Herpes Infection in Pregnant Women: Risks and Management - Obstetrics and Gynecology

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Herpes infection during pregnancy, particularly in the late stages, poses significant concerns for both the mother and the newborn. The two main types of herpes simplex virus (HSV) that affect humans are HSV-1 and HSV-2. While HSV-1 is commonly associated with oral herpes, HSV-2 is primarily linked to genital herpes. However, both types can cause infections in either area.

When a pregnant woman is diagnosed with a herpes infection close to her delivery date, several factors must be considered to manage the situation effectively. The timing of the infection is crucial. If a woman acquires a primary herpes infection during the last trimester, especially within a few weeks of delivery, there is a higher risk of transmission to the infant during childbirth. This is particularly concerning if the mother has active lesions at the time of delivery.

Risks to the Newborn:
The primary risk to the newborn is neonatal herpes, which can be severe and potentially life-threatening. Neonatal herpes can manifest in various forms, including skin lesions, encephalitis, and disseminated disease affecting multiple organs. The risk of transmission is highest if the mother has an active outbreak at the time of delivery. If the mother is experiencing her first outbreak or has active lesions, the likelihood of the virus being transmitted to the baby during vaginal delivery increases significantly.

Management Strategies:
1. Assessment and Diagnosis: During prenatal visits, healthcare providers should assess for any signs of herpes infection. This includes a thorough examination of the genital area for lesions or sores. If a pregnant woman presents with symptoms suggestive of a herpes outbreak, such as painful blisters or sores, further testing may be warranted to confirm the diagnosis.

2. Delivery Planning: If a pregnant woman has active genital herpes lesions at the time of labor, a cesarean section (C-section) is often recommended to minimize the risk of transmission to the baby. This is especially true for women who have a primary infection or recurrent outbreaks late in pregnancy.

3. Antiviral Therapy: Antiviral medications, such as acyclovir, may be prescribed to pregnant women with a history of herpes to reduce the risk of an outbreak during delivery. For women with recurrent herpes, starting antiviral therapy at 36 weeks of gestation can help suppress the virus and decrease the likelihood of an outbreak during labor.

4. Monitoring and Support: Close monitoring of the mother and the newborn is essential. If the mother has a history of herpes and experiences any symptoms of an outbreak, immediate medical attention should be sought. Newborns should be observed for any signs of infection, and if there are concerns, appropriate testing and treatment should be initiated promptly.

5. Education and Counseling: It is vital for pregnant women to be educated about the risks associated with herpes infections and the importance of informing their healthcare providers about any history of herpes. Counseling can help alleviate fears and provide guidance on managing the condition during pregnancy and delivery.

In conclusion, herpes infection in pregnant women requires careful management to protect both the mother and the newborn. Early detection, appropriate antiviral therapy, and planning for delivery are essential components of care. If a pregnant woman is diagnosed with herpes close to her delivery date, she should work closely with her healthcare provider to determine the best course of action to minimize risks to her baby.