Pons J C, Vial P, Rozenberg F, Daffos F, Lebon P, Imbert M C, Strub N, Frydman R
Service de Gynécologie-Obstétrique 1, Hôpital Cochin-Port-Royal, Paris.
J Gynecol Obstet Biol Reprod (Paris). 1995;24(8):829-38.
The first case of prenatal diagnosis of congenital varicella by amniotic fluid viral culture and PCR is reported. Chickenpox is a benign disease in children, but it can lead to severe complications in the adult, especially in the pregnant woman. Five percent of women in childbearing age are not immunised, and the incidence of gestational chickenpox is between 1 and 7 per 10,000. The consequences of this primary infection during pregnancy can be severe for the mother, because of the risk of serious varicella pneumonia, and for the fetus. The fetal infection depends on the gestational age at which the maternal infection occurs. The 2% evaluated risk of fetopathy is maximal between the 7th and 20th week of amenorrhoea. The reported congenital abnormalities are essentially cutaneous, neurological, ophthalmological and musculo-squeletal lesions. A prenatal diagnosis can be suggested: the revelation of defects by ultrasound scan confirms the fetal affection, and can justify pregnancy termination; on the other hand, amniocentesis and cordocentesis are not totally safe, and cannot always assert the fetal contamination or its level of affection. From the therapeutical point of view, prevention with polyvalent gamma-globulin is prescribed to non-immunised pregnant women who have been in contact with the virus. On the opposite, in case of contracted chickenpox, the treatment of the mother with an association of polyvalent gamma-globulin and acyclovir is still controversial since, although probably effective, it may not be safe for the fetus. The solution may reside in the vaccination, soon available, of non-immunised women in childbearing age.
本文报告了首例通过羊水病毒培养和聚合酶链反应（PCR）对先天性水痘进行产前诊断的病例。水痘在儿童中是一种良性疾病，但在成人中，尤其是孕妇中，可能会导致严重并发症。5%的育龄妇女未接种疫苗，妊娠期水痘的发病率为每10000人中有1至7例。孕期初次感染对母亲和胎儿都可能产生严重后果。母亲方面，有发生严重水痘肺炎的风险；胎儿方面，胎儿感染取决于母亲感染时的孕周。评估显示，在闭经第7至20周时，胎儿病变风险最高，为2%。报告的先天性异常主要为皮肤、神经、眼科和肌肉骨骼病变。可进行产前诊断：超声检查发现缺陷可确诊胎儿患病，并可作为终止妊娠的依据；另一方面，羊膜穿刺术和脐带穿刺术并非完全安全，且不能总是确定胎儿是否受到感染或感染程度。从治疗角度来看，对于未接种疫苗且接触过病毒的孕妇，建议使用多价γ球蛋白进行预防。相反，对于已感染水痘的孕妇，使用多价γ球蛋白和阿昔洛韦联合治疗仍存在争议，因为尽管可能有效，但对胎儿可能不安全。解决办法可能在于为未接种疫苗的育龄妇女尽快提供疫苗接种。
