Most people face the herpes virus for the first time in childhood. This virus is the cause of chicken pox. After the transferred disease the skin becomes smooth again, but the virus continues to persist in the body in the form of a latent infection, which makes itself felt with a decrease in immunity. The gestation period is especially dangerous in this respect. Shingles and pregnancy is a very bad combination and can bring a lot of inconvenience. During pregnancy, the weakened organism of the expectant mother often becomes a victim of the varicella zoster virus. How does shingles during pregnancy affect the health of a future mother and the baby?
Causes of the Virus
Shingles during pregnancy is an exacerbation of a herpetic infection caused by a chickenpox virus, which the woman had previously suffered from. In pregnancy, exacerbation of herpes infection can lead to unpleasant consequences. That’s why a woman should pay attention to her health condition. Even if the slightest signs of exacerbation appear, immediately consult a doctor.
Risk factors for development of shingles:
- excessive heat loss;
- transferred infectious diseases.
Shingles is contagious, but only people who have never contracted chicken pox can get infected. Newborns born to mothers with rashes on the skin are also at risk. Keep in mind that the virus is transmitted by direct physical contact with a sick person. The patient remains infectious during the first few days of illness until dense yellowish crusts appear on the skin.
In all the people who once had chicken pox, the virus remains in the body in an intact state. With a significant decrease in immunity, the virus leaves the cells and begins to multiply actively in the body. The virus of chickenpox affects the nervous system and skin cells. On average, the risk of getting shingles is no more than 10% for each person throughout life.
Herpes zoster affects the nerve tissue, skin and mucous membranes. The clinic of shingles develops in the area of a specific dermatome – the cutaneous area, which is innervated by the affected nerve.
Most often, rashes are localized on the chest, face and head, less often – on the limbs and lower back. The rash is strictly linear. It appears along the nerve, on one side and does not cross the median line of the body.
Thus, the pathological focus cannot cross the border of the chest, abdomen and waist. This peculiarity is taken into account while making a diagnosis.
Clinical Picture of Shingles and Pregnancy
The disease always begins with a pain syndrome. Sometimes pain along the affected nerve can be intolerable. There is soreness because of the friction of clothing and accidental touching the skin.
What’s more, the body temperature rises, nearby lymph nodes increase.
On the third or fifth day from the moment of the onset of pain, skin components of shingles appear: in the area of the skin in the region affected by the virus, there is swelling and hyperemia, which are quickly replaced by a typical herpetic rash. The vesicles are grouped and filled with a clear liquid. The pain decreases. Pouring new elements lasts up to 1.5 weeks.
The rash with shingles in pregnant women is quickly opened, forming erosions and ulcers. Serous detachable substance dries and forms a crust.
Throughout the disease, the pregnant woman has a marked weakness and headache.
Complicated forms of the disease are described by the formation of deep ulcers and suppuration.
Keep in mind that, the disappearance of the rash on the skin does not mean complete recovery. The virus again hides in the cells, calming down until another exacerbation. Many women, after healing of the blisters, have pain along the course of the affected nerves – postherpetic neuralgia. The pain is difficult to treat and can last for a long time.
Shingles lasts on average for 2-4 weeks. Still, there are cases when the disease persisted for several months. During pregnancy, shingles can occur at any time from conception to the childbirth, as well as in the postpartum period.
Dangerous symptoms of shingles and pregnancy:
- pain in the eyes;
- nausea and vomiting;
- severe headache;
- tension of the occipital muscles;
- loss of taste or smell;
- severe muscle weakness;
- loss of consciousness.
The appearance of these symptoms indicates the development of serious complications and requires immediate help of a specialist.
What’s the Danger of Shingles and Pregnancy?
Shingles during pregnancy can lead to a higher probability of neurological complications development:
- neuralgia of the facial and trigeminal nerve;
In more rare cases (if the process is localized on the head), the involvement of the eyes in the process is possible. In such situations, the damage to the cornea and retina develops. As a result it can lead to loss of vision.
The consequences of shingles and pregnancy are mainly determined by the time at which a relapse occurred.
