HSV in pregnancy

Question 1

What is HSV in pregnancy (Aetiology, RF)

Answer 1

DNA virus- herpes
two types - 1 (oral>genital) and 2 (genital>oral)
spread to neonate through direct contact with maternal secretions (risk 41% with primary, 2% with reccurent)

transmitted via sexual/physical contact,
RF- unprotected sex, immunosupress, other STI
2% of preg women

Question 2

Sx of HSV in pregnancy (mother and child)

Answer 2

Matenral - asymptomatic, oral/genital herpes,
disseminated herpes (encephelitis, heapatitis, disseminated skin lesion

Child - can be Skin eye mouth (SEM), CNS +SEM, or disseminated
SEM- skin eye and mouth-45%
Blistering vesicular rashh, chorioretinitis

CNS+SEM -30%, nortality 6%, present 10d-4w post partum
Seizures, irritable, temperature
lethargy, poor feeding, bulging fontanelle
+ SEM sx

Disseminated - 25%, 30% mortality
Encephelitis (70%), CNS (60%), hepatitis, pneunomitis, DOC
no skin lesion

Question 3

Ix and Mx of HSV in pregnancy

Answer 3

Ix - cliical diagnosis +STI screen. PCR virus

Acute infection- aciclovir TDS
maternal -<26w- 26w to delivery
if >26w - oral aciclo until delivery
neonate- IV acuclovir, 14d if SEM, 21d other

Question 4

Delivery with HSV in pregnancy

Answer 4

Primary infection –
1st episode >6w before EDD - SVD
1st <6w- C section and HSV testing

if chose vaginal delivery - avoid rupture of membrane
IV aciclovir to mum and neonate
avoid invasive procedures (forceps)

If reccurent- SVD as 2% risk, protected with mum Ig
daily aciclovir fro 36w GA
avoid invasive procedures