• Evidence demonstrates that a conservative method, permitting vaginal delivery when an anogenital lesion occurs, hasn’t been linked with an increase in the occurrence of neonatal HSV cases.
• Vaginal delivery must be provided to women with recurring genital herpes lesions at the start of labor.
A C-section delivery can be taken into consideration but the danger to the mother as well as future pregnancies ought to be compared with the tiny risk of neonatal HSV transmission with recurring disease (0 to 3% for vaginal delivery).
The ultimate choice of vaginal delivery set against C-section ought to be made by the mother (who must base her choice on the extremely low transmission risk versus any other pregnancy or child-birth risk factors and the risks related to caesarean section.
• It’s been stated that invasive procedures (such as fetal blood sampling, fetal scalp electrodes application, instrumental deliveries and artificial rupture of membranes) increase the possibility of HSV infection to the neonate.
• However, given the tiny background risk (0 to 3%) of transmission within this group, the increased risk linked to invasive procedures is not likely to be clinically significant, so, if required, they could be used.
• Women must be managed in line with standard NICE (National Institute for Health and Care Excellence) intrapartum procedures.
• There’s no evidence to direct the management of women with spontaneous membrane rupture at term, but numerous clinicians will advise advancing delivery to minimize the period of possible HSV exposure of the fetus.
7. Genital herpes in PPROM (preterm prelabor rupture of membranes) (before 37+0 weeks of gestation)
Primary Genital Herpes During PPROM
• There is insufficient evidence to tell excellent obstetric practice once PPROM is complicated due to primary HSV infection. Management ought to be guided using multidisciplinary team discussion that involves the neonatologists, obstetricians, and genitourinary medicine doctors and will rely on the gestation that PPROM took place. If the decision has been made for instant delivery, then the expected advantages of a C-section will stay. If there is primary conservative management, the mother ought to be recommended to get intravenous Aciclovir 5 mg/kg for every 8 hours.
• Prophylactic corticosteroids must be deemed to decrease the preterm delivery implications upon the neonate. If delivery is indicated within six weeks of the initial infection, delivery via C-section could still offer some advantage regardless of the extended rupture of membranes.
Recurring Genital Herpes in PPROM
• When PPROM occurs while genital herpes lesions appear, the risk of transmission to the new-born is extremely small and could be outweighed by the mortality and morbidity linked to premature delivery.
• In the PPROM’s case before 34 weeks, there’s evidence to state that expectant management is proper, with oral Aciclovir 400 mg thrice a day for the mother. Following this gestation, it’s suggested that management is carried out in line with pertinent RCOG procedures on PPROM as well as antenatal corticosteroid administration to decrease neonatal mortality and morbidity and isn’t influenced materially by the occurrence of recurring genital herpes lesions.