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Primary Genital Herpes Simplex Virus Type I in Preterm Prelabour Rupture of Membranes at 30 Weeks Gestation

机译:妊娠30周时胎膜早破引起的原发性生殖器单纯疱疹病毒I型

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摘要

Background. Disseminated herpes simplex virus (HSV) in the neonate is associated with significant morbidity and mortality. Current guidelines recommend caesarean in third-trimester maternal primary genital HSV outbreaks to prevent transmission from mother to fetus. In the premature fetus, however, expectant management is often necessary to reduce morbidity of prematurity. The benefit of performing caesarean after 6 hrs of rupture of membranes (ROM) to reduce maternal-fetal transmission is unclear. Case. A female patient with primary genital HSV type 1 outbreak coinciding with preterm, prelabour rupture of membranes (PPROM) at 30 + 3 weeks' gestation. An immediate caesarean section was not performed after multidisciplinary team discussion due to the benefits of glucocorticoids on immune complications of prematurity. The patient had expectant management for 5 days with intravenous (IV) aciclovir and then delivered an infant vaginally with disseminated neonatal HSV. Conclusion. We address the rare presentation of primary HSV infection associated with PPROM and the dilemma of how to manage these patients given the limited literature. We discuss the role of intrauterine compartment monitoring with amniocentesis, the mode of delivery when ROM has occurred for 120 hours, expectant management to reduce prematurity, and the effectiveness of aciclovir to reduce viral shedding in the prevention of neonatal HSV.
机译:背景。新生儿中传播的单纯疱疹病毒(HSV)与明显的发病率和死亡率相关。目前的指南建议在孕晚期孕妇原发性HSV暴发中进行剖腹产,以防止从母亲传播给胎儿。然而,在早产胎儿中,经常需要进行预期管理以减少早产儿的发病率。膜破裂(ROM)6小时后进行剖腹产以减少母婴传播的益处尚不清楚。案件。一名女性女性,原发性生殖器1型HSV暴发,在妊娠30 + 3周时与胎膜早破(PPROM)相吻合。由于糖皮质激素对早产儿免疫并发症的益处,在多学科小组讨论之后未进行立即剖腹产。患者使用静脉(IV)阿昔洛韦进行了预期的治疗,为期5天,然后将婴儿播散了新生儿HSV并阴道分娩。结论。在文献有限的情况下,我们解决了与PPROM相关的原发性HSV感染的罕见表现,以及如何处理这些患者的难题。我们讨论了羊膜腔穿刺术对子宫腔室监测的作用,ROM发生120小时时的分娩方式,预期管理以减少早产,以及阿昔洛韦在预防新生儿HSV中减少病毒脱落的有效性。

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