Herpes,Pregnancy
Cesarean Section Appropriate in Women With Active Genital HSV
Laurie Barclay, MD;
Medscape Medical News 2003. © 2003 Medscape
Jan. 7, 2003 — Cesarean section has been the standard of care for women with active genital herpes simplex virus (HSV) infection, but prior evidence supporting this standard has been lacking. Results of a prospective cohort study evaluating mother-to-infant transmission, which were published in the Jan. 8 issue of The Journal of the American Medical Association, suggest that this standard is appropriate.
“Neonatal herpes most commonly results from fetal exposure to infected maternal genital secretions at the time of delivery,” write Zane A. Brown, MD, and colleagues from the University of Washington in Seattle. “No data exist on whether cesarean delivery, the standard of care for women with genital herpes lesions at the time of delivery, reduces HSV transmission.”
Of 58,362 pregnant women enrolled between January 1982 and December 1999, 40,023 had cervical and genital HSV cultures, and 31,663 had serum samples tested for HSV.
Of 202 women testing positive for HSV during labor, 10 women (5%) delivered infants with HSV infection (odds ratio [OR], 346; 95% confidence interval [CI], 125 – 956). The HSV transmission rate in women who tested positive for HSV was 1.2% of 85 cesarean deliveries and 7.7% of 117 vaginal deliveries (OR, 0.14; 95% CI, 0.02 – 1.08; P = .047).
Other risk factors for neonatal HSV were first-episode infection, isolation of HSV from the cervix, HSV-1 vs. HSV-2 isolation, invasive monitoring, delivery before 38 weeks, and maternal age younger than 21 years.
Rates of neonatal HSV infection per 100,000 live births were 54 for HSV-seronegative women (95% CI, 19.8 – 118); 26 for women who were seropositive only for HSV-1 (95% CI, 9.3 – 56); and 22 for women who were HSV-2 seropositive (95% CI, 4.4 – 64).
“Neonatal HSV infection rates can be reduced by preventing maternal acquisition of genital HSV-1 and HSV-2 infection near term,” the authors write, recommending cesarean delivery and limiting invasive monitoring in women shedding HSV. “Antiviral, behavioral, and, of course, vaccine approaches to reduce transmission from mother to infant need evaluation in large multi-institutional trials to determine the most effective and economical strategies.”
JAMA. 2003;289(2):203-209