestation
  • Test for varicella-zoster immunoglobulin G antibodies
  • Test results should be available within 2 days
  • If varicella-zoster immunoglobulin G is negative – seek expert opinion (obstretic specialist) patient might need immunoglobulin prophylaxis
  • If the varicella-zoster immunoglobulin is positive, reassure the woman that she is immune and cannot catch chicken pox
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3

History:

  • You are FY2 in GP
  • A 34 year old lady has come to you with some concerns
  • Her 3 year old boy was diagnosed with chicken pox yesterday , her husband took him to the GP with history of fever and rash
  • Her baby is doing well now
  • She is worried about her unborn child , she is 36 weeks pregnant
  • She is generally fit and well , pregnancy going uneventful so far
  • Has taken all antenatal heck ups
  • She is immunized in childhood
  • She had chicken pox in childhood; also her son is up to date with vaccine

Task: Talk to her and address her concerns
Concern: Will my unborn baby get chicken pox?
Examination: Take observation , head to toe, Examination of tummy (verbalize , fetal heart sound)
Management: Greet and confirm identity, Take focused history

History of son’s chicken pox

  • what symptoms does he have?
  • When did he start feeling unwell? Any rash? Any fever?
  • Did he go to see a Dr?
  • is he taking any Meds?
  • How is he doing now?
  • Have you been in contact with him since he was diagnosed?

History of exposure:

  • Is he living with you?
  • Has he been with you for the last 7days?
  • Have you been in contact with him?

History of chickenpox in the mom:

  • do you have any symptoms?
  • Any fever? Any rash? Any headache?
  • Did you vomit?

History of exposure in the mom:

  • Did you have chickenpox as a child?
  • Did you have vaccination for chickenpox?
  • Ask about her pregnancy, hows pregnancy going so far
  • Red flags (HTN , GDM , pre eclampsia etc)
  • DESA
  • MAFTOSA
  • Verbalize examination and summarize

Assure her:

  1. she doesn’t need to worry as she had chicken pox as a child, she is unlikely to suffer from chicken pox again
  2. This is a one-time infection and is unlikely to affect your pregnancy. If the baby was to be affected by chickenpox.
  3. The baby would be born with chickenpox and he will need treatment but the baby will not any abnormalities because your pregnancy is 36weks. chickenpox will not have any effect on the baby as all organs are formed, so risk of abnormalities is low.
  • Investigation: Test for immunoglobulin G ab
  • Advice: pregnancy related advice , food and hygiene
  • Safety netting: rash. fever