The 1st Trimester
Shingles in pregnant women is most dangerous for the fetus in the first trimester. Thus, at terms of up to 12-14 weeks, a virus that penetrated the fetoplacental barrier causes irreversible consequences in the form of serious malformations and deformities.
If the pregnancy persists and does not end with spontaneous abortion, the baby will suffer from the so-called varicella syndrome. It is characterized by:
- organs dystrophy;
- small-for-date newborn;
- underdevelopment of limbs;
- anomalies in the development of the organ of vision;
- deforming scars on the skin;
- mental retardation.
The 2nd trimester
The fetus, infected with the herpes zoster virus in the second half of pregnancy, tolerates intra-uterine varicella. In the second trimester, the probability of congenital malformations and deformities is significantly reduced, but is not excluded.
Symptoms of fetal disease are determined by ultrasound. There is a violation of fetoplacental blood flow, developmental lag, brain damage and a number of other markers of infection. Also, childbirth may occur too early. What’s more, before the 22nd week a miscarriage may occur.
If the fetus is viable, then congenital chicken pox is diagnosed. Neurological symptomatology (brain pathology), characteristic skin manifestations are noted, and the mucous membrane, liver and lung lesions are also involved. As a result, the child is placed under artificial lung ventilation. Still, mortality levels are quite high in this case.
The 3rd Trimester
When diagnosing a pregnant woman for shingles within a period of more than 36 weeks, an emergency cesarean section is performed to prevent infection of the fetus. If a woman is diagnosed with herpes at 39 weeks of gestation, the doctors induce labor or perform C-section.
The child, infected in the third trimester, suffers from chickenpox in the uterus. Consequences in the form of congenital infection are the same as for infection in the 2nd trimester. They include characteristic lesions of the brain, skin and mucous membranes,as well as, liver and lungs.
After a birth with the transferred intra-uterine infection the clinic of shingles can appear in the child at any terms.
Diagnosis of shingles during pregnancy does not cause any problems on the basis of clinical picture.
Ultrasound examination of the fetus. After 2-4 weeks after the appearance of the herpes zoster, ultrasound can visualize the changes.
Signs of intrauterine infection:
- the appearance of strands, suspensions in the amniotic fluid;
- lag of the fetus from the gestation period;
- hypamnions or polyhydramnios;
- change in the placenta;
- atresia of tubular organs;
- fetal hyperechogenic bowel;
- enlargement of renal pelvis;
- cysts of plexus of vessels;
- pathology of brain structures.
With shingles, at the early stages of pregnancy, doctors often diagnose a missed miscarriage in the absence of a heartbeat at the 7th week and more and also, underdevelopment of coccygeal-parietal size.
Shingles in pregnant women is treated in the hospital. Treatment is carried out in two ways:
- A local one, with the use of antiseptics, stains and antiviral ointments;
- A general one, with the use of antiviral agents, anti-inflammatory and anesthetic blocks.
Practically all antiviral agents are contraindicated for the treatment of herpes zoster during pregnancy. Doctors and women find themselves at a dead end when deciding the issue of shingles treatment during pregnancy.
The greatest harm is causes by the drugs in the first trimester. But since the pathogen carries no less danger to the fetus, the opinion of the doctors becomes unanimous – the pregnancy at the early period against the background of herpes zoster is interrupted, the same is evidenced by the reviews of pregnant women who have had this infection.
In rare cases, such a disease does not leave consequences for the developing embryo. In the second trimester antiviral agents are prescribed with caution, since they are all very toxic to the fetus.
Treatment of shingles in the first trimester, if the woman decided to save pregnancy, is carried out with interferon preparations.
Treatment of shingles in the second and third trimesters includes acyclovir, ganciclovir, valacyclovir and interferon drugs.
It is also difficult to stop the pain syndrome, which, with shingles, is very pronounced. Absolutely all painkillers during pregnancy are contraindicated.
The least harm is expected from taking Paracetamol, so it is prescribed for pain relief. The remaining non-steroidal anti-inflammatory drugs – Ibuprofen, Nimesulide – are contraindicated.
Local treatment includes treatment of rashes at home with hydrogen peroxide, a solution of potassium permanganate, etc.