Document Detail


Herpes simplex and human papillomavirus genital infections: controversy over obstetric management.
MedLine Citation:
PMID:  1963124     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Plasma inhibitory factors, high levels of sex hormones, and depression of cell-mediated immunity may interfere with the natural host resistance to viral infections during pregnancy. It is apparent that hormonal, immunologic, and vascular changes in pregnancy may account for increased replication of herpes and for enhanced growth of condylomatous lesions. The challenge is to develop a rational plan of management for pregnant patients with herpes simplex or human papilloma virus infection. There has been a reevaluation of previous recommendations for the management of herpes in pregnancy. Although the consequences of neonatal infection are severe or fatal, the value of routine weekly screening is questionable. This regimen is a poor predictor of neonatal exposure to herpes since only one fourth of women shedding virus at the time of delivery can be identified by routine cultures. The mode of delivery should therefore be based on the presence or absence of lesions at the time of confinement. Cesarean section should be reserved for patients with lesions or with prodromal symptoms of recurrent disease at the time of delivery. Patients with ruptured membranes and active genital lesions should also be delivered by cesarean section. The spectrum of HPV-related diseases in pregnancy is poorly understood. Many questions remain unanswered. It may not be practical to treat very large or extensive genital warts during pregnancy. A cesarean section may be the best choice in these cases. It may be premature to recommend cesarean section for delivery of all pregnant women with symptomatic genital HPV infection. More data are needed. We recommend laser ablation of condylomatous lesions when discovered during pregnancy. Laser vaporization is associated with minimal morbidity when used by experienced surgeons. Trichloroacetic acid is excellent for minimal disease or for treatment of recurrences in pregnancy. Since the immune system seems to play an important role in control of viral disease, we advise pregnant patients to adopt a lifestyle which promotes health. We advise a balanced diet, an appropriate exercise program, and an environment free of unnecessary stress. We suggest avoidance of cigarettes, drugs, and alcohol.
Authors:
N G Osborne; M D Adelson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical obstetrics and gynecology     Volume:  33     ISSN:  0009-9201     ISO Abbreviation:  Clin Obstet Gynecol     Publication Date:  1990 Dec 
Date Detail:
Created Date:  1991-04-03     Completed Date:  1991-04-03     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0070014     Medline TA:  Clin Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  801-11     Citation Subset:  IM    
Affiliation:
Health Science Center, State University of New York, Syracuse.
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MeSH Terms
Descriptor/Qualifier:
Female
Herpes Genitalis / diagnosis,  drug therapy*
Humans
Infant, Newborn
Papillomaviridae*
Pregnancy
Pregnancy Complications, Infectious / diagnosis,  therapy*
Tumor Virus Infections / diagnosis,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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