Outbreak during pregnancy

Genital herpes and pregnancy: Understanding the risks | Your Pregnancy Matters

Be honest with your doctor about your history with herpes – or if you suspect you may have herpes. This allows them to take additional precautions beyond what they might normally provide during pregnancy, labor, and delivery to safeguard your baby from contracting the virus.

Genital herpes is one of the most common health conditions in the U.S. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 6 people between the ages of 14 and 49 have it. Approximately 22% of pregnant women in the U.S. have genital herpes. Two percent contract it during pregnancy – that's 1 in 50 pregnant women.

Two viral strains can cause genital herpes. HSV-2 (herpes simplex virus) is the most common and typically spreads through sexual contact. HSV-1, which is best known for causing cold sores, can also produce genital lesions (blisters or open sores). More than half of adults in America get HSV-1 at some point in their lives.

Herpes is generally manageable in adults. However, it can cause serious health problems in newborns. During delivery, your baby may be exposed to the virus, even if you are not having an outbreak.

Herpes infection occurs in less than 1% of births, but it can cause severe illness in newborns, such as:

Blindness
Deafness
Seizures
Serious infections, such as viral meningitis
Recurrent sores on the skin, eyes, genitals, or mouth
organ damage, including to the liver, lungs, and heart

Tell your doctor if you or your partner have herpes or if you may have been exposed. By knowing, we can take extra precautions to reduce your baby's risk of infection during delivery and in their first few weeks at home. If you’re not certain but think you may have had herpes in the past, we can do a blood test to determine whether you have had the infection.

If you are concerned about privacy, we will note in your chart not to discuss the condition in front of anyone at your appointments – we are happy to accommodate this common request.

"Tell your doctor if you or your partner have herpes or if you may have been exposed. By knowing, we can take extra precautions to reduce your baby's risk of infection during delivery and in their first few weeks at home."
Robyn Horsager-Boeher, M.D.

How can I manage herpes during pregnancy?

There is no evidence to suggest pregnancy causes flare-ups. The American College of Obstetricians and Gynecologists says 75% of pregnant women who have herpes, however, can expect to have an outbreak during pregnancy.

During pregnancy, you should watch for symptoms of the virus becoming active, such as tingling, itching, or burning around where the sore will eventually appear.

If you have a history of herpes (or your blood test is positive), your provider may prescribe an antiviral medication such as acyclovir (Valtrex) to reduce the risk of spreading the virus or having an outbreak around the time of your delivery.

We typically recommend starting an antiviral at 36 weeks or sooner if you are at risk for preterm birth. The antiviral medications are safe during pregnancy. In fact, we can give the same medications to your baby if needed.

Will I need a C-section if I have herpes?

A cesarean (C-section) can’t completely prevent herpes transmission. But it does substantially decrease the risk to your baby if you have a lesion or report typical symptoms by bypassing contact with the vagina and labia.

Once you go into labor, we’ll carefully examine you for genital lesions. If we see something suspicious, we will recommend a C-section.

If you have no symptoms and no sores in the genital region, a vaginal delivery may be safe. Lesions can sometimes appear in other areas, such as the legs or back. If this is the case, we’ll cover them to make sure the baby doesn’t come into contact with them.

How can I protect my newborn from getting herpes?

If your partner has herpes and you don’t, do not have sex and oral sex the last few weeks of pregnancy. Condoms can reduce the risk of transmission but aren’t 100% effective. There’s no reason to risk a new infection close to delivery.

In the unlikely event your baby has been exposed, we’ll treat the baby with antiviral medications. HSV can’t be passed through breast milk, so unless you have sores or lesion on your breasts, breastfeeding is safe.

With visitors, do not allow anyone who has a cold sore or has had one recently to hold your baby. Same goes for people who have a cold or virus. Insist that anyone who wants to hold or touch your newborn wash their hands first – this should be the norm anyway due to COVID-19.

