How to manage chickenpox during pregnancy: case reports

Chickenpox is a human infection that occurs mainly during childhood. Infection during pregnancy is therefore rare but may cause a congenital infection with malformation in less than 1% of cases. A specific management should be proposed at diagnosis in order to reduce materno-fetal transmission and morbimortality. Three cases were herein presented focusing on the main at-risk situations for pregnant women, whom immunological status against varicella was unknown. The first case focused on a varicella eruption during early pregnancy that leads to a lethal outcome. The second one described the management of varicella contact during early pregnancy. This woman was treated by specific immunoglobulins, leading to a positive outcome. The third case focused on another varicella contact, at the end of pregnancy. The woman was treated by acyclovir, before and after delivery, to limit materno-fetal consequences. In conclusion, after a suspicious contact, a serology assay has to be performed to know the immune status of the pregnant woman against varicella. In case of seronegativity, prevention against varicella infection should be carried out using specific immunoglobulins or valacyclovir. Clinical varicella does not require virology confirmation but requires immediate treatment with valacyclovir especially when it occurs during the first trimester.