OGCO-C1.6 Herpes simplex viral infection in pregnancy

Question 1

When is the risk of neonatal herpes highest?

Answer 1

When women acquires genital herpes in the third trimester, particularly within 6 weeks of delivery

Question 2

What is Mx of pregnant women with recurrent genital herpes?
1st or 2nd trimester acquisition of primary genital herpes (until 27+6 weeks of gestation)?
3rd trimester acquisition of primary genital herpes (from 28 weeks of gestation)?

Answer 2

Question 3

What is mode of delivery of 3rd trimester acquisition of primary genital herpes (from 28 weeks of gestation)?

Answer 3

Caesarean section (no daily suppressive acyclovir as caesarean section recommended)

Question 4

What is recommended doses of antiviral medications for herpes in pregnancy
Primary/1st ep infection
Symptomatic recurrent episode
Daily suppression
Severe or disseminated disease

Answer 4

Question 5

What needs to be counselled?

Answer 5

• Women who volunteered a history of recurrent genital herpes infection should be informed early in pregnancy about the implication of recurrent disease at the time of labour and to report symptomatic recurrence as soon as it is noticed.
• Parents should be advised to report early signs of possible neonatal infection after delivery (e.g. lethargy, fever, poor feeding or lesions).

Question 6

What is Mx for primary genital herpes at the time of delivery?

Answer 6

Benefit of C section reduces if the membranes have been ruptured for greater than 4 hours. However there may be some benefit in performing a C-section even after this time interval.

Question 7

What is Mx for women with primary genital herpes also present with PPROM?

Answer 7

• Prophylactic corticosteroids should be considered to reduce the implications of preterm delivery upon the infant.
• If delivery indicated within 6 weeks of primary infection, delivery by C-section may still offer some benefit despite prolonged rupture of membranes.

Management of women with recurrent genital herpes who also present with PPROM, there is evidence to suggest expectant management (including oral acyclovir 400mg 3 times daily for the mother) as the risk of neonatal transmssion is very small.