Genital herpes is a common condition, and we are well-equipped to help reduce your baby's risks. If you or your partner has a history of herpes, talk with your Ob/Gyn. We are eager to help you have a safe pregnancy and delivery.

To visit with an Ob/Gyn, call 214-645-8300 or request an appointment online.

Herpes & Pregnancy – American Sexual Health Association

If a woman with genital herpes has virus present in the birth canal during delivery, herpes simplex virus (HSV) can be spread to an infant, causing neonatal herpes, a serious and sometimes fatal condition. Neonatal herpes can cause an overwhelming infection resulting in lasting damage to the central nervous system, mental retardation, or death. Medication, if given early, may help prevent or reduce lasting damage, but even with antiviral medication, this infection has serious consequences for most infected infants.

While neonatal herpes is a serious condition, it is also very rare. Less than 0.1% of babies born in the United States each year get neonatal herpes. By contrast, some 20-25% of pregnant women have genital herpes. This means that most women with genital herpes give birth to healthy babies.

Understanding the Risk

Babies are most at risk for neonatal herpes if the mother contracts genital herpes late in pregnancy. This is because a newly infected mother does not have antibodies against the virus, so there is no natural protection for the baby during birth. In addition, a new herpes infection is frequently active, so there is an increased possibility the virus will be present in the birth canal during delivery.

Women who have genital herpes before they become pregnant have a very low risk of transmitting the virus to their babies. This is because their immune systems make antibodies that are temporarily passed to the baby through the placenta. Even if herpes is active in the birth canal during delivery, the antibodies help protect the baby. In addition, if a mother knows she has genital herpes, her doctor or midwife can take steps to protect the baby.

Herpes can also be spread to the baby in the first weeks of life if he or she is kissed by someone with an active cold sore (oral herpes). In rare instances, herpes may be spread by touch, if someone touches an active cold sore and then immediately touches the baby. Again, simple precautions can be taken to protect an infant from this type of exposure. To protect your baby, don’t kiss him or her when you have a cold sore, and ask others not to. If you have a cold sore, wash your hands before touching the baby.

Managing Genital Herpes During Pregnancy

If you’re pregnant and you have genital herpes, you may be concerned about the risk of spreading the infection to your baby. Be reassured that the risk is extremely small—especially if you have had herpes for some time. The following steps can help make the risk even smaller:

Talk with your obstetrician or midwife. Make sure they know you have genital herpes.
At the time of labor, your healthcare provider should examine you early in labor with a strong light to detect any sores or signs of an outbreak. Let your provider know if you have any signs of an outbreak—itching, tingling, or pain.
If you have an active outbreak at the time of delivery, the safest course is a Cesarean section to prevent the baby from coming into contact with virus in the birth canal. If you do not have an active outbreak, you can have a vaginal delivery.
Ask your provider not to break the bag of waters around the baby unless necessary. The bag of waters may help protect the baby against any virus in the birth canal.
Ask your provider not to use a fetal scalp monitor (scalp electrodes) during labor to monitor the baby’s heart rate unless medically necessary. This instrument makes tiny punctures in the baby’s scalp, which may allow herpes virus to enter. In most cases, an external monitor can be used instead.
Ask that a vacuum or forceps not be used during delivery unless medically necessary. These instruments can also cause breaks in the baby’s scalp, allowing virus to enter.
After birth, watch the baby closely for about three weeks. Symptoms of neonatal herpes may include a skin rash, fever, crankiness, or lack of appetite. While these can be symptoms of several mild illnesses, don’t wait to see if your baby will get better. Take him or her to the pediatrician at once. Be sure to tell the pediatrician you have genital herpes.

Remember, the odds are strongly in favor of your having a healthy baby.

