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  #1  
Old 08-15-2011
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Virus Pregnant Herpes and Transmission to Baby!

A 23-year-old G3P2 presents for a routine obstetric (OB) visit at 34 weeks. She reports a history of genital herpes for 5 years. She reports that she has had only two outbreaks during the pregnancy, but is very concerned about the possibility of transmitting this infection to her baby. Which of the following statements is accurate regarding how this patient should be counseled?

A) There is no risk of neonatal infection during a vaginal delivery if no lesions are present at the time the patient goes into labor.
B) The patient should be scheduled for an elective cesarean section at 39 weeks of gestation to avoid neonatal infection.
C) Starting at 36 weeks, weekly genital herpes cultures should be done.
D) The herpes virus is commonly transmitted across the placenta in a patient with a history of herpes.
E) Suppressive antiviral therapy can be started at 36 weeks to help prevent an outbreak from occurring at the time of delivery.
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Old 08-15-2011
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hmmm A...if there aren't any active lesion you can do vaginal delivery..I haven't come across indications for suppressive antiviral at 36 wks...
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Old 08-15-2011
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Originally Posted by Kais_MD View Post
hmmm A...if there arent any active lesion you can do vaginal delivery..I havent come across indications for suppressive antiviral at 36 wks...
I agree. It is A
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Old 08-15-2011
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A
There is no risk of neonatal infection during a vaginal delivery if no lesions are present at the time the patient goes into labor.
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Old 08-15-2011
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A) There is no risk of neonatal infection during a vaginal delivery if no lesions are present at the time the patient goes into labor.
i think is better answer

but E also a q came in usmle counsult said e is possible too
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Old 08-15-2011
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I also chose A but the Correct answer is E.
Explanation
A maternal HSV infection can be passed to the fetus via vertical transmission. If a pregnant woman with a history of herpes has no lesions present at the time she goes into labor, vaginal delivery is permitted. If lesions are present at the time of labor, then there is a 3% to 5% risk of transmitting the infection to the fetus, and cesarean delivery is recommended. Viral shedding can occur without the presence of a lesion. It is not recommended that a patient with a history of herpes be scheduled for an elective cesarean section. It is not recommended that weekly genital viral cultures be performed because such cultures do not predict whether a patient will be shedding the virus at the time of delivery. For patients at or beyond 36 weeks gestation, daily suppressive therapy with an antiviral medication such as acyclovir can be used to try to decrease the risk of viral shedding and outbreaks and the likelihood of a cesarean section.

Source Pretest Obs/gyn...
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  #7  
Old 08-15-2011
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Originally Posted by step1an View Post
I also chose A but the Correct answer is E.
Explanation
A maternal HSV infection can be passed to the fetus via vertical transmission. If a pregnant woman with a history of herpes has no lesions present at the time she goes into labor, vaginal delivery is permitted. If lesions are present at the time of labor, then there is a 3% to 5% risk of transmitting the infection to the fetus, and cesarean delivery is recommended. Viral shedding can occur without the presence of a lesion. It is not recommended that a patient with a history of herpes be scheduled for an elective cesarean section. It is not recommended that weekly genital viral cultures be performed because such cultures do not predict whether a patient will be shedding the virus at the time of delivery. For patients at or beyond 36 weeks gestation, daily suppressive therapy with an antiviral medication such as acyclovir can be used to try to decrease the risk of viral shedding and outbreaks and the likelihood of a cesarean section.

Source Pretest Obs/gyn...
hmmm Nice..thanks..I had never seen it before..although i hope i dont get these technical questions on the exams if i havent seen them before....almost no text mentions this..
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Old 08-15-2011
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I agree, this was an odd one so thats why i posted it here.
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Help

Thanks for this question. But I am a little confused because according to the explanation:

" If a pregnant woman with a history of herpes has no lesions present at the time she goes into labor, vaginal delivery is permitted."

and

choice A: There is no risk of neonatal infection during a vaginal delivery if no lesions are present at the time the patient goes into labor.

Doest this mean that there is still a risk of neonatal infection if no leisions are present during vaginal delivery?
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Old 08-16-2011
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Originally Posted by roshini View Post
Thanks for this question. But I am a little confused because according to the explanation:

" If a pregnant woman with a history of herpes has no lesions present at the time she goes into labor, vaginal delivery is permitted."

and

choice A: There is no risk of neonatal infection during a vaginal delivery if no lesions are present at the time the patient goes into labor.

Doest this mean that there is still a risk of neonatal infection if no leisions are present during vaginal delivery?
yes, there is risk but its minimal. We always have to balance risks vs. benefits and the surgical and anesthetic risks of c-section are way much higher than the asymptomatic herpes.
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Old 08-16-2011
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Default herpes

Over 70 million people are living with STDs in the U.S. alone, as well as an estimated 400 million people worldwide. An estimated 40 million people have herpes which is a chronic viral infection. About 500,000 new people get symptomatic herpes each year.1 in 5 Americans presently have an STD and nearly 80% of people that are infected with an STD do not know it. Dating with H+ at HerpesFinder...site
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Originally Posted by herpesfinder View Post
Over 70 million people are living with STDs in the U.S. alone, as well as an estimated 400 million people worldwide. An estimated 40 million people have herpes which is a chronic viral infection. About 500,000 new people get symptomatic herpes each year.1 in 5 Americans presently have an STD and nearly 80% of people that are infected with an STD do not know it. Dating with H+ at HerpesFinder...site
nice Id! "Herpesfinder" ROFL!
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