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ULTRASOUND APPEARANCE
OF VARICELLA EMBRYOPATHY
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Sequelae are dependent on fetal age at the time of infection.
· In
most cases (up to 97%), the fetus remains healthy without showing any clinical
or serologic evidence of illness.
· If
intrauterine infection does occur, it may result in congenital varicella
syndrome, neonatal varicella, or asymptomatic seroconversion.
Varicella embryopathy consists of a spectrum of abnormalities ranging from
disseminated infection involving all organ systems to less severe disease with
only skin and ocular involvement (1). This usually occurs when varicella
infection occurs <20 weeks GA. Mean rate of embyopathy when infection <20
weeks = 2.2% (95% CI 0%-4.6%) (2).
- Polyhydramnios (occurs in the
majority of cases and may rarely be the only sonographic abnormality) (3).
- Hyperechoic foci within the
liver (3), corresponding to areas of dystrophic calcification.
- Fetal hydrops (thought to be
due to myocardial involvement or myocardial stress due to uremia) (3).
- Limbs (club feet, limb
atrophy and shortening) (3,4).
- Craniofacial abnormalities
include, ocular abnormalities, microphthalmia, optic atrophy and
cerebellar dysplasia (3,5).
- Hydrocephalus has been
reported (6).
The interval between primary infection and ultrasonographically
detectable signs may be at least five weeks (3,4).
- Hanshaw JB. Varicella-zoster
infections. In: Viral diseases of the fetus and newborn. 2nd ed.
Philadelphia: WB Saunders 1985:161.
- Pastuszak AL, Levy M, Schick
B et.al. Outcome after maternal varicella infection in the first 20 weeks
of pregnancy. N Engl J Med 1994300:901-905.
- Pretorius DH, Hayward I,
Jones KL et.al. Sonographic evaluation of pregnancies with maternal
varicella infection. J ULtrasound Med 1992;11:459-463.
- Scharf A, Scherr O, Enders G
et.al. Virus detection in fetal tissue of a premature delivery with
congenital varicella syndrome: A case report. J Perinat Med 1990;18:317.
- Groce C, Itani O.
Pathogenesis of congenital infection with three diverse viruses:
Varicella-zoster, human parovavirus and human immunodeficiency virus.
Semin Perinatol 1989;13:287.
- Mazzella M, Arioni C, Bellini
C et.al. Sever hydrocephalus associated with congenital varicella
syndrome. Can Med Assoc J 2003;168(5):561-563.