Obstetrics & Gynecology

Answer 4 Cesarean delivery. Neonatal HSV infection acquired from the mother is associated with significant neonatal mortality and morbidity. The recommendation by the American College of Obstetricians and Gynecologists for patients with HSV infection outbreaks at the time of labor is to perform a cesarean delivery to try to avoid this transmission; there is an increased risk for perinatal transmission of HSV to the neonate at the time of labor and during vaginal delivery. Although the risk is higher during a primary HSV infection, the risk is still present for a recurrent episode of HSV infection. It is also important to note that a cesarean delivery does not protect against perinatal transmission or neonatal HSV infection all the time, but it does substantially decrease the risk for transmission. Expectant management would endanger the life of the neonate. Betadine douching, antibiotic ointments, and pelvic ultrasonography are ineffective management modalities in this case. SUGGESTED READINGS 1. Langenberg AG, Corey L, Ashley RL, et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. New Engl J Med 1999;341:1432-8. 2. Scott LL, Sanchez PJ, Jackson GL, et al. Acyclovir suppression to prevent cesarean delivery after first-episode genital herpes. Obstet Gynecol 1996;87:69-73. Click here to return to the questions

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