acyclovir and Fetal-Membranes--Premature-Rupture

Identify measures to diagnose, prevent and treat genital herpes infection during pregnancy and childbirth and neonatal infection.. Bibliographic search from Medline, Cochrane Library databases and research of international clinical practice guidelines.. Genital herpes lesion is most often due to HSV2 (LE2). The risk of HSV seroconversion during pregnancy is 1 to 5% (LE2). Genital herpes ulceration during pregnancy in a woman with history of genital herpes corresponds with a recurrence. In this situation, there is no need for virologic confirmation (grade B). In case of genital lesions in a pregnant woman that do not report any genital herpes before, it is recommended to perform a virological confirmation by PCR and HSV type specific IgG (Professional consensus). In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200mg 5 times daily) or valacyclovir (1000mg twice daily) for 5 to 10 days is recommended (grade C). In case of recurrent herpes during pregnancy, antiviral therapy with acyclovir (200mg 5 times daily) or valacyclovir (500mg twice daily) can be administered (grade C). The risk of neonatal herpes is estimated between 25% and 44% in case of initial episode (LE2) and 1% in case of recurrence (LE3) at the time of delivery. Antiviral prophylaxis should be offered for women with first episode genital herpes or recurrent genital herpes during pregnancy from 36 weeks of gestation and until delivery (grade B). In case of a history of genital herpes without episode of recurrence during pregnancy, it is not recommended routinely offer a prophylactic treatment (professional consensus). A cesarean section should be performed if there is a suspicion of first episode genital herpes at the onset of labor (grade B), in the event of premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In case of recurrent genital herpes at the onset of labor, cesarean delivery will be all the more considered if the membranes are intact and vaginal delivery will be all the more considered in case of prolonged rupture of membranes (professional consensus). Neonatal herpes is rare and mainly due to HSV-1 (LE3). In most of the case of neonatal herpes, the mothers have no history of genital herpes (LE 3). In case of suspicion of neonatal herpes, different samples (blood and cerebrospinal fluid) for HSV PCR must be carried out to confirm the diagnosis (professional consensus). Any newborn suspected of neonatal herpes should be treated with intravenous acyclovir (60mg/kgs/day 3 times daily) (grade A) prior to the results of HSV PCR (professional consensus). The duration of the t

Topics: Acyclovir; Antiviral Agents; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Gestational Age; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; MEDLINE; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Risk Factors; Serotyping

We report a case of non-immune hydrops fetalis (NIHF) caused by herpes simplex virus type 2 (HSV-2) in an infant whose mother had recurrent HSV-2 infection. In spite of prematurity, severe disseminated infection and hydrops, the infant survived and was neurologically intact. HSV-2-induced NIHF is extremely rare, particularly in the setting of recurrent maternal infection, and this case is, to our knowledge, the first report of a surviving infant. HSV-2 should be considered in the differential diagnosis of NIHF and early initiation of empiric acyclovir therapy is recommended in this setting, pending the results of virologic diagnostic tests.

Topics: Acyclovir; Antiviral Agents; Extraembryonic Membranes; Female; Fetal Membranes, Premature Rupture; Herpes Genitalis; Humans; Hydrops Fetalis; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Young Adult

Maternal human immunodeficiency virus (HIV) and genital herpes simplex virus (HSV) infection in pregnancy have potential for vertical transmission that may result in death or morbidity. The risk increases with preterm delivery and prolonged ruptured membranes. When managing preterm premature rupture of membranes, the risk of transmission must be weighed against the risk of prematurity. Before 32 to 34 weeks, expectant management is preferred for patients with well controlled HIV or recurrent active genital HSV infection. For patients with advanced HIV disease or primary genital HSV infection, the risk of vertical transmission is higher and many clinical factors need to be considered.

