Brocklehurst P, Carney O, Ross E, Mindel A
Academic Department of Genitourinary Medicine, Middlesex Hospital, London, UK.
Br J Obstet Gynaecol. 1995 Oct;102(10):791-7. doi: 10.1111/j.1471-0528.1995.tb10844.x.
To determine clinical practice amongst obstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection.
All Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection.
There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81%) routinely examined the genitals for evidence of a recurrence. When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (chi 2 = 30.38, P < 0.0001). Five hundred and ninety-six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture. The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for caesarean section regardless of recurrences at delivery was considered an acceptable indication for operative delivery by 745 obstetricians (62%).
确定英国产科医生在复发性生殖器疱疹感染孕妇产前及产时管理方面的临床实践情况。
向居住在英国的皇家妇产科学院所有成员及院士发送问卷，询问他们对复发性生殖器疱疹感染孕妇的管理情况。
问卷回复率为76%。在1201名回复的产科医生中，只有369名（31%）承认其所在单位有关于孕期疱疹管理的正式政策。然而，718名（60%）提倡定期筛查，其中463名（64%）进行常规产前拭子病毒培养。临产时，974名产科医生（81%）常规检查生殖器有无复发迹象。当被问及在何种情况下剖宫产被认为是生殖器疱疹感染女性合适的分娩方式时，1107名（92%）认为临产时有可见的活动性病灶就足够了。然而，当胎膜破裂超过4小时且存在生殖器病灶时，只有678名（56%）认为这是剖宫产的指征。进行产前筛查的产科医生在这种情况下更倾向于认为剖宫产合适（卡方 = 30.38，P < 0.0001）。596名产科医生（50%）认为产前筛查时在临产前不久获得的病毒培养阳性是剖宫产的指征，尽管在这组人中192名（32%）表示他们不进行病毒培养产前筛查。438名受访者（36%）认为患者报告复发但无可见疾病证据是剖宫产的合适指征。745名产科医生（62%）认为产妇要求剖宫产，无论分娩时有无复发，都是手术分娩的可接受指征。
