Ans. is 'C' i.e., Ophthalmic examination Clinical situation Maternal intervention Fetal surveillance Intervention for newborn Susceptible mother with close exposure at any point in pregnancy o Confirm susceptible status : VZV serology o If susceptible, consider administration of VZ IG or immune globulin (IVIG) within 96 hours of exposure No intervention necessary if mother not susceptible or mother does not develop clinical syndrome No intervention necessary if mother not susceptible or mother does not develop clinical syndrome Uncomplicated maternal chickenpox in the first 20 weeks of pregnancy o Symptom control for fever, pruritis and volume depletion o Consider oral acyclovir for 7 days to reduce the duration of rash and number of lesions o Contact (gloves, gowns) and air - borne precautions if in hospital o Discussion on risk of congenital varicella syndrome (CVS) and continuation of pregnancy is warranted o Level II ultrasound at 18 - 20 weeks and / or 5 weeks after onset of maternal rash, plus o Sequential ultrasound over the course of pregnancy to detect features of in utero recurrent fetal infection o Consider fetal MRI for CNS abnormalities not seen on ultrasound Ophthalmic examination at birth Uncomplicated maternal chickenpox anytime between 20 weeks of gestation to 5 days prior to delivery o Symptom control for fever, pruritis and volume depletion o Consider oral acyclovir to reduce duration of rash and number of lesions o Contact (gloves, gowns) and air - borne precautions if in hospital o Not an indication for termination of pregnancy as risk of CVS is extremely low o Level 11 ultrasound at 18-20 weeks of gestation and / or 5 weeks after onset of maternal rash Ophthalmic examination at birth. Uncomplicated maternal chickenpox 5 days before delivcery of 2 days post partum As above Not special monitoring required o VZ IG at birth as soon as maternal rash is recognized o IV acyclovir if severe illness o Contact (gloves, gowns) and air - borne precautions in the nursery Complicated maternal chicken pox (pneumonia, CNS disease) or disseminated zoster o Admit to hospital : respiratory support may be required o IV acyclovir o Consider IV antibiotics for pneumonia superinfection o Contact and air - borne precautions As above for relevant gestational age As above for relevant gestational age Maternal zoster in late pregnancy o Confirm diagnosis if lumbosacral area with PCR or DFA o Consider use of acyclovir with 72 hours of rash appearing No special monitoring required Contact (gloves, gowns) and air - borne precautions in the nursery if zoster confirmed. o Exposure to chickenpox is defined as household contact, face-to-face contact with an index case for at least 5 minutes, being indoors with an index case for more than 1 hour.