In a positive herpes mother, what is the current recommendation for delivery?

• A. Nothing, treat outbreaks if needed.
• B. Prophylactic antiviral treatment throughout pregnancy
• C. C-section to reduce risk of dissemination
• D. Vaginal delivery with barrier precautions

Answer: (C)

Neonatal herpes can be severe, and the baby is most at risk when exposure occurs during birth through an infected birth canal. The safest approach if the mother has active genital herpes or prodromal symptoms at the time of labor is cesarean delivery to prevent the neonate from passing through infected secretions. If there are no active lesions, vaginal delivery is generally acceptable, though some clinicians use antiviral suppression late in pregnancy to reduce outbreaks; this does not replace the need for cesarean when active lesions are present. Barrier precautions during birth do not reliably prevent transmission if lesions are present.