CESAREAN DELIVERY FOR WOMEN PRESENTING WITH GENITAL HERPES LESIONS - EFFICACY, RISKS, AND COSTS

Objective.-To assess the effect of cesarean delivery on neonatal and m aternal morbidity and mortality and their associated costs for two pop ulations of women presenting with genital herpes lesions at delivery: those with and those without a history of genital herpes. Data Sources .-MEDLINE (search for herpes simplex virus and neonatal, cesarean, and mortality) and recognized experts. Data Extraction.-The quality of th e overall data used for baseline values was graded using a predetermin ed scale. Results.-The practice of cesarean delivery for women with a history of genital herpes lesions that recur at delivery results in mo re than 1580 excess cesarean deliveries performed for every poor neona tal outcome prevented, a cost per neonatal herpes case averted of $2.5 million and a cost per quality-adjusted life-year gained of $203 000. For these women, lowering the efficacy of cesarean delivery or the he rpes simplex virus vertical transmission rate could result in maternal deaths outnumbering neonatal deaths prevented. In contrast, cesarean delivery for women with no history of genital herpes simplex virus who have lesions at delivery has low maternal costs per neonatal benefit and saves money. Conclusions.-Women who present with their first clini cal episode of genital herpes at delivery should have a cesarean secti on performed. However, the current practice of cesarean delivery for w omen with a history of genital herpes lesions that recur at delivery r esults in high maternal morbidity and mortality at substantial financi al expense, underscoring the urgency of examining alternative manageme nt strategies.