Cleary Kirsten Lawrence, Paré Emmanuelle, Stamilio David, Macones George A
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, USA.
BJOG. 2005 Jun;112(6):731-6. doi: 10.1111/j.1471-0528.2005.00540.x.
To evaluate the merits of serum screening for herpes simple virus (HSV) in pregnant women with no history of prior HSV infection.
Clinical decision analysis.
Hypothetical cohort of pregnant women in first trimester with no clinical history of HSV infection.
We used decision analysis techniques to compare three strategies for antepartum screening for HSV in women with no history of infection: (1) universal screening; (2) targeted screening in women estimated to be at high risk for infection; and (3) current care (no screening). For the screening strategies, we considered screening at 35 weeks of gestation, with prophylactic antiviral therapy for seropositive women. For all women, we assumed caesarean delivery in the setting of symptomatic infection at delivery. We performed a literature review of English-language publications to derive probability estimates for the rate of HSV seropositivity in asymptomatic pregnant women, and the risks of symptomatic HSV infection and asymptomatic shedding at the time of delivery. We determined the modification of rates of viral shedding, symptomatic lesions and caesarean section with the use of prophylactic suppression therapy for seropositive women based on available data. We chose neonatal herpes with severe sequelae, neonatal death, as well as caesarean delivery as clinically relevant outcomes.
Number of cases of neonatal death, neonatal HSV with severe sequelae, neonatal HSV with moderate sequelae, patients screened, patients treated and caesarean section with each strategy.
Universal maternal screening reduced the total number of deaths and severe sequelae secondary to neonatal HSV. Universal screening required treatment of 3849 women to prevent one case of neonatal death or disease with severe sequelae from HSV. Targeted screening of high risk women treatment of 2277 women to prevent one death or case of severe disease. Universal screening reduced the rate of neonatal HSV attributable to recurrent HSV by 79.3%. Caesarean delivery was reduced with both screening strategies. We used one-way sensitivity analyses to evaluate the robustness of our model.
Maternal screening reduced the number of cases of neonatal HSV. Screening also reduced the rate of caesarean delivery. However, employing universal screening will likely result in a significant expenditure of medical resources because the number needed to treat to avert a single case of neonatal herpes is high.
评估对无单纯疱疹病毒（HSV）既往感染史的孕妇进行血清学筛查的益处。
临床决策分析。
假设的孕早期无HSV感染临床病史的孕妇队列。
我们采用决策分析技术比较了对无感染史女性进行产前HSV筛查的三种策略：（1）普遍筛查；（2）对估计感染风险高的女性进行针对性筛查；（3）当前的医疗方式（不筛查）。对于筛查策略，我们考虑在妊娠35周时进行筛查，对血清学阳性的女性给予预防性抗病毒治疗。对于所有女性，我们假设在分娩时有症状性感染的情况下进行剖宫产。我们对英文出版物进行了文献综述，以得出无症状孕妇中HSV血清学阳性率、分娩时症状性HSV感染和无症状排毒风险的概率估计。我们根据现有数据确定了对血清学阳性女性使用预防性抑制治疗对病毒排毒率、症状性病变和剖宫产率的影响。我们选择有严重后遗症的新生儿疱疹、新生儿死亡以及剖宫产作为临床相关结局。
每种策略下的新生儿死亡病例数、有严重后遗症的新生儿HSV病例数、有中度后遗症的新生儿HSV病例数、筛查的患者数、接受治疗的患者数以及剖宫产数。
普遍的孕产妇筛查减少了新生儿HSV继发的死亡和严重后遗症总数。普遍筛查需要治疗3849名女性才能预防1例因HSV导致的新生儿死亡或有严重后遗症的疾病。对高危女性进行针对性筛查需要治疗2277名女性才能预防1例死亡或严重疾病病例。普遍筛查使复发性HSV导致的新生儿HSV发生率降低了79.3%。两种筛查策略均降低了剖宫产率。我们进行了单向敏感性分析以评估我们模型的稳健性。
孕产妇筛查减少了新生儿HSV病例数。筛查还降低了剖宫产率。然而，采用普遍筛查可能会导致大量医疗资源的支出，因为避免1例新生儿疱疹所需治疗的人数较多。