Treatment while Pregnant

Many women wonder about taking antiviral medication during pregnancy to suppress outbreaks in the third trimester. The U.S. Food and Drug Administration (FDA) has approved no drug against herpes for this purpose. Nonetheless, acyclovir is used by some physicians to treat women with genital herpes at the end of pregnancy. Small studies suggest that acyclovir taken daily during the last month of pregnancy will prevent recurrences and, therefore, decrease the need for Cesarean sections, but some experts remain concerned about the safety of fetal exposure to the medication.

At the present time, acyclovir’s manufacturer does not recommend its use during pregnancy. On the other hand, the company has tracked the experiences of several hundred women who took the drug during pregnancy, some of them inadvertently, and the evidence to date suggests that acyclovir does not carry increased risk of birth defects or adverse pregnancy outcome. On the strength of this data, the use of daily, suppressive treatment during the last month of pregnancy is becoming increasingly common.

Women who Don’t Have Genital Herpes

The greatest risk of neonatal herpes is to babies whose mothers contract a genital infection late in pregnancy. While this is a rare occurrence, it does happen, and can cause a serious, even life-threatening, illness for the baby. The best way you can protect your baby is to know the facts about HSV and how to protect yourself. The first step may be finding out whether you already carry the virus.

You can talk to your healthcare provider about testing for genital herpes. If you test negative for genital herpes, but your partner has genital or oral herpes, you may acquire it unless you take steps to prevent transmission. The following steps can help protect you from getting an infection during pregnancy:

If your partner has genital herpes, abstain from sex during active outbreaks. Between outbreaks, use a condom from start to finish every time you have sexual contact, even if your partner has no symptoms. (HSV can spread when no symptoms are present.) Consider abstaining from sex (oral, vaginal, and anal) during the last trimester.
Do not let your partner perform oral sex on you if your partner has an oral herpes (cold sores, fever blisters). This can give you genital herpes.
If you don’t know whether your partner has genital HSV, you may wish to ask your partner to be tested.
If you experience genital symptoms, or believe you have been exposed to genital HSV, tell your obstetrician or midwife at once. However, be aware that herpes can lie dormant for several years. What appears to be a new infection is occasionally an old one that is causing symptoms for the first time. Talk with your provider about the best way to protect your baby.
When a pregnant woman does contract a new genital HSV infection during the last trimester, many providers will prescribe antiviral medication. If lesions or prodromal symptoms are present at the time of labor, a Cesarean section is the safest course to prevent the baby from coming into contact with virus in the birth canal. If the infection is acquired late in pregnancy, many providers would recommend a Cesarean section even without lesions present.

Preeclampsia and pregnancy | Ida-Tallinna Keskhaigla

The purpose of this leaflet is to provide the patient with information about the nature, occurrence, risk factors, symptoms and treatment of preeclampsia.

What is preeclampsia?

Pre-eclampsia is a disease that occurs during pregnancy and is characterized by high blood pressure and protein in the urine. Preeclampsia is one of the most common complications of pregnancy. Epilepsy-like seizures occur in severe preeclampsia and are life-threatening.

What symptoms may indicate the development of preeclampsia?

High blood pressure - blood pressure values are 140/90 mmHg. Art. or higher. If systolic (upper) or diastolic (lower) blood pressure rises by 30 mm Hg. Art. or more, then such an increase cannot be ignored.

Protein in urine - 300 mg in urine collected over 24 hours, or +1 value on a rapid test.

Swelling of the arms, legs or face , especially under the eyes or if the swelling leaves a depression in the skin when pressed. Edema can occur in all pregnant women and is generally harmless, but rapidly developing edema should be taken into account.

Headache that does not improve after taking pain medication.

Visual disturbances - double vision or blurred vision, dots or flashes before the eyes, auras.

Nausea or pain in the upper abdomen - These symptoms are often mistaken for indigestion or gallbladder pain. Nausea in the second half of pregnancy is not normal.

Sudden weight gain - 2 kg or more per week.

