A pregnant lady acquires chickenpox 3 days prior to delivery. She delivers by normal vaginal route which of the following statement is true?
(A) Both mother and baby are safe (B) Give antiviral treatment to mother before delivery (C) Give antiviral treatment to baby (D) Baby will develop neoatal varicella syndrome
(D) Varicella infection in pregnancy:

If varicella infection occurs in a pregnant female during first half of pregnancy (M/C time of transmission-13 to 20 weeks) it results in congenital varicella syndrome in the fetus.
Congenital varicella syndrome in characterized by chorioretinitis, microophthalmia, cerebral cortical atrophy, IUGR, hydronephrosis and skin or bone defects.
Congenital varicella syndrome is an indication for doing MTP.
Congenital defects rarely occurs if varicella infection occurs after 20 weeks.
The terminology varicella embryopathy is not used these days.
Neonatal varicella iin characterized by pneumonitis, hepatitis and DIC.
The severity of neonatal infection is inversely related to the concentration of maternal antibodies present in the newborn circulation. Mother starts producing and transferring antibodies approximately 5 days after the onset of her disease.Thus, babies born 5 days or more from the beginning of maternal disease will be protected.

Fernando Arias 3/e, p 156

Perinatal varicella exposure just before or during delivery poses a serious threat to newborns and so Varicella Ig should be given to all neonates of born to mothers who have clinical evidence of varicella 5 days before and upto 2 days after delivery.
The use of VZIG decreases the chances of neonatal varicella and also modify the clinical course but it does not always prevent severe or fatal varicella. Expectant treatment with close observation, followed by prompt initiation of antiviral therapy on suspicion of neonatal varicella is recommended.
Antiviral treatment (acyclovir) is given to neonates only if they develop neonatal varicella syndrome.
Vaccine is not secreted in breast milk, so postpartum vaccination should not be delayed because of breast feeding.