Osborne N G, Adelson M D
Health Science Center, State University of New York, Syracuse.
Clin Obstet Gynecol. 1990 Dec;33(4):801-11. doi: 10.1097/00003081-199012000-00014.
Plasma inhibitory factors, high levels of sex hormones, and depression of cell-mediated immunity may interfere with the natural host resistance to viral infections during pregnancy. It is apparent that hormonal, immunologic, and vascular changes in pregnancy may account for increased replication of herpes and for enhanced growth of condylomatous lesions. The challenge is to develop a rational plan of management for pregnant patients with herpes simplex or human papilloma virus infection. There has been a reevaluation of previous recommendations for the management of herpes in pregnancy. Although the consequences of neonatal infection are severe or fatal, the value of routine weekly screening is questionable. This regimen is a poor predictor of neonatal exposure to herpes since only one fourth of women shedding virus at the time of delivery can be identified by routine cultures. The mode of delivery should therefore be based on the presence or absence of lesions at the time of confinement. Cesarean section should be reserved for patients with lesions or with prodromal symptoms of recurrent disease at the time of delivery. Patients with ruptured membranes and active genital lesions should also be delivered by cesarean section. The spectrum of HPV-related diseases in pregnancy is poorly understood. Many questions remain unanswered. It may not be practical to treat very large or extensive genital warts during pregnancy. A cesarean section may be the best choice in these cases. It may be premature to recommend cesarean section for delivery of all pregnant women with symptomatic genital HPV infection. More data are needed. We recommend laser ablation of condylomatous lesions when discovered during pregnancy. Laser vaporization is associated with minimal morbidity when used by experienced surgeons. Trichloroacetic acid is excellent for minimal disease or for treatment of recurrences in pregnancy. Since the immune system seems to play an important role in control of viral disease, we advise pregnant patients to adopt a lifestyle which promotes health. We advise a balanced diet, an appropriate exercise program, and an environment free of unnecessary stress. We suggest avoidance of cigarettes, drugs, and alcohol.
血浆抑制因子、高水平性激素以及细胞介导免疫的抑制，可能会干扰孕期宿主对病毒感染的天然抵抗力。显然，孕期的激素、免疫和血管变化可能是疱疹病毒复制增加以及湿疣病变生长加快的原因。面临的挑战是为患有单纯疱疹或人乳头瘤病毒感染的孕妇制定合理的管理方案。对于孕期疱疹管理的既往建议已进行了重新评估。虽然新生儿感染的后果严重甚至致命，但常规每周筛查的价值值得怀疑。这种方案对新生儿接触疱疹病毒的预测性较差，因为通过常规培养只能识别出四分之一在分娩时排毒的女性。因此，分娩方式应根据分娩时是否存在病变来决定。剖宫产应保留给分娩时有病变或复发性疾病前驱症状的患者。胎膜破裂且有活动性生殖器病变的患者也应行剖宫产。孕期与HPV相关疾病的范围了解甚少。许多问题仍未得到解答。孕期治疗非常大或广泛的尖锐湿疣可能不切实际。在这些情况下剖宫产可能是最佳选择。对于所有有症状的生殖器HPV感染的孕妇推荐剖宫产可能为时过早。需要更多数据。我们建议在孕期发现湿疣病变时进行激光消融。经验丰富的外科医生使用激光汽化时发病率极低。三氯乙酸对于轻微病变或孕期复发的治疗效果极佳。由于免疫系统似乎在控制病毒性疾病中起重要作用，我们建议孕妇采取促进健康的生活方式。我们建议均衡饮食、适当的锻炼计划以及避免不必要压力的环境。我们建议避免吸烟、吸毒和饮酒。
