Genital herpes in pregnancy
Genital herpes during pregnancy - a very unpleasant and serious illness.Its complications and exacerbations can make heavy and during the pregnancy itself.
Genital herpes during pregnancy -
general information Genital herpes is a viral disease recurring.There are two types of agents: HSV-1 and HSV-2.In recent years, increased the incidence of genital herpes.It should be noted that 3/4 of all patients with genital herpes disease is asymptomatic or atypical, but at the same time, the virus excretion occurs.Infection sexual partner usually occurs during asymptomatic recurrence.In 90% of cases of neonatal herpes confirmed at the time of birth of the mother lacking symptoms of genital herpes.
causative agent of genital herpes is most often herpes simplex virus type-2.In 15% of cases the disease is caused by HSV type-1.Both viruses are transmitted by contact.A history indication for herpes are present in 5% of pregnant women.Serological studies have shown that antibodies to HSV type-2 are found in 20-40% of the population.This reduces the risk of primary HSV infection during pregnancy and its transmission to the newborn.In discordant couples in which women are seronegative, a high risk of primary infection in pregnant women.genital herpes rate is higher among women than among men.Women about 4 times more susceptible to infection than men.Transmission of the virus is carried by saliva, semen, cervical secretions or contact with herpetic lesions of the skin and mucous membranes.The virus enters the mucous membranes or broken skin, where it occurs in the first subsequent replication.Then, the virus penetrates the retrograde axonal transport in the posterior horn of the spinal cord nucleus is replicated and included in the latent phase.
analysis on genital herpes
Since pregnancy by itself is always a powerful exertion of all the forces of the body, depletion of immunity and protective means - is inevitable.All latent infections, including genital herpes during pregnancy, usually exacerbated.What to do?For this reason, even before pregnancy it is recommended that all women be tested for the presence of the virus of genital herpes and to receive appropriate treatment if necessary.
If laboratory studies have shown that a woman is a carrier of the herpes simplex virus, but passive - the likelihood of complications in the unborn baby is small.However, provided that the level of antibodies in her normal.A pregnant woman passes the child not only the genital herpes virus, and antibodies.
But if genital herpes in pregnant women is exacerbated in the genital tract, or on the cervix appear rash - this is a problem that you need to do something.Infection of the child with genital herpes during delivery is very, very likely.In most cases, a cesarean section is inevitable: the risk of contracting genital herpes when the child passes through the birth canal under certain circumstances is very high: 9 cases out of 10.
What threatens the fetus genital herpes?
most serious consequences can occur after the initial infection with genital herpes during pregnancy.In this situation, the virus has a devastating impact on the fetus.If genital herpes infection occurs in the first half of pregnancy, the risk of miscarriage increases three times, in other cases, the child may be born with deformities.Upon infection with genital herpes during the second half of pregnancy, the fetus may develop congenital viral pneumonia, heart defects, microcephaly and other diseases.
degree of risk of contracting genital herpes is caused by the weight of the fruit of the disease in the mother.A significant role is played and the duration of the passage of the baby through the birth canal.
avoid all the problems described above with genital herpes infection couples need more planning pregnancy, undergo laboratory diagnostics, making it in order to establish the presence or absence in the body of the herpes simplex virus.It is important that both parents were examined.There are situations when the mother is not a carrier of the virus, and her father has genital herpes.In such a situation it is necessary to prevent infecting women with herpes simplex virus.It is strongly recommended to use condoms during sexual intercourse during pregnancy.
diagnosis of genital herpes in pregnant
In general, diagnosis is made on clinical grounds.Genital herpes infection may be suspected when a characteristic rash.To identify the virus PCR method is used.With the help of specific tests for antibodies to HSV-1 and HSV-2 can be proved primary herpes genital infection as a result of seroconversion.Within 1 to 2 weeks relatively slowly increased titers IgG-antibodies, which does not always occur with titers IgM- and IgA-antibodies.When recurrent herpes with clinical symptoms with or without antibodies often behave normally, so they do not represent the values in the diagnostic plan.In doubtful cases, reactivation of herpes is necessary to carry out PCR diagnostics.
Genital herpes during pregnancy - treatment
scheme of treatment of genital herpes during pregnancy following.
