Delivery Management in Maternal Varicella Peripartum Infection with Vulvar Lesions: A Case Report

1.1. Introduction: Maternal varicella near term carries the risk of neonatal varicella. Transmission is usually transplacental, cases of maternal genital lesions near delivery have never been described. 1.2. Case Presentation: Our patient presented at 36th week with primary varicella with vulvar vesicles. The day following the rash development she ruptured membranes. We decided for an urgent cesarean section and the newborn was not infected and did not present complications due to prematurity. VZV specific immunoglobulins were administered to the newborn after collection of cord blood. Molecular virology studies confirmed VZV presence in vulvar vesicles and that the newborn was uninfected, with negative PCR on cord blood, throat swab and urine. The virus was found in amnio-chorial membranes. At 28 days of life the infant developed uncomplicated varicella after exposure to her older brother who was infected. 1.3. Discussion: In absence of specific guideline on this scenario and in absence of similar cases in literature, we suggest a cesarean section should be performed in case of maternal varicella with genital lesions. In case of rupture of membranes performing it as soon as possible might be recommendable to avoid ascending transmission. Rapid confirmation of VZV in vulvar lesions is valuable.