8. CONDITION: Perinatal Herpes Simplex Virus Infections
A. Confirmation of Diagnosis:
(1) Characteristic visible lesions;
(2) Immunofluorescent test or culture if either is available.
B. Management:
(1) If there are no visible lesions at the onset of labor, vaginal delivery is acceptable.
(2) Weekly surveillance cultures of pregnant women with a history of HSV infection, but no visible lesions, are not necessary and vaginal delivery is acceptable.
(3) Amniocentesis in an attempt to rule out intrauterine infection is not recommended for mothers with HSV infection at any stage of gestation.
(4) Term patients who have visible lesions and are in labor or who have ruptured membranes should undergo Cesarean delivery.
(5) For patients with active HSV infections and premature rupture of membranes remote from term, there is not enough data to recommend a management protocol that would apply in all clinical situations. The risk of extreme prematurity must be weighed against the risk of neonatal HSV infection. The patient should be encouraged to take an active role in this decision.
(6) Monitoring by fetal scalp electrode is not contraindicated if needed to adequately asses the fetal condition in women with a history of HSV infection but without lesions or symptoms.
(7) Every effort should be made to avoid direct contact with herpetic lesions by the newborn.
(8) Mothers with visible HSV infections should be allowed to breast-feed, providing there are no visible lesions in the regions of the breasts and she has been counseled regarding the possibility of spreading the virus by direct contact.
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