P. Brocklehurst et al., THE MANAGEMENT OF RECURRENT GENITAL HERPES INFECTION IN PREGNANCY - APOSTAL SURVEY OF OBSTETRIC PRACTICE, British journal of obstetrics and gynaecology, 102(10), 1995, pp. 791-797
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.