As a rule, there is a mild course of the disease that occurs at the end of pregnancy and has a good prognosis. Sometimes, preeclampsia can worsen quickly and be dangerous to both mother and fetus. In such cases, rapid diagnosis and careful monitoring of the mother and child are of paramount importance.

Unfortunately, most women show symptoms in the final stages of the disease. If you experience any of the above symptoms, you should contact your midwife, gynecologist, or the Women's Clinic emergency department.

Is preeclampsia called toxemia of pregnancy?

Previously, pre-eclampsia was really called toxicosis, or toxemia, since it was believed that the cause of the disease was toxins, that is, poisons in the blood of a pregnant woman.

What is the difference between preeclampsia and gestational hypertension?

Pregnancy hypertension is an increase in blood pressure above normal after the 20th week of pregnancy. With hypertension of pregnant women, protein in the urine is not observed.

What is HELLP syndrome?

HELLP syndrome is one of the most severe forms of preeclampsia. HELLP syndrome is rare and sometimes develops before symptoms of preeclampsia appear. Sometimes the syndrome is difficult to diagnose, as the symptoms resemble gallbladder colic or a cold.

When does preeclampsia occur?

Preeclampsia usually occurs after the 20th week of pregnancy. As a rule, preeclampsia goes away after delivery, but complications can occur up to six weeks after delivery, during which careful monitoring of the condition is necessary. If by the sixth week after birth, blood pressure does not return to normal, then you need to contact a cardiologist, who will begin treatment against hypertension.

What is the cause of preeclampsia?

The causes of the disease are still not clear, there are only unproven hypotheses.

How does the disease affect pregnant women and pregnancy?

Most preeclamptic pregnancies have a favorable outcome and a healthy baby is born. However, the disease is very serious and is one of the most common causes of death of the child and mother. Preeclampsia affects a woman's kidneys, liver, and other vital organs, and if left untreated, it can cause seizures (eclampsia), cerebral hemorrhage, multiple organ failure, and death.

How does the disease affect the fetus?

In preeclampsia, the fetus does not receive enough oxygen and nutrients to grow, and intrauterine growth retardation may occur. In addition, the placenta may separate from the uterine wall before the baby is born. Since the only treatment for preeclampsia is childbirth, sometimes a pregnancy has to be terminated prematurely. Until the 34th week of pregnancy, the lungs of the fetus have not yet matured, and steroid hormones are administered intravenously to the pregnant woman to prepare her lungs. In addition to the immaturity of the lungs, the health of a premature baby is threatened by many other diseases.

Who is at risk of developing preeclampsia?

Preeclampsia occurs in approximately 8% of pregnant women, many of whom have no known risk factors.

What are the risk factors for preeclampsia?

Patient-related risk factors

First pregnancy
Pre-eclampsia during a previous pregnancy
Age over 40 or under 18
High blood pressure before pregnancy
Diabetes before or during pregnancy
Multiple pregnancy
Overweight (BMI> 30)
Systemic lupus erythematosus or other autoimmune disease
Polycystic ovary syndrome
Long interval between two pregnancies

Risk factors associated with the patient's family

What is the prevention and treatment of preeclampsia

During the first trimester screening, or Oscar test, in addition to the most common chromosomal diseases, the risk of preeclampsia is also calculated. In case of high risk, pregnant women are advised to take aspirin (acetylsalicylic acid) at a dose of 150 mg in the evenings until the 36th week of pregnancy. This helps reduce the chance of preeclampsia by the 34th week of pregnancy by up to 80%.

Childbirth is the only treatment for preeclampsia. Sometimes a child can be born naturally, but sometimes, if the disease is very acute, an emergency caesarean section is necessary. The best time to have a baby is after the 37th week of pregnancy. Bed rest, medications, and, if necessary, hospitalization can sometimes help bring the condition under control and prolong the pregnancy. Often, a doctor will refer a woman with preeclampsia to the hospital for observation, as the condition of the fetus and pregnant woman may suddenly worsen.

