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Mothers with varicella during the first or second trimester should be carefully monitored since intrauterine infection may lead to CVS. Fetal ultrasound and magnetic resonance imaging at 16 to 22 weeks gestational age or 5 weeks after infection can identify signs of CVS (Figure 3) [55,56]. Laboratory investigations for VZV DNA in placental villi, fetal blood or amniotic fluid and for VZV IgM in fetal blood are only indicated if suspicious fetal abnormalities can be detected [55]. However, several studies have shown that the presence of VZV DNA alone does not necessarily correlate with fetal disease [57]. Thus, the question of how severely the fetus is affected cannot be answered definitely. This and the low risk of CVS should be considered in counseling women with varicella in early pregnancy. Termination of pregnancy is only indicated if there are definitive signs of serious fetal abnormalities.An antiviral treatment has immediately to be intro-duced at first signs of varicella pneumonia or other dis-seminated infections. As the only therapeutic agent, aci-clovir is indicated in pregnant women. Aciclovir has to be administered orally at a dosage of 5 x 800 mg or in-travenously at a concentration of 3 x 10-15 mg/kg for 7-10 days. Zoster during pregnancy should only be treated with aciclovir in severe courses of the disease [58]. To date, there are no controlled studies concerning antiviral chemotherapy in preventing CVS
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