Auriti Cinzia, Piersigilli Fiammetta, De Gasperis Marco Rossi, Seganti Giulio
Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Fetal Diagn Ther. 2009;25(2):224-9. doi: 10.1159/000220602. Epub 2009 May 27.
A woman contracted chickenpox in the 12th week of gestation. Her general practitioner and later the consultant obstetrician warned her about the small risk of giving birth to a disabled child. She decided to continue the pregnancy without undergoing invasive tests to diagnose fetal intrauterine infection. Symptoms of congenital varicella syndrome (CVS) were detected by ultrasound in the 29th and 34th weeks of gestation. On admission to hospital, the baby was not considered infectious and was not isolated because polymerase chain reaction analysis to detect varicella zoster virus (VZV) DNA in the blood, cerebrospinal fluid, saliva, skin scrapings and feces gave negative results. He was also not separated from his mother. The mother was without clinical complications. Varicella during pregnancy may result in VZV transmission to the fetus or newborn. Intrauterine VZV infection in the first 28 weeks of gestation may result in CVS with limb deformities, brain abnormalities and mental retardation. Usually the newborn is not infectious, and therapy and isolation are unnecessary. When the mother catches the infection in the second trimester, the newborn may manifest shingles in the first 2 years of life. A maternal rash erupting 5 days before to 2 days after delivery is frequently associated with clinically severe varicella in the newborn, leading to high mortality if untreated. Then the newborn is infectious and must be isolated. This case report underlines the need for expert medical counseling for women who contract chickenpox at any time during pregnancy. It also underlines the importance of immunizing susceptible women of childbearing age before they become pregnant.
一名妇女在妊娠第12周感染了水痘。她的全科医生以及后来的产科顾问医生都警告过她，生出残疾儿童的风险很小。她决定继续妊娠，未接受侵入性检查以诊断胎儿宫内感染。在妊娠第29周和第34周时，通过超声检测到先天性水痘综合征（CVS）的症状。入院时，婴儿不被认为具有传染性，也未被隔离，因为对血液、脑脊液、唾液、皮肤刮屑和粪便进行的聚合酶链反应分析检测水痘带状疱疹病毒（VZV）DNA的结果均为阴性。他也没有与母亲分开。母亲没有临床并发症。孕期感染水痘可能导致VZV传播给胎儿或新生儿。妊娠前28周的宫内VZV感染可能导致CVS，出现肢体畸形、脑部异常和智力发育迟缓。通常新生儿不具有传染性，无需治疗和隔离。当母亲在妊娠中期感染时，新生儿可能在出生后的头2年出现带状疱疹。分娩前5天至分娩后2天出现的母亲皮疹通常与新生儿临床上严重的水痘有关，如不治疗会导致高死亡率。此时新生儿具有传染性，必须隔离。本病例报告强调了对孕期任何时候感染水痘的妇女进行专业医学咨询的必要性。它还强调了在育龄易感妇女怀孕前进行免疫接种的重要性。