Does bed rest help?

Sometimes bed rest is enough to bring mild preeclampsia under control. In this case, the patient often visits a doctor who measures blood pressure, does blood and urine tests, and monitors the course of the disease. The condition of the fetus is also often examined using a cardiotocogram (CTG) and ultrasound.

Are drugs used to treat preeclampsia?

High blood pressure sometimes requires medication. The medications used have few side effects, the drugs prescribed do not have much effect on the fetus, but are very important in the treatment of maternal high blood pressure.

Seizures are a rare but very serious complication of preeclampsia. Magnesium sulfate is sometimes given intravenously to prevent seizures in a pregnant woman with preeclampsia both during and after childbirth. It is safe for the fetus, but the mother may experience side effects such as hot flashes, sweating, thirst, visual disturbances, mild confusion, muscle weakness, and shortness of breath. All these side effects disappear when the drug is discontinued.

Can preeclampsia recur?

Preeclampsia does not necessarily recur in the next pregnancy, but the main risk factor for preeclampsia is the presence of preeclampsia in a previous pregnancy(s). Risk factors for relapse include the severity of the previous case and the woman's overall health during pregnancy. A woman who has previously had preeclampsia should consult a gynecologist during a new pregnancy or when planning a pregnancy.

ITK1013
The information material was approved by the Health Services Quality Committee of East-Tallinn Central Hospital on 27.01.2021 (Minutes No. 2-21).

what to do with outbursts of bad mood if you are expecting a baby be upset - this is just the anger of pregnant women and you can survive it.

It is normal for a pregnant woman to be a little irritable. Nausea, swelling, a change in taste preferences, a heightened sense of smell, trips to the toilet every 15 minutes - it’s quite forgivable to sometimes be upset because of this. But if rage takes over you, floods you completely and you can’t cope with it in any way - this is the anger of pregnant women.

OB/GYN and Verwell Health expert Jessica Shepard, in her commentary for Romper, explained that the reason for uncontrollable rage during pregnancy is the change in the amount of estrogen and progesterone.

At least not uncommon. Approximately every seventh pregnant woman is faced with the fact that her mood is seriously changing. Dr. Lauren Demosthenes, OB/GYN and chief medical expert for pregnancy app Babyscripts, says: “Adapting to pregnancy can be physically and emotionally stressful. Pregnancy entails changes in the body, sometimes causes sleep disturbance and much more.

Anger is the strongest emotion one can feel about this.

Interesting topics

Hatred, nocturnal orgasms and other unexpected effects of pregnancy that are not usually talked about

Experts say that the chances of feeling the anger of pregnant women are especially high in the first trimester, since it (and the beginning of the second trimester) account for the most serious hormonal changes.

However, hormones can make women angry late in pregnancy and even some time after childbirth.

Your hands are shaking, your eyes are getting dark, your heart is pounding - of course, this is also felt by the fetus in the womb. Mood disorders during pregnancy can lead to slow fetal growth. These babies sometimes have a less regular sleep pattern after birth and get less sleep.

If you do not pay attention to your condition and do not regulate it in any way, the anger of pregnant women can smoothly flow into postpartum depression.

Nobody expects you to be constantly happy during pregnancy. But if feelings are difficult to control, it is better to tell your doctor about them right away. A gynecologist can refer you to a psychotherapist or psychiatrist, and then they will figure out whether psychotherapy can be dispensed with or drugs are needed.

Try to normalize your routine: sleep more, walk, rest. In addition, support can be found from relatives, antenatal groups, or online forums for mothers-to-be. Try to get your anger under control with meditation, yoga, breathing exercises, and other anti-stress practices.

See a psychologist: the support of a competent specialist will help reduce symptoms (although, of course, will not take control of raging hormones).

The most important thing: do not blame yourself for what is happening.

No one is safe from this, and your feeling of guilt makes you more vulnerable, shakes your nervous system, which is not very stable now.