Selective cesarean delivery in women with genital herpes - adapted from Obstetrics and Gynecology, F

Date: May 15, 1995

Liberal use of cesarean delivery has previously been advocated in cases of maternal genital herpes infection as a means of preventing transmission of the infection to the infant during vaginal delivery In 1988, the American College of Obstetricians and Gynecologists published practice guidelines recommending cesarean delivery only if herpetic lesions were present when delivery was imminent. Roberts and colleagues report on the impact of these guidelines at a large inner-city medical center.

The investigators reviewed medical records of women with genital herpes who delivered before and after implementation of the new guidelines. Between January 1984 and July 1986, management of women with genital herpes included weekly cultures beginning at 34 weeks of gestation and continuing until delivery; cesarean section was performed if there was any evidence or suspicion of active infection. Women with genital herpes who delivered between November 1988 and December 1991 were managed according to the new guidelines. Deliveries in the interim period were not included in the analysis because different protocols were m operation within the institution. Also, deliveries after 1991 were not studied because most infected mothers were involved in a trial of prophylactic antiviral therapy.

The 96 women in the earlier group and the 217 women who delivered later were similar in age, parity, median gestation at delivery, and mean infant birth weight. Approximately 40 percent of women in each group had their first episode of genital herpes infection during the index pregnancy.

The percentage of women with active lesions at the time of delivery did not differ significantly (25 percent in the earlier group and 18 percent in the later group). The rate of cesarean delivery was 59 percent in the earlier group and 37 percent in the later group, a significant change. Ten percent of women in each group had repeat cesarean deliveries. In the earlier group, 23 percent of cesarean deliveries were attributed to the presence of active herpetic lesions or symptoms and 9 percent were attributed to obstetric indications. In the later group, 17 percent of cesarean deliveries were performed because of herpetic lesions and 20 percent were performed because of obstetric indications. Between 1984 and 1991, neonatal herpes infection developed in three infants. None of the mothers of these infants had been diagnosed with genital herpes during pregnancy.

The authors conclude that implementation of the 1988 guidelines resulted in a significant decline in the rate of cesarean delivery without neonatal consequences. (Obstetrics & Gynecology, February 1995, vol. 85, p. 261.)

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