Which of the following would be informed to the pregnant client with genital herpes to protect the fetus?

JODHPUR AIIMS SNO-2018

Obstetrics & Gynaecology

Medium

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

A Caesarean section is the recommended mode of delivery for a pregnant woman who has active genital herpes lesions or prodromal symptoms at the onset of labor.
This procedure allows the baby to be delivered without passing through the birth canal, thereby avoiding direct contact with the herpes simplex virus (HSV).
This is the most effective intervention to prevent vertical transmission and protect the newborn from neonatal herpes, a severe and potentially fatal infection.

Option A: Total abstinence from sexual activity throughout the entire pregnancy is not a standard medical recommendation for preventing neonatal herpes. The risk of transmission to the fetus is primarily at the time of delivery.
Option C: While daily acyclovir is a common prophylactic therapy, it is used to suppress the virus and prevent an outbreak from occurring around the time of delivery. It does not guarantee an outbreak won't happen, and it is not the primary intervention if lesions are already present.
Option D: A Sitz bath is a comfort measure for the mother. It helps to soothe the pain and itching of genital lesions but provides no protection to the fetus from the virus.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of genital herpes in pregnancy and prevention of neonatal herpes as background academic context rather than a clinical decision trigger.
Nurses are responsible for educating pregnant clients with a history of HSV about the delivery plan, the importance of reporting any new lesions or prodromal symptoms (like tingling or itching), and the reasons for a potential C-section.
The severity of neonatal herpes cannot be overstated. It can cause disseminated infection, central nervous system disease, and long-term neurological impairment or death. This underscores the critical importance of prevention.
What if? If a woman with a history of genital herpes has no active lesions or prodromal symptoms at the time of labor, a vaginal delivery is generally considered safe, especially if she has been on suppressive antiviral therapy.

How to Approach the Question

First, identify the central goal of the question: 'to protect the fetus'. This means you are looking for an intervention that directly prevents harm to the baby.
Evaluate each option based on its mechanism of action in relation to the fetus.
Option A (Abstinence): This relates to sexual transmission between adults, not directly to protecting the fetus at birth.
Option B (Caesarean section): This physically separates the baby from the source of infection (lesions) during birth. This is a direct protective measure.
Option C (Acyclovir): This is a preventive (prophylactic) measure to stop lesions from appearing. It's indirect and not foolproof. If lesions appear anyway, this option is no longer the primary protection.
Option D (Sitz bath): This is for maternal comfort and has no effect on the fetus.

Concept Tested & Keywords

Concept Tested: Management of genital herpes in pregnancy and prevention of neonatal herpes.
Stem keywords: pregnant client, genital herpes, protect the fetus
Lead-in keywords: Which of the following
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

QXb0JifO43bFREMzNgpp0i

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 2004-2006