Scott L L, Sanchez P J, Jackson G L, Zeray F, Wendel G D
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
Obstet Gynecol. 1996 Jan;87(1):69-73. doi: 10.1016/0029-7844(95)00357-6.
To determine if suppressive acyclovir therapy given to term gravidas experiencing a first episode of genital herpes simplex virus (HSV)-infection during pregnancy decreases the need for cesarean delivery for that indication.
Forty-six pregnant women with first episodes of genital herpes during pregnancy were randomly assigned to receive oral acyclovir 400 mg or placebo, three times per day, from 36 weeks' gestation until delivery as part of a prospective, double-blind trial. Herpes simplex virus cultures were obtained when patients presented for delivery. Vaginal delivery was permitted if no clinical recurrence was present; otherwise, a cesarean was performed. Neonatal HSV cultures were obtained and infants were followed-up clinically.
None of the 21 patients treated with acyclovir and nine of 25 (36%) treated with placebo had clinical evidence of recurrent genital herpes at delivery (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.002-0.745; P = .002). No woman treated with acyclovir had a cesarean for herpes, compared with nine of 25 (36%) of those treated with placebo (OR 0.04, CI 0.002-0.745; P = .002). No patient in either treatment group experienced asymptomatic genital viral shedding at delivery. No neonate had evidence of herpes infection or adverse effects from acyclovir.
Suppressive acyclovir therapy reduced the need for cesarean for recurrent herpes in women whose first clinical episode of genital HSV occurred during pregnancy. Suppressive acyclovir treatment did not increase asymptomatic viral shedding and was not harmful to the term fetus.
确定在孕期首次发生单纯疱疹病毒（HSV）感染的足月孕妇中，给予抑制性阿昔洛韦治疗是否能减少因该指征而行剖宫产的需求。
作为一项前瞻性双盲试验的一部分，46名孕期首次发生生殖器疱疹的孕妇被随机分配，从妊娠36周直至分娩，每天3次口服400毫克阿昔洛韦或安慰剂。患者分娩时采集单纯疱疹病毒培养样本。若没有临床复发情况，则允许经阴道分娩；否则，进行剖宫产。采集新生儿HSV培养样本，并对婴儿进行临床随访。
接受阿昔洛韦治疗的21名患者中，无一例在分娩时有复发生殖器疱疹的临床证据；而接受安慰剂治疗的25名患者中有9例（36%）有此证据（优势比[OR]0.04，95%置信区间[CI]0.002 - 0.745；P = 0.002）。接受阿昔洛韦治疗的女性中，没有因疱疹而行剖宫产的，而接受安慰剂治疗的25名女性中有9例（36%）因疱疹行剖宫产（OR 0.04，CI 0.002 - 0.745；P = 0.002）。两个治疗组中均没有患者在分娩时出现无症状生殖器病毒脱落。没有新生儿有疱疹感染的证据或阿昔洛韦的不良反应。
抑制性阿昔洛韦治疗减少了孕期首次临床发作生殖器HSV的女性因复发性疱疹而行剖宫产的需求。抑制性阿昔洛韦治疗未增加无症状病毒脱落，且对足月胎儿无害。
