••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^141
❍ What is the maternal fetal vertical transmission rate?
Primary: 30% to 60%, nonprimary first episode: 33%, recurrent 0% to 3%.
❍ What is the risk of transmission for women with a history of recurrent disease and no visible lesions at delivery?
2:10,000.
❍ In what situations should cesarean delivery be considered for prevention of neonatal HSV?
Cesarean delivery should be performed for women with active genital lesions or symptoms such as vulvar pain or
burning at delivery, which may indicate an impending outbreak.
❍ Is cesarean delivery recommended for women with recurrent HSV lesions on the back, thigh, or buttock?
No. These lesions may be covered with an occlusive dressing.
❍ What is the most common congenital infection in the United States?
Cytomegalovirus (CMV).
❍ How can vertical transmission of CMV occur?
Transplacental infection, exposure to contaminated genital tract secretions at parturition or breastfeeding.
❍ When is the risk of transmission of CMV the highest?
Primary maternal infection has a risk of transmission of 30% to 40%, while a recurrent infection has a risk of
0.15% to 2%. The overall risk of infection is greatest in the third trimester (but is more severe when infection
occurs in the first trimester).
❍ What are symptoms of congenital CMV syndrome?
Growth restriction, microcephaly, intracranial calcifications, chorioretinitis, sensorineural defects,
hepatosplenomegaly, jaundice, hemolytic anemia, thrombocytopenia purpura, and mental retardation.
❍ What is the sensitivity of CMV immunoglobulin M (IgM) serologic assays?
50% to 90%.
❍ What are possible consequences of fetal acquisition of parvovirus B19 infection?
Spontaneous abortion, hydrops fetalis, and stillbirth.
❍ When does hydrops develop due to parvovirus B19?
Within 10 weeks of maternal infection.
❍ What fetal monitoring should be done for women diagnosed with parvovirus B19?
Serial ultrasounds should be performed every 2 weeks. MCA Doppler should be used to diagnose fetal anemia.
❍ What are the characteristics of congenital varicella syndrome?
Skin scarring, limb hypoplasia, chorioretinitis, and microcephaly.