الفهرس 
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Abstract
The present study was undertaken to highlight the incidence of
HSV infection with pregnancy in one of the university hospitals in upper Egypt (Sohag university hospital) An attempt was made to identify the risk of infection on pregnant women with bad obstetric history which implies previous unfavourable foetal outcome in terms of two or more consecutive spontaneous abortions, early neonatal deaths, stillbirths, intrauterine foetal deaths, intrauterine growth retardations and congenital anomalies and those who had a history of old HSV or presented with a new infection and following the foetal outcome of that pregnancy to see how the infection is risky to it.
Serological evaluation for HSV infections was carried out by Elisa test through detecting anti( HSV) IgG and IgM antibodies in serum of pregnant women confirmed by PCR test (THE CORNER STONE) for diagnosis for positive herpes simplex IgM detecting HSV DNA in the samples.
The age distribution of pregnant women included in the study showed that the mean age (SD) was27.27 (3.83%) and the median was 27.5(20-36%) for the pregnant women.
Medical history of studied population showed that 38(63.33%)had history of fascial vesicular eruption.14(23.33%) had history of genital ulceration. none of them had history of preterm labour. 10(16.67%) had history of neonatal death. 36(60.00%) had familial history of vesicular eruption or ulceration and, 28 (46.67%) had not history of abortion.16 (26.67%) just one time for abortion . 12(20.00%) had twice . 2(3.33%) and 3(3.33%) had 3and4 times for abortion respectively.
In the pregnant women included in the study 14(23.33%) were positive for anti –HSV(1) IgM antibodies. 44 (73.33%) were positive for anti HSV(1) IgG antibodies. 4 (6.67%) were positive for anti HSV(2) IgM antibodies.. 38 (63.33%) were positive for anti –HSV(2) IgG antibodies. 14 (23.33%) were positive for PCR test. 44 (73.33%) had a normal outcome while 16 (26.67%) had a dead foetal outcome
In the tested cases for anti HSV (1) IgG antibodies , 44 cases tested positive. Among 44cases tested positive 22(50.00%) had history of abortion (p value 0.004).
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Summary
In the 60 cases tested for anti HSV(2)IgM antibodies ,4 tested positive. among 4 tested positive 2(50.00%) had history of BOH(bad obstetric history)neonatal death(P value 0.06).
In the 60 cases tested for anti HSV(2) IgG antibodies 38 cases tested positive . Among 38 cases tested positive20 (52.63%) cases had history of abortion (P value 0.058).
Among the tested pregnant women tested 14 tested positive for PCR. Among 14 tested positive 12(85.71%) had history for fascial vesiculation (P value 0.001) . 14 (100%)had fascial vesiculation in their general examination(P value 0.003) .
In the 60 tested pregnant women 16 had a dead foetal outcome. Among 16 dead foetal outcome 10 (62.50%) of them their mothers had positive PCR (P value 0.001), 10 (62.50%)of them their mothers had positive anti HSV(1) IgM antibodies(P value 0.004). 6 had a vaginal delivery.
CONCLUSION
The study show the association of HSV infection and its risky effect on foetal outcome of high risky pregnant women presented with BOH bad obstetric history, had history for HSV and those presented with symptomes suggestive for HSV infection.
HSV infection which is one of TORCH infections is considered a known causal factor, which is treatable. Further extended studies are needed to see risk of HSV infection on risked pregnant women and their foetal outcome.
This infection can be transmitted to the foetus resulting in congenital infection and or sporadic pregnancy loss .This can allow close monitoring. Early diagnosis and early intervention.
Recommendation
Further extended studies are needed to see risk of HSV infection on pregnant women and their foetal outcome.
Women’s history of genital herpes should be evaluated early in pregnancy. Women with known recurrent genital herpes simplex virus (HSV) should be counselled about the risks of transmission of HSV to their neonates at delivery.
At delivery, women with recurrent HSV should be offered a Caesarean section if there are prodromal symptoms or in the presence of a lesion suggestive of HSV.
Women with known recurrent genital HSV infection should be offered acyclovir or valacyclovir suppression at 36 weeks gestation to decrease the risk of clinical lesions and viral shedding at the time of delivery and therefore decrease the need for caesarean section.
Women with primary genital herpes in the third trimester of pregnancy have a high risk of transmitting HSV to their neonates and should be counselled accordingly and should be offered a Caesarean section to decrease this risk.
A pregnant woman who does not have a history of HSV but who has had a partner with genital HSV should have type-specific serology testing to determine her risk of acquiring genital HSV in pregnancy before pregnancy or as early in pregnancy as possible. Testing should be repeated at 32 to 34 weeks’ gestation.