Mode of Delivery Debate Continues Over Women with Active Herpes


Mode of Delivery Debate Continues Over Women with Active Herpes

Ob. Gyn. News

February 15, 1995

Obstetricians who attended a workshop at the annual meeting of the International Herpes Management Forum could not agree to recommend vaginal birth for pregnant women with a lesion from recurrent genital herpes, according to this article by Sherry Boschert.

Several European members were clearly frustrated that they could not persuade their American colleagues to drop their recommendation for cesarean section in these cases. About one tenth of the women with recurrent herpes will have a lesion when they go into labor.

A Rotterdam gynecologist told Boschert of his disappointment and added, "The rate of cesarean sections has gone down dramatically in the Netherlands, and there was not a single extra case of neonatal herpes. That was reached primarily by telling [obstetricians] not to operate on women with a history of genital herpes."

Only 8 percent of Dutch babies are born by cesarean section, compared with 13 percent of Norwegian babies and 22 percent of babies in the United States. In the States, maternal mortality is four times higher with cesarean section than with vaginal birth, and cesarean section causes 20 times as much morbidity.

It is primary infection of primary herpes simplex virus that carries a 50 percent chance of infecting the baby. With recurrent herpes the rate of neonatal infection is between 1 and 3 percent.

A study published in the Journal of the American Medical Association (JAMA 270:77-82, 1993) found that about 1,580 "excess" cesarean sections would be necessary to prevent one case of neonatal herpes. A large number of excess cesareans puts mothers at risk because of the higher risk of maternal death associated with cesareans. At the meeting, a Norwegian professor of obstetrics and gynecology cited a study that calculated one maternal death for every 1.75 cases of neonatal herpes prevented by automatic cesarean section for recurrent herpes.

An obstetrician from Israel complained to the group that much of the medical world follows the lead of the United States. "To change the practice in my country, we must try to change the practice in the United States," he said.

The American reaction to these comments was summed up by Dr. Larry Corey from Seattle's University of Washington School of Medicine, who conceded that cesareans might not be warranted in cases of recurrent herpes lesions. Because "you can't manage it rationally in the United States' for fear of lawsuits, he still recommends cesareans in such cases.

Ina May Gaskin.

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