Treatment in I trimester:
Treatment in II trimester:
Treatment in the III trimester:
To reduce the number of caesarean sections because genital herpes can recommend suppressive therapy with acyclovir before birth, the recommended dose of acyclovir provide a high degree of safety to the fetus.Treatment of pregnant women in the III trimester of doses of acyclovir 200 mg 4 times daily for 2-3 weeks before delivery significantly reduces the number of surgical delivery.This therapy is all the more justified that HSV-diagnosis before birth can not always be carried out quickly, and often the physician receives the results of the study took place after birth.
addition to use of acyclovir in childbirth all new mothers with genital herpes genital tract is recommended treatment with antivirals (Poludan solution), limiting the number of vaginal examination during labor and the prohibition of the use of any obstetric operations (amniotomy, fetal scalp electrodes on the head, and so on).When examinations in III trimester pregnant women in childbirth and be sure to check that there are no characteristic lesions on the genitals.
Childbirth with genital herpes
Pregnant with fresh eruptions rodorazreshayut by Caesarean section.The indications for cesarean section are also:
For 10-14 days prior to the caesarean section as prescribed acyclovir suppressive doses, because even fully operational generations do not prevent intrapartum fetal infection with HSV infection.In the case of vaginal delivery at all of the above conditions, the newborn immediately after birth is prescribed therapeutic doses of intravenous acyclovir.Child isolated mother to recover, to eliminate neonatal infection observed for 12- 14 days.If we can not exclude a child infected at birth, the newborn is carried out serological studies using PCR, urine and stool analysis, and discharge from the eyes and throat.In the postpartum period is recommended mandatory breastfeeding newborns, regardless of the type of herpes infection in the mother, because breast milk is the source of antiherpetic antibodies, even if the detection of HSV antigen in it.
infection In primary genital herpes during pregnancy - 50% of children with recurrent herpes and only 5% of children are born with signs of focal or generalized herpes.The frequency of neonatal herpes, according to various sources, ranging from 1: 2500 to 1:60 000 live births.Manifestations neonatal herpes expressed to varying degrees.The lowest level is classified as a form of localized skin lesions, eye and mouth (20-40% of cases of neonatal herpes, without treatment in 50-70% of infants may go into generalized form or encephalitis, often relapsing within 1 year of life).More aggravated form a CNS - herpes encephalitis (about 30% of neonatal herpes, early clinical signs - at 2-3 weeks of age, 40-60% of patients with no specific rashes on the skin and mucous membranes).With the development of encephalitis mortality is 50% in survivors is a risk of further violations on the part of the central nervous system.The best prognosis observed in localized form, only 7z children suffer in the future from neurological and other complications.And third, the most severe form - disseminated disease involving many organs such as the liver, lungs, and various gland and brain (approximately 20-50% of cases of neonatal herpes, the beginning - at 5- 10 th day of life, clinical symptoms are nonspecificand reminiscent of neonatal sepsis).When this degree of severity of the disease mortality increased to 90%, and the surviving children have certain complications.In the presence of HSV-1 forecast for the life and health is better than with HSV-2 infection.HSV-1 infection usually manifests as a localized form of neonatal herpes.HSV-2 usually causes the development of disseminated forms of infection and herpes encephalitis.
For the prevention of perinatal herpes of all newborns from mothers with genital herpes after birth is necessary to examine cord blood for the presence of HSV in the blood, as well as to determine the titer of antibodies antiherpetic and compare with those of the mother.In identifying the child HSV IgM antibody or antigen, as well as in excess of the level of IgG antibodies in the mother should diagnose neonatal herpes and start spending antiherpethetical and immunostimulatory therapy (immunoglobulin).Therapy of neonatal herpes with acyclovir is performed at a dose of 5 mg / kg body weight every 8 hours for 10 days, the child is required to be hospitalized.
With the development of the baby in the first 6 weeks of life symptoms of encephalitis or septicemia in the presence of infection in the mother gerpetichekoy should always be suspected neonatal herpes and conduct relevant research.Furthermore, even in the absence of laboratory and clinical evidence of neonatal herpes aged 1 month study should be repeated for the detection and determination of the titer of HSV IgM and IgG in the blood of the child.In the case of IgM or 4.3-fold increase in IgG titer should also diagnose neonatal herpes.
Upon confirmation of perinatal herpes for 3 weeks of continuous therapy is performed by intravenous administration of acyclovir regardless of the form of herpes.When properly administered therapy is 50% mortality from disseminated forms of infection, herpetic encephalitis - 14% and is not marked with a localized form of infection.
Thus, in perinatal herpes are the following main points.
Genital herpes in pregnancy - prevention
Prevention of vertical transmission of HSV infection:
Thus, the main provisions of perinatal herpes prevention are:
Identification of pregnant women with the risk of vertical transmission of HSV:
Pregnancy and childbirth at risk of verticaltransmission:
newborn Maintain at risk of vertical transmission of HSV: