Cesarean Delivery for Women Presenting With Genital Herpes Lesions

Randolph, Adrienne G.; Ae, Washington; Cg, Prober

doi:10.1001/jama.1993.03510010083035

Cited by 99 publications

(10 citation statements)

References 24 publications

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“…This will impose a major abdominal operation on 414 women in order to possibly save one neonate from a serious HSV infection. Randolph and coworkers calculated 1580 excess C/S for every poor neonatal outcome (15). Further, our study shows that some of the neonates are infected in spite of C/S.…”

Section: Discussionsupporting

confidence: 52%

Neonatal herpes in Denmark 1977–1991

Fonnest

Weber

1997

Acta Obstet Gynecol Scand

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Section: Discussionsupporting

confidence: 52%

Neonatal herpes in Denmark 1977–1991

Fonnest

Weber

1997

Acta Obstet Gynecol Scand

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“…In order to prevent neonatal herpes infection in women with recurrent genital herpes infection it has been recommended that the baby is delivered by caesarean section if there is evidence of active herpes lesions at the time of delivery 4,5 . However, although the consequences of neonatal herpes infection are very severe, the risk of acquiring neonatal herpes infection following vaginal delivery in a woman with active recurrent lesions at delivery is small.…”

Section: Introductionmentioning

confidence: 99%

A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection

Brocklehurst

Kinghorn

Carney

et al. 1998

BJOG

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Objective To evaluate the efficacy and safety of a suppressive course of acyclovir in late pregnancy in women with recurrent genital herpes infection on the incidence of viral shedding, herpes lesion development and caesarean section for recurrent genital herpes.Design Double-blind, randomised placebo controlled clinical trial.Setting Adepartment of genitourinary medicine in Sheffield and an antenatal clinic in London.Population Pregnant women with recurrent genital herpes infection at < 36 weeks of gestation.Methods Participating women were given acyclovir 200 mg four times a day (or matching placebo) from 36 weeks of gestation until the time of delivery. Women were seen weekly and viral cultures were obtained from the cervix and vulva. Decisions regarding mode of delivery were lefl to the discretion of the attending obstetrician.Main outcome measures Delivery by caesarean section for recurrent genital herpes infection. Number of episodes of recurrent genital herpes infection and number of episodes of asymptomatic viral shedding during the treatment period. In addition blood was taken at two weekly intervals to determine acyclovir levels.Results The total number of women recruited was 63 (3 1 received acyclovir and 32 received placebo). The number of women undergoing delivery by caesarean section for recurrent herpes at the time of delivery was 12 (19%). The odds ratio for delivery by caesarean section in women taking acyclovir, compared with those talung placebo, was 0.44 (95% CI 0.09-1.59). The odds ratio for clinical recurrences during treatment was 0.10 (95% confidence interval 0.00-0.86) and the odds ratio for clinical recurrence or asymptomatic shedding during treatment was 0.32 (95% CI 0.05-1.56).Conclusion This trial was unable to demonstrate that acyclovir can significantly decrease the number of caesarean section deliveries; however, the number of clinical recurrences was significantly reduced. Two episodes of asymptomatic virus shedding both occurred in women taking acyclovir. At the present time there is little evidence to suggest that acyclovir should be used outside randomised controlled trials for the suppression of recurrent genital herpes infection during pregnancy.

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“…It remains standard practice in Canada to perform a caesarean section (CS) for women with visible genital HSV lesions at the time of delivery to prevent neonatal HSV infection. This is a controversial policy for women with recurrent genital HSV because it is estimated that 1580 CSs must be performed to prevent one case of neonatal HSV (2). Women with a history of genital HSV are commonly prescribed anti-virals from 36 weeks’ gestation until delivery.…”

Section: Prevention and Management Of Neonatal Herpes Simplex Virus Imentioning

confidence: 99%

What Is New from the Canadian Paediatric Society Committee on Infectious Diseases and Immunization?

Robinson

2014

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Cesarean Delivery for Women Presenting With Genital Herpes Lesions

Cited by 99 publications

References 24 publications

Neonatal herpes in Denmark 1977–1991

Neonatal herpes in Denmark 1977–1991

A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection

What Is New from the Canadian Paediatric Society Committee on Infectious Diseases and Immunization?

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