Re: Herpes in Pregnancy

From: Geffrey Klein, MD (gklein@icsi.net)
Mon Aug 16 16:04:12 1999


At 3:16 PM -0500 on 8/16/99, Ronald E. Ainsworth wrote:

> I have a new patient whose first pregnancy delivered vaginally and
> developed severe CNS disease due to genital herpes. Apparently the CNM
> who delivered her "missed" a small herpetic lesion on the vulva and the
> only history of lesions was in her partner. The options, as I see them
> include: 1)perform the cesarean section as requested, 2) follow her
> according to the standard guidelines, with cesarean section only if
> there are lesions present at term or 3)place her on antiviral therapy
> during the last trimester of pregnancy. At this point she is now
> strongly requesting cesarean section. How many would agree to her
> request if she maintains her strong convictions, in spite of medical
> evidence that it is probably an "unnecessary cesarean section?"

I learned this one from Dr. Joe when he came to Baylor and presented a talk on the same subject. I would tell her that a cesarean may not protect her baby and that there is no evidence to say it is more likely to protect her baby over vaginal delivery. After discussion of the risks of cesarean, if she still wanted it, I would do it.. Need to document the chart well...

I don't think a negative culture at term or third trimester acyclovir would reassure her in any way...

_______________________ Geffrey H. Klein, MD

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geffrey.klein@obgyn.net
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