Herpes simplex encephalitis in pregnancy

Herpes simplex encephalitis in pregnancy

520 Correspondence should read: “Twelve in the third trimester therapy were culture The data in Table II of 19 women who were colonized and who rec...

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520

Correspondence

should read: “Twelve in the third trimester therapy were culture The data in Table II

of 19 women who were colonized and who received no antibiotic positiue at the time of delivery.” are correct. Susan E. Gardner, M.D. Martha Yow, M.D.

Pediatric Infectious Disease Section Department of Pediatrics Baylor College of Medicine Houston, Texas 77030

A possible maneuver of infant at cessrwn section To the Editors:

Preventive medicine is surely the greatest aspect of science. This holds especially true in the practice of obstetrics, for both expectant mother and infant. In obviating possible trauma