A 25-year-old G1P0 female at 25 wks of gestation comes to you for antenatal check up. She has had an uncomplicated pregnancy but has 5 years history of Genital Herpes infection. She is usually asymptomatic and has had 3 flares in the past 5 years. She is concerned about exposing her unborn child to infection-What is the most appropriate counsel to offer to this patient.
High-Yield Explanation
Herpes Simplex Virus infection in pregnancy:
Most common time of Mother To Child transmission is–at the time of delivery
About 50% women with HSV is first trimister abort while infection in second half can lead to IUGR, preterm labor.
ACOG does not recommend a routine screening for HSV
Viral isolation is the defective means of diagnosis for HSV infection
Specimens are obtained from any active lesions as well as from cervix and vagina
PCR can also be done
DOC during pregnancy-Acyclovir (safe in lactation also) × 7–10 days
ACOG recommends daily viral therapy at or beyond 36 weeks for women who have recurrences during pregnancy as it decreases the outbreaks at term and so decreased need for cesarean Cesarean section is indicated for women with active genital lesions or in patients having prodromal symptoms of herpes viz genital pain and tingling (ans 22). Cesarean is not indicated in women with a h/o HSV infection but no active genital tract lesion/prodromal symptoms at the time of delivery.
If no active breast lesions are present–patient can breastfeed.
Now with this background about HSV infection, lets have a look at the options
Option a: administer one dose of acyclovir if she has active genital herpes at the time of delivery-incorrect as acyclovir should be given for 7–10 days in case of active herpes infection.
Option b: administer prophylaxis with acyclovir from now and uptil delivery whether she has active herpes or not–again incorrect as we have to give acyclovir for 7–10 days, then stop and restart at 36 weeks of gestation.
Option c: perform elective LSCS even if mother is asymptomatic at the time of delivery. – again Incorrect
Option d: perform elective LSCS only if mother has active herpes at the time of delivery. – correct