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- May 28, 2012
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I'm currently reading over ACOG guidelines for this and am confused about what to do with a laboring mothering who comes in with a new, primary genital HSV infection discovered on PE and PCR testing while she is in labor. Obviously, she gets a C-section because she has active genital lesions. But does she get any form of antiviral therapy in the meantime? Is it basically seen as too late to be of any clinical use, or does she get acyclovir any way because it can't be of any harm? I haven't been able to find a definitive answer to this, and I need to for purposes of a test.
There's also this in the bulletin....
"Data regarding interventions to reduce vertical transmission in the specific setting of primary herpes are limited. One randomized trial of acyclovir versus placebo given from 36 weeks of gestation until delivery to women with their first episode of genital herpes infection during pregnancy found a significant reduction in clinical recurrences at delivery (35). The number of cesarean deliveries for clinical herpes recurrences was reduced; however, the total number of cesarean deliveries in the treatment and placebo groups was similar. The number of deliveries was insufficient to evaluate efficacy of antiviral treatment to prevent neonatal herpes. Evidence of the effectiveness of cesarean delivery before labor for the prevention of vertical transmission is lacking."
There's also this in the bulletin....
"Data regarding interventions to reduce vertical transmission in the specific setting of primary herpes are limited. One randomized trial of acyclovir versus placebo given from 36 weeks of gestation until delivery to women with their first episode of genital herpes infection during pregnancy found a significant reduction in clinical recurrences at delivery (35). The number of cesarean deliveries for clinical herpes recurrences was reduced; however, the total number of cesarean deliveries in the treatment and placebo groups was similar. The number of deliveries was insufficient to evaluate efficacy of antiviral treatment to prevent neonatal herpes. Evidence of the effectiveness of cesarean delivery before labor for the prevention of vertical transmission is lacking."