Herpes in preg

Question 1

Mx of herpes in preg

Answer 1

1st and 2nd T-
No increased risk of miscarriage
Refer to GUM
400mg Aciclovir TDS for 5 days then from 36 weeks to delivery

3rd T (>28w)
Continue aciclovir till delivery
Inc risk of perinatal morbidity
Delivery by CS- if primary inf (check IgG)

If 2nd inf- Low risk of neonatal herpes (0-3%)- can have sVD

If HIV +- Treat from 32 weeks

Question 2

Preterm mx

Answer 2

If PPROM-
Primary inf- CS delivery or treat w IV aciclovir
Recurrent inf- Start oral aciclovir, no need for urgent delivery

Question 3

Complications for mum

Answer 3

Encephalitis
Hepatitis
Disseminated skin lesions

Question 4

Risk to baby

Answer 4

Higher if primary infection in preg.
Worst in 3rd T, within 6 weeks of delivery, 41% risk of transmission

70% infants w herpes have disseminated or CNS inf.
60% have NO skin, eye or mouth lesions.

Question 5

Mx of baby (if primary infection in mum)

Answer 5

CS- no swabs/ rx needed, Normal PN mx.

SVD- Swab skin, conjunctiva, oropharynx and rectum.
LP not needed, unless unwell.
Rx w aciclovir IV.
Can be breastfed.

Question 6

Mx of baby (2nd inf)

Answer 6

No swabs needed
No treatment- unless unwell or concerns.
Routine PN care