Although varicella is a common infection in the United States, pregnant women are infrequently infected. Varicella pneumonia is an even rarer though potentially fatal complication during pregnancy. Fulminant respiratory collapse often ensues and is associated with greater than 40% mortality. We successfully treated three patients for varicella pneumonia in pregnancy. Critical points of management include prompt diagnosis of the disease and recognition of the complications, rapid transfer to a facility capable of providing intensive care (including ventilatory support) and early initiation of aggressive antiviral chemotherapy.