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Re: 32 week PROM Recent Herpes outbreFrom: Efrain Ramirez (eramirezt@coqui.net)Mon Jan 17 19:11:36 2005
One question - was there a written consultation? Personally - I see no reason whatsoever to do a C/S now - what's his thought process??? --the literature does not support that advice - IMHO and here is some from from ACOG... "In which situations should cesarean delivery be considered? Cesarean delivery is indicated in women with active genital lesions or symptoms of vulvar pain or burning, which may indicate an impending outbreak. The incidence of infection in infants whose mothers have recurrent infections is low, but cesarean delivery is warranted because of the potentially serious nature of the disease. The low incidence of neonatal HSV has raised concern that cesarean delivery is unwarranted for recurrent genital herpes (41). The extent to which maternal antibodies will protect a neonate from infection during a recurrence has not been determined with certainty. Cesarean delivery is not warranted in women with a history of HSV infection but with no active genital disease during labor (42). " How should a woman with active HSV and preterm premature rupture of membranes be managed? In the decision to deliver a patient with preterm premature rupture of membranes and active HSV, the risk of prematurity versus the potential risk of neonatal disease should be considered. In pregnancies remote from term, especially in women with recurrent disease, there is increasing support for continuing the pregnancy to gain benefit from time and glucocorticoids (45). If this expectant management plan is followed, treatment with an antiviral agent is indicated. Concern has been raised about the potential effects of glucocorticoids on patients with viral infection, but there is no conclusive evidence that this is a concern in this setting. The decision to perform a cesarean delivery depends on whether active lesions are present at the time of delivery. The utility of suppressive antiviral therapy to prevent ascending infection has not been proven. The lack of evidence complicates the situation, because it is clear that premature neonates are at the greatest risk of infection. In such situations, it may be appropriate to consult personnel well versed in the management of such complicated cases. " "Summary The following recommendations are based on limited or inconsistent scientific evidence (Level B): Women with primary HSV during pregnancy should be treated with antiviral therapy. Cesarean delivery should be performed on women with first-episode HSV who have active genital lesions at delivery. For women at or beyond 36 weeks of gestation with a first episode of HSV occurring during the current pregnancy, antiviral therapy should be considered. The following recommendations are based primarily on consensus and expert opinion (Level C): Cesarean delivery should be performed on women with recurrent HSV infection who have active genital lesions or prodromal symptoms at delivery. Expectant management of patients with preterm labor or preterm premature rupture of membranes and active HSV may be warranted. For women at or beyond 36 weeks of gestation who are at risk for recurrent HSV, antiviral therapy also may be considered, although such therapy may not reduce the likelihood of cesarean delivery. In women with no active lesions or prodromal symptoms during labor, cesarean delivery should not be performed on the basis of a history of recurrent disease.
>At Mon, 17 Jan 2005, DoctorJoe@aol.com wrote:
-- "The opposite of a correct statement is a false statement. But the opposite of a profound truth may well be another profound truth."
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