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July 7, 1993, Vol 270, No. 1 >
ARTICLE | July 7, 1993

Cesarean Delivery for Women Presenting With Genital Herpes Lesions: Title and subTitle BreakEfficacy, Risks, and Costs FREE

Adrienne G. Randolph, MD; A. Eugene Washington, MD, MSc; Charles G. Prober, MD
[+] Author Affiliations

Reprints not available.


JAMA. 1993;270(1):77-82. doi:10.1001/jama.1993.03510010083035
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References

Objective.  —To assess the effect of cesarean delivery on neonatal and maternal morbidity and mortality and their associated costs for two populations of women presenting with genital herpes lesions at delivery: those with and those without a history of genital herpes.

Data Sources.  —MEDLINE (search for herpes simplex virus and neonatal, cesarean, and mortality) and recognized experts.

Data Extraction.  —The quality of the overall data used for baseline values was graded using a predetermined scale.

Results.  —The practice of cesarean delivery for women with a history of genital herpes lesions that recur at delivery results in more than 1580 excess cesarean deliveries performed for every poor neonatal outcome prevented, a cost per neonatal herpes case averted of $2.5 million and a cost per quality-adjusted life-year gained of $203 000. For these women, lowering the efficacy of cesarean delivery or the herpes simplex virus vertical transmission rate could result in maternal deaths outnumbering neonatal deaths prevented. In contrast, cesarean delivery for women with no history of genital herpes simplex virus who have lesions at delivery has low maternal costs per neonatal benefit and saves money.

Conclusions.  —Women who present with their first clinical episode of genital herpes at delivery should have a cesarean section performed. However, the current practice of cesarean delivery for women with a history of genital herpes lesions that recur at delivery results in high maternal morbidity and mortality at substantial financial expense, underscoring the urgency of examining alternative management strategies.(JAMA. 1993;270:77-82)

