herpes in pregnancy

  • related: Infections in Pregnancy
  • The most common mode of vertical transmission is direct contact between the fetus and genital tract lesions (eg, cervix, vagina, vulva) during vaginal delivery.
  • low risk of vertical transmission in patients without an active HSV lesion or prodromal symptoms (eg, malaise, myalgia).
  • the most effective strategy to decrease the risk of vertical transmission is to prevent an active HSV lesion at the time of delivery with suppression
  • Therefore, patients with a history of HSV are provided acyclovir suppression beginning at 36 weeks gestation that is continued until delivery.
  • At delivery, patients without prodromal symptoms or active genital HSV lesions can be delivered vaginally as the risk for perinatal transmission is minimal.
  • Patients with active genital HSV at delivery require a cesarean delivery to prevent direct contact between the fetus and the lesion