HSV in Pregnancy Flashcards
Discuss the assessment and management of HSV infection during pregnancy
Impression
HSV is one of several infections screened for as a part of normal antenatal care, as it can have significant implications during pregnancy for obstetric outcomes.
Key complications of vertical transmission:
- localised skin-eye-mouth disease (SEM)
- neonatal HSV meningoencephalitis - fevers, seizures, brain damage
- disseminated HSV infection (life-threatening): risk of death CNS, myocarditis, hepatitis, necrotising enterocolitis, DIC, neutropenia.
HSV in Pregnancy - History
History
PC - primary infection: genital ulcers, pruritus, fever, dysuria. Recurrent: prodrome + non-tender lesions
- HSV history: any previous infection/lesions
- obstetric history, gynae history
- PMHx, PSHx
HSV in Pregnancy - Examination
Examination
- general appearance + vitals (Temp)
- systems review
- external genitalia assessment: vesicles/ulcerated lesions
HSV in Pregnancy - Investigations
Investigations
- Key/Diagnostic: Genital Swab of lesions + PCR, HSV serology (IgG for HSV1/2)
- Bedside: other STI screening
additional routine antenatal investigations
HSV in Pregnancy - Management
Management
Is stratified into high and low risk for transmission
Low risk
Is when seroconversion occurs well before deliver (prior to 30-34 wks gestation)
- suppressive antiviral therapy (acyclovir) from 36wks till delivery
- careful examination for any active lesions, go for caesarean if any vaginal lesions
- close postpartum monitoring, breast-feeding okay as long as no herpetic lesions/
High risk
Is when there is primary infection close to delivery without seroconversion.
- suppressive antiviral therapy from 36wks gestation
- delivery by Caesarean section, avoid invasive instruments in vaginal delivery inevitable
- neonatal screening and monitoring for symptoms, prophylactic treatment with acyclovir 20mg/kg
- breastfeeding okay if no herpetic lesions