Topics: Acyclovir; Antiretroviral Therapy, Highly Active; Antiviral Agents; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Herpes Genitalis; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Pregnancy; Time Factors; Viral Load

Acyclovir (ACV) given to HSV-2 positive women after 36 weeks reduces adverse outcomes but its benefit at lower gestation was undocumented. We determined the effect of oral acyclovir administered from 28 to 36 weeks on premature rupture of membranes (PROM) primarily and preterm delivery risk.. This was a randomized, double-blind placebo-controlled trial among 200 HSV-2 positive pregnant women at 28 weeks of gestation at Mulago Hospital, Uganda. Participants were assigned randomly (1:1) to take either acyclovir 400 mg orally twice daily (intervention) or placebo (control) from 28 to 36 weeks. Both arms received acyclovir after 36 weeks until delivery. Development of Pre-PROM by 36 weeks and preterm delivery were outcomes.. One hundred women were randomised to acyclovir and 100 to placebo arms between January 2014 and February 2015. There was tendency towards reduction of incidence of PROM at 36 weeks but this was not statistically significant (4.0% versus 10.0%; RR 0.35; 95% 0.11-1.10) in the acyclovir and placebo arms respectively. However, there was a significant reduction in the incidence of preterm delivery (11.1% versus 23.5%; RR 0.41; 95% 0.20-0.85) in the acyclovir and placebo arms respectively.. Oral acyclovir given to HSV-2 positive pregnant women from 28 to 36 weeks reduced incidence of preterm delivery but did not significantly reduce incidence of pre-PROM.. www.pactr.org, PACTR201311000558197 .

Topics: Acyclovir; Adult; Antiviral Agents; Delivery, Obstetric; Double-Blind Method; Female; Fetal Membranes, Premature Rupture; Gestational Age; Herpes Genitalis; Herpesvirus 2, Human; Humans; Infant, Newborn; Mothers; Pregnancy; Premature Birth; Uganda

The diagnosis of preterm premature rupture of membranes (PROM) is based on pooling, ferning, and Nitrazine tests; definitive diagnosis is made with a blue dye test.. A 21-year-old woman, gravida 1 para 0, at 25 5/7 weeks of gestation was admitted for preterm PROM with positive findings of pooling, Nitrazine, and ferning. Her cervix was bluish with white plaques. Amniotic fluid volume was normal. On hospital day 8, her discharge ceased; examination was negative for pooling, Nitrazine, and ferning. A blue dye tampon test was negative. A Pap test result from her hospitalization returned consistent with herpes infection.. The diagnosis of preterm PROM should be constantly reevaluated in the setting of a normal amniotic fluid volume.

Topics: Acyclovir; Adult; Amniotic Fluid; Antiviral Agents; Diagnosis, Differential; Female; Fetal Membranes, Premature Rupture; Gynecological Examination; Herpes Genitalis; Humans; Papanicolaou Test; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Reproducibility of Results; Uterine Cervicitis; Valacyclovir; Valine

A fatal case of fulminant hepatic failure that occurred in the neonatal period is reported in a premature infant born after 27 4/7-weeks' gestation. Immediately after birth the infant had severe hypoxia and hypotension resulting from birth asphyxia, hypovolemic shock, and septicemia. At autopsy, histological appearance of the liver showed virtually total hepatocellular necrosis without features of fibrosis. Although the exact cause of hepatocellular injury cannot be fully ascertained, it is assumed that hypoxia and hypotension must have been the predominant factors leading to massive hepatic necrosis.

Topics: Acyclovir; Alanine Transaminase; Aspartate Aminotransferases; Bicarbonates; Cloxacillin; Dopamine; Female; Fetal Hypoxia; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature, Diseases; Liver; Male; Necrosis; Netilmicin; Pancuronium; Partial Thromboplastin Time; Penicillins; Pregnancy; Prothrombin Time; Sepsis; Shock; Sodium; Sodium Bicarbonate

Amniotic band syndrome, which is frequently seen in association with prolonged rupture of membranes, is due to the amnion forming fibrous strands that encircle fetal parts. This causes compression and necrosis of the underlying skin. We report a case of herpes simplex virus infection localized to these lesions.

Topics: Acyclovir; Amniotic Band Syndrome; Female; Fetal Membranes, Premature Rupture; Herpesviridae Infections; Humans; Infant, Newborn; Injections, Intravenous; Pregnancy; Skin Diseases, Infectious

A case of primary herpes simplex vaginitis during pregnancy became complicated by rupture of membranes at 25.5 weeks' gestation. The patient was treated with intravenous acyclovir shortly after rupture, and managed expectantly. Genital lesions rapidly abated, and the infant was delivered by cesarean section at 26.5 weeks' gestation after labor ensued. Transplacental passage of acyclovir was documented. The infant then was treated with a ten-day course of intravenous acyclovir. The infant has remained culture negative for 12 months after delivery.

Topics: Acyclovir; Adult; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Herpes Genitalis; Humans; Infant, Newborn; Infant, Premature; Pregnancy; Pregnancy Complications, Infectious