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  #1  
Old 05-30-2012
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Question husband has shingles & wife is pregnant !!

A 29-year-old patient, gravida II, para I, is seen at her obstetrician-gynecologist (OB-GYN) clinic for her 6-week prenatal checkup. She has no current complaints and has no history of significant disease. Her previous pregnancy was uneventful. She had a normal vaginal delivery of a healthy girl who has had no serious illness since. She is currently staying with her parents while her husband is away for a business trip. Her father is under treatment for a painful vesicular skin rash that appeared 2 days ago and is clearly limited to a well-defined single dermatomal distribution on his back. Medications are one prenatal vitamin every day. Physical exam and routine screening lab results are within normal limits. What is the most appropriate recommendation for this patient?

A. Administer intravenous acyclovir if seronegative for varicella-zoster virus
B. Administer oral acyclovir regardless of serological status
C. Administer varicella vaccine if seronegative for varicella-zoster virus
D. Administer varicella-zoster immune globulin if seronegative for varicella-zoster virus
E. Administer varicella-zoster immune globulin regardless of serological status
F. Fetal monitoring via serial ultrasound for the next 10 weeks regardless of serological status
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Old 05-30-2012
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Im going with D, since exposure time is <96h though not sure
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id say D i guess..

but im not sure between D and E
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Quote:
Originally Posted by tyagee View Post
A 29-year-old patient, gravida II, para I, is seen at her obstetrician-gynecologist (OB-GYN) clinic for her 6-week prenatal checkup. She has no current complaints and has no history of significant disease. Her previous pregnancy was uneventful. She had a normal vaginal delivery of a healthy girl who has had no serious illness since. She is currently staying with her parents while her husband is away for a business trip. Her father is under treatment for a painful vesicular skin rash that appeared 2 days ago and is clearly limited to a well-defined single dermatomal distribution on his back. Medications are one prenatal vitamin every day. Physical exam and routine screening lab results are within normal limits. What is the most appropriate recommendation for this patient?

A. Administer intravenous acyclovir if seronegative for varicella-zoster virus
B. Administer oral acyclovir regardless of serological status
C. Administer varicella vaccine if seronegative for varicella-zoster virus
D. Administer varicella-zoster immune globulin if seronegative for varicella-zoster virus
E. Administer varicella-zoster immune globulin regardless of serological status
F. Fetal monitoring via serial ultrasound for the next 10 weeks regardless of serological status
D. Administer varicella-zoster immune globulin if seronegative for varicella-zoster virus.

Although the Q bank might say that the exposure is not significant since it is on the back and is a covered lesion.

Quote:
All pregnant women who have significant exposure to VZV infection (defined as "living in the same household as a person with active chickenpox or herpes zoster or face-to-face contact with a person with chickenpox or uncovered zoster for at least 5 minutes"), who have no history of chickenpox and who are seronegative (or serological testing is not readily available), should be offered ZIG.
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Option D (Administer varicella-zoster immune globulin if seronegative for varicella-zoster virus) is correct. One must assume that the patient has been exposed sufficiently and that the occurrence of primary varicella infection as an adult while pregnant is a sufficiently adverse event to warrant some intervention. Passive immune protection based on documented need is the favored algorithm here.

Option A (Administer intravenous acyclovir if seronegative for varicella-zoster virus) is incorrect. Pregnant women who develop chickenpox should be treated with oral Acyclovir to minimize maternal symptoms; if pneumonia develops, they should be treated with IV acyclovir. The patient has no evidence of varicella infection at this time.

Option B (Administer oral acyclovir regardless of serological status) is incorrect. Pregnant women who develop chickenpox should be treated with oral acyclovir to minimize maternal symptoms; if pneumonia develops, they should be treated with intravenous (IV) acyclovir. The patient has no evidence of varicella infection at this time.

Option C (Administer varicella vaccine if seronegative for varicella-zoster virus) is incorrect. Nonpregnant women of reproductive age who have no history of varicella infection should be offered varicella vaccine. In pregnant women the vaccine itself would not help and could induce infection.

Option E (Administer varicella-zoster immune globulin regardless of serological status) is incorrect. One must assume that the patient has been exposed sufficiently and that the occurrence of primary varicella infection as an adult while pregnant is a sufficiently adverse event to warrant some intervention. Passive immune protection based on documented need is the favored algorithm here.

Option F (Fetal monitoring via serial ultrasound for the next 10 weeks regardless of serological status) is incorrect. Pregnant women who have acute Parvovirus B19 infection during pregnancy should be monitored with serial ultrasound examinations for at least 10 weeks following infection for the presence of hydrops fetalis.
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