Ob: Hsv In Pregnancy

Front 1

Neonatal congenital HSV affects how many infants?

Back 1

about 1/15000 deliveries
(1/3500 in USA)

Front 2

What are the 3 levels of neonatal HSV disease?

Back 2

1) skin, eyes, mouth
2) CNS (w/o skin/eye/mouth)
3) disseminated (90% fatal)

Front 3

How is HSV transmitted to the fetus/neonate? (i.e. what are the modes of transmission?)

Back 3

1) Congenital in utero (Transplacental)
2) Intrapartum from birth canal
3) Nosocomial (staff/family members)

Front 4

How is neonatal HSV treated?

Back 4

IV Acyclovir
Consult Pediatrician/Neonatologist

Front 5

What percentage of pregnant women are positive for HSV1/HSV2 antibodies?

What percentage of genital lesions are caused by HSV2?

Back 5

HSV1: 60%
HSV2: 20%

(90% of women +HSV2 don't know it)

genital tract disease is now about 50% HSV1 and 50% HSV2

**HSV1 is more often implicated in neonatal HSV in Canada

Front 6

List 3 'types' of infection

Back 6

1) Primary
2) Non-Primary, first recognized ep.
3) Recurrent

Front 7

List the symptoms of HSV infection.

Back 7

may be: none --> severe
usually worse with primary infection

genital:
lesions
burning
itching
pain
systemic
fever
H/A
tender lymphadenopathy

Front 8

What is the highest-risk scenario for neonatal HSV infection acquired at vaginal delivery?

What is the risk of HSV transmission to the neonate?

Back 8

Primary maternal infection in 3rd trimester
(no maternal antibodies)

50%

Front 9

Should C/S be recommended to women with primary HSV infection identified in the 3rd trimester?

Back 9

Yes

Front 10

How can maternal symptoms of primary or recurrent HSV infection be treated?

Back 10

Acyclovir 400mg TID x 7-14d
Valacyclovir 500mg BID x 7-14d

IV Acyclovir if severe infection

Front 11

List indications for C/S in maternal genital HSV infection.

Back 11

1) Usual obstetrical indications
2) Primary infection, 3rd trimester
3) Prodromal symptoms or lesions (all perineal lesions) at parturition with ROM <= 4h

Front 12

How would you manage PPROM <34wks with a history of genital HSV?

Back 12

Start prophylactic antiviral therapy as for antenatal recurrent infection protocol
(Acyclovir 400mg TID or Valacyclovir 500mg BID)

Front 13

Has acyclovir or valacyclovir been found to teratogenic or harmful in:

a) pregnancy
b) breast-feeding

Back 13

a) no
b) no

Front 14

What is the risk of intrapartum transmission of HSV to a neonate if the mother has recurrent genital HSV and an active lesion at delivery?

Back 14

About 2-5%

Front 15

True or False: HSV viral shedding can occur even in the abscence of visible lesions

Back 15

True
(the risk of neonatal transmission at delivery is significantly higher if lesions are present)

Front 16

List fetal effects of transplacental transmission of HSV (in utero)

Back 16

IUGR
microcephaly
hepatosplenomegaly
IUFD/stillbirth

(very rare)

Front 17

Is anti-HSV serology screening recommended for all pregnant women?

Back 17

No

Front 18

What counseling should be provided to discordant couples (female negative, male positive)

Back 18

Type-specific serology to predict risk
If at risk:
Avoid sexual contact (oral-ano-genital)
If contact:
condoms
prophylactic antiviral for female
Repeat serology at 32-34wks

Front 19

What intrapartum invasive devices/procedures should be avoided for women with a history of genital HSV?

Back 19

1) FSE
2) fetal scalp gas measurement
3) All intrauterine devices (e.g. IUPC)

Front 20

How would you manage a women with a history of genital herpes leading up to parturition

Back 20

Start prophylactic antiviral medication at 35-36wks
acyclovir 400mg TID, or
valacyclovir 500mg BID