HSV in Pregnancy

Question 1

HSV in pregnancy CS & suppression

Answer 1

1st/2nd Trimester and delivery within 6 weeks - recommend CS

3rd trimester and within 4 week so birth - CS recommended

ACV/VCV from 32 weeks till delivery

Question 2

Famciclovir in pregnancy

Answer 2

CI as no safety data

Question 3

1st episode of GH at labour

Answer 3

Risk of neonatal acquisition - 41%

CS recommended but effect reduced if PROM > 4h

IV ACV intrapartum 5mg/kg TDS

Neonatal IV ACV 20mg/kg TDS

Question 4

Neonatal HSV risk based on timing of infection

Answer 4

Primary @ labour - 41%
Non primary 1st episode - 25%
Recurrent GH - 2%

Question 5

Recurrent GH @ labour

Answer 5

2% risk of acquisition

Vaginal delivery recommended

Preterm PROM (PPROM): High risk neonatal case - prophylactic steroid and ACV.

Question 6

Neonatal HSV risk groups - Ix & Tx

Answer 6

1. HIGHEST: symptoms consistent with HSV

SEM swabs
EDTA blood PCR
CSF PCR
FBC, LFT, clotting

ACV 20mg/kg TDS for 10 days if all tests negative
14 days for SEM

21 days for CNS or disseminated
Oral ACV 300mg/m2 TDS for 6 MONTHS to prevent recurrence

2. HIGH: Acquisition within past 6 months and baby asymptomatic, born by vaginal or CS with PROM

SAME test as HIGHEST

SAME Tx as HIGHEST

3. LOW: active recurrent GH or born <37 weeks with history of recurrent HSV

SEM + EDTA HSV PCR only

Treatment only if positive result

4. LOWEST: asymptomatic baby born > 37 week

NO testing