REFERENCES

1 +
Chuang T.  Neonatal herpes: incidence, prevention and consequences. Am J Prev Med . 1988;;4:47-53.
2 +
Whitley R, Arvin A, Prober C, et al.  Predictors of morbidity and mortality in neonates with herpes simplex virus infections. N Engl J Med . 1991;;324: 450-454.
3 +
Stone EM, Brooks CA, Guinan ME, Alexander ER.  National surveillance for neonatal herpes simplex virus infections. Sex Transm Dis . 1989;;16:152-156.
4 +
Whitley RJ, Corey L, Arvin A, et al.  Changing presentation of herpes simplex virus infection in neonates. J Infect Dis . 1988;;158:109-116.
5 +
Binkin NJ, Koplan JP.  The high cost and low efficacy of weekly viral cultures for pregnant women with recurrent genital herpes: a reappraisal. Med Decis Making . 1989;;9:225-230.
6 +
Libman MD, Dascal A, Kramer MS, Mendelson J.  Strategies for the prevention of neonatal infection with herpes simplex virus: a decision analysis. Rev Infect Dis . 1991;;13:1093-1104.
7 +
Gibbs RS, Amstey MS, Sweet RL, Mead PB, Sever JL.  Management of genital herpes infection in pregnancy. Obstet Gynecol . 1988;;71:779-780.
8 +
Nahmias AJ, Josey WE, Naib ZM.  Perinatal risk associated with maternal genital herpes simplex virus infection. Am J Obstet Gynecol . 1971;;110:825-837.
9 +
Baldwin S, Whitley RJ.  Teratogen update: intrauterine herpes simplex virus infection. Teratology . 1989;;39:1-10.
10 +
Corey L, Adams HG, Brown ZA, Holmes KK.  Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med . 1983;;98:958-972.
11 +
Brown ZA, Vontver LA, Benedetti J, et al.  Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med . 1987;;317:1246-1251.
12 +
Bujko M, Sulovic V, Sbutega-Milosevic G, Zivanovic V.  Mode of delivery and level of passive immunity against herpes simplex virus. Clin Exp Obstet Gynecol . 1989;;16:6-8.
13 +
Nahmias AJ, Keyserlin HH, Kerrick GM.  Herpes simplex.  In: Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1983;:636-678.
14 +
Pauker SG, Kassirer JP.  Decision analysis. N Engl J Med . 1987;;316:250-258.
15 +
Sullender WM, Yasukawa LL, Schwartz M, et al.  Type specific antibodies to herpes simplex virus type 2 (HSV-2) glycoprotein G in pregnant women, infants exposed to maternal HSV-2 infection at delivery, and infants with neonatal herpes. J Infect Dis . 1988;;157:164-171.
16 +
Boucher FD, Yasukawa LL, Bronzan RN, et al.  A prospective evaluation of primary genital herpes simplex virus type 2 infections acquired during pregnancy. Pediatr Infect Dis J . 1990;;9:499-504.
17 +
Brown ZA, Benedetti J, Ashley R, et al.  Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med . 1991;;324:1247-1252.
18 +
Arvin AM, Hensleigh PA, Prober CG, et al.  Failure of antepartum maternal cultures to predict the infant's risk of exposure to herpes simplex virus at delivery. N Engl J Med . 1986;;315:796-800.
19 +
Corey L, Spear PG.  Infections with herpes simplex viruses, part II. N Engl J Med . 1986;;314:749-757.
20 +
Catalano PM, Merritt AO, Mead PB.  Incidence of genital herpes simplex virus at the time of delivery in women with known risk factors. Am J Obstet Gynecol . 1991;;164:1303-1306.
21 +
Prober CG, Arvin AM.  Genital herpes and the pregnant woman. Curr Clin Top Infect Dis . 1989;;10: 1-26.
22 +
Whitley R, Arvin A, Prober C, et al.  A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection. N Engl J Med . 1991;; 324:444-449.
23 +
The Cesarean Birth Task Force. Cesarean Childbirth . Bethesda, Md: National Institutes of Health; 1981;. Dept of Health and Human Services publication (NIH) 82-2067.
24 +
Bashore RA, Phillips WH, Brinkman CR.  A comparison of the morbidity of midforceps and cesarean delivery. Am J Obstet Gynecol . 1990;;162:1428-1435.
25 +
Danforth DN.  Cesarean section. JAMA . 1985;; 253:811-818.
26 +
Alan Guttmacher Institute. Blessed Events and the Bottom Line: Financing Maternity Care in the United States . New York, NY: Alan Guttmacher Institute; 1987;:18.
27 +
Petitti DB, Cefalo RC, Shapiro BA, et al.  Inhospital maternal mortality in the United States: time trends and relation to method of delivery. Obstet Gynecol . 1982;;59:6-12.
28 +
Arnold CB, ed.  Births by cesarean: cost changes, 1982-83 to 1986. Stat Bull Metrop Insur Co . 1988;;69: 18-25.
29 +
Hospital Fact Book: A Comparison of California and United States Hospital and Health Data . 11th ed. Sacramento, Calif: California Association of Hospitals and Health Systems; 1986;.
30 +
US Bureau of the Census. Statistical Abstract of the US: 1991 .111th ed. Washington, DC: US Government Printing Office; 1991;.
31 +
Chang TW, O'Keefe P.  Cesarean section and genital herpes. N Engl J Med . 1977;;296:573.
32 +
Layde PM, Von Allmen SD, Oakley GP.  Congenital hypothyroidism control programs: a cost-benefit analysis. JAMA . 1979;;241:2290-2292.
33 +
Shankaran S, Cohen SN, Linver M, Zonia S.  Medical care costs of high-risk infants after neonatal intensive care: a controlled study. Pediatrics . 1988;; 81:372-378.
34 +
Weinstein MC, Stason WB.  Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med . 1977;;296:716-721.
35 +
Chuang T-Y, Su WPD, Perry HO, Ilstrup DM, Kurland LT.  Incidence and trend of herpes progenitalis: a 15-year population study. Mayo Clin Proc . 1983;;58:436-441.
36 +
Chang TW, O'Keefe P.  Cesarean section and genital herpes. JAMA . 1977;;296:573.
37 +
Stray-Pederson B.  Acyclovir in late pregnancy to prevent neonatal herpes simplex. Lancet . 1990;;336:756.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Chuang T.  Neonatal herpes: incidence, prevention and consequences. Am J Prev Med . 1988;;4:47-53.
