THE MANAGEMENT OF RECURRENT GENITAL HERPES INFECTION IN PREGNANCY - APOSTAL SURVEY OF OBSTETRIC PRACTICE

Objective To determine clinical practice amongst obstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection. Methods All Members and Fellows o f the Royal College of Obstetricians and Gynaecologists resident in th e UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection. Results There was a 76% response rate to the questionnaire. Of the 12 01 obstetricians who responded, only 369 (31%) admitted to having a fo rmal policy governing the management of herpes in pregnancy within the ir unit. However, regular screening was advocated by 718 (60%), of who m 463 (64%) performed regular antenatal swabs for viral culture. At th e time of presentation in labour 974 obstetricians (81%) routinely exa mined the genitals for evidence of a recurrence. When asked in what ci rcumstances caesarean section would be considered an appropriate metho d of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. Howe ver, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an ind ication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who perform ed antenatal screening (chi(2) = 30.38, P < 0.0001). Five hundred and ninety-six obstetricians (50%) felt that a positive viral culture obta ined at antenatal screening from the most recent occasion prior to pre sentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture. The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for c aesarean section regardless of recurrences at delivery was considered an acceptable indication for operative delivery by 745 obstetricians ( 62%). Conclusions 1. There seems to be little agreement amongst obstet ricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.