The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice

Abstract

Objective To determine clinical practice amongst bstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection. Methods All Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection. Results There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81)routinely examined the genitals for evidence of a recurrence. When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (χ2= 30.38, P < 0.0001). Five hundred and ninety‐six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture. The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for caesarean section regardless of recurrences at delivery was onsidered an acceptable indication for operative delivery by 745 obstetricians (62%). Conclusions 1. There seems to be little agreement amongst obstetricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.

Management of women with recurrent genital herpes in pregnancy in Australia

“…Similar discrepancies were noted in a study from the United Kingdom. 6 Trainees were more familiar with recent developments. For instance, in the case of ruptured membranes of more than 4 hours with a HSV recurrence where there is little evidence that performing a caesarean section would reduce risk to the baby, 8 9 trainees were significantly less likely to perform a caesarean section when compared with fellows.…”

Local therapy as a modern trend in the treatment of vaginal infections

“…Ключевыми элементами данной экосистемы являются вагинальный эпите-лий и вагинальная флора [4,14,15,16].…”

Should acyclovir prophylaxis be used in late pregnancy in women with recurrent genital herpes infection? How to use a clinical decision analysis.

“…If there is evidence of an active recurrence then delivery by caesarean section is recommended to avoid the risk of mother to child transmission. 5 If there is no evidence of an active recurrence then a vaginal delivery is anticipated. The risk of mother to child transmission is unknown but estimates suggest that it can be no higher than 8%6 although many authorities believe it is significantly lower than this and some have suggested that it is negligible.7 As a consequence of the current management policy many women with recurrent genital herpes infection present at the time of labour undergo caesarean section when the risk to the neonate appears to be small.…”