2 +
Whitley R, Arvin A, Prober C, et al.  Predictors of morbidity and mortality in neonates with herpes simplex virus infections. N Engl J Med . 1991;;324: 450-454.
3 +
Stone EM, Brooks CA, Guinan ME, Alexander ER.  National surveillance for neonatal herpes simplex virus infections. Sex Transm Dis . 1989;;16:152-156.
4 +
Whitley RJ, Corey L, Arvin A, et al.  Changing presentation of herpes simplex virus infection in neonates. J Infect Dis . 1988;;158:109-116.
5 +
Binkin NJ, Koplan JP.  The high cost and low efficacy of weekly viral cultures for pregnant women with recurrent genital herpes: a reappraisal. Med Decis Making . 1989;;9:225-230.
6 +
Libman MD, Dascal A, Kramer MS, Mendelson J.  Strategies for the prevention of neonatal infection with herpes simplex virus: a decision analysis. Rev Infect Dis . 1991;;13:1093-1104.
7 +
Gibbs RS, Amstey MS, Sweet RL, Mead PB, Sever JL.  Management of genital herpes infection in pregnancy. Obstet Gynecol . 1988;;71:779-780.
8 +
Nahmias AJ, Josey WE, Naib ZM.  Perinatal risk associated with maternal genital herpes simplex virus infection. Am J Obstet Gynecol . 1971;;110:825-837.
9 +
Baldwin S, Whitley RJ.  Teratogen update: intrauterine herpes simplex virus infection. Teratology . 1989;;39:1-10.
10 +
Corey L, Adams HG, Brown ZA, Holmes KK.  Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med . 1983;;98:958-972.
11 +
Brown ZA, Vontver LA, Benedetti J, et al.  Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med . 1987;;317:1246-1251.
12 +
Bujko M, Sulovic V, Sbutega-Milosevic G, Zivanovic V.  Mode of delivery and level of passive immunity against herpes simplex virus. Clin Exp Obstet Gynecol . 1989;;16:6-8.
13 +
Nahmias AJ, Keyserlin HH, Kerrick GM.  Herpes simplex.  In: Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1983;:636-678.
14 +
Pauker SG, Kassirer JP.  Decision analysis. N Engl J Med . 1987;;316:250-258.
15 +
Sullender WM, Yasukawa LL, Schwartz M, et al.  Type specific antibodies to herpes simplex virus type 2 (HSV-2) glycoprotein G in pregnant women, infants exposed to maternal HSV-2 infection at delivery, and infants with neonatal herpes. J Infect Dis . 1988;;157:164-171.
16 +
Boucher FD, Yasukawa LL, Bronzan RN, et al.  A prospective evaluation of primary genital herpes simplex virus type 2 infections acquired during pregnancy. Pediatr Infect Dis J . 1990;;9:499-504.
17 +
Brown ZA, Benedetti J, Ashley R, et al.  Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med . 1991;;324:1247-1252.
18 +
Arvin AM, Hensleigh PA, Prober CG, et al.  Failure of antepartum maternal cultures to predict the infant's risk of exposure to herpes simplex virus at delivery. N Engl J Med . 1986;;315:796-800.
19 +
Corey L, Spear PG.  Infections with herpes simplex viruses, part II. N Engl J Med . 1986;;314:749-757.
20 +
Catalano PM, Merritt AO, Mead PB.  Incidence of genital herpes simplex virus at the time of delivery in women with known risk factors. Am J Obstet Gynecol . 1991;;164:1303-1306.
21 +
Prober CG, Arvin AM.  Genital herpes and the pregnant woman. Curr Clin Top Infect Dis . 1989;;10: 1-26.
22 +
Whitley R, Arvin A, Prober C, et al.  A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection. N Engl J Med . 1991;; 324:444-449.
23 +
The Cesarean Birth Task Force. Cesarean Childbirth . Bethesda, Md: National Institutes of Health; 1981;. Dept of Health and Human Services publication (NIH) 82-2067.
24 +
Bashore RA, Phillips WH, Brinkman CR.  A comparison of the morbidity of midforceps and cesarean delivery. Am J Obstet Gynecol . 1990;;162:1428-1435.
25 +
Danforth DN.  Cesarean section. JAMA . 1985;; 253:811-818.
26 +
Alan Guttmacher Institute. Blessed Events and the Bottom Line: Financing Maternity Care in the United States . New York, NY: Alan Guttmacher Institute; 1987;:18.
27 +
Petitti DB, Cefalo RC, Shapiro BA, et al.  Inhospital maternal mortality in the United States: time trends and relation to method of delivery. Obstet Gynecol . 1982;;59:6-12.
28 +
Arnold CB, ed.  Births by cesarean: cost changes, 1982-83 to 1986. Stat Bull Metrop Insur Co . 1988;;69: 18-25.
29 +
Hospital Fact Book: A Comparison of California and United States Hospital and Health Data . 11th ed. Sacramento, Calif: California Association of Hospitals and Health Systems; 1986;.
30 +
US Bureau of the Census. Statistical Abstract of the US: 1991 .111th ed. Washington, DC: US Government Printing Office; 1991;.
31 +
Chang TW, O'Keefe P.  Cesarean section and genital herpes. N Engl J Med . 1977;;296:573.
32 +
Layde PM, Von Allmen SD, Oakley GP.  Congenital hypothyroidism control programs: a cost-benefit analysis. JAMA . 1979;;241:2290-2292.
33 +
Shankaran S, Cohen SN, Linver M, Zonia S.  Medical care costs of high-risk infants after neonatal intensive care: a controlled study. Pediatrics . 1988;; 81:372-378.
34 +
Weinstein MC, Stason WB.  Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med . 1977;;296:716-721.
35 +
Chuang T-Y, Su WPD, Perry HO, Ilstrup DM, Kurland LT.  Incidence and trend of herpes progenitalis: a 15-year population study. Mayo Clin Proc . 1983;;58:436-441.
36 +
Chang TW, O'Keefe P.  Cesarean section and genital herpes. JAMA . 1977;;296:573.
37 +
Stray-Pederson B.  Acyclovir in late pregnancy to prevent neonatal herpes simplex. Lancet . 1990;;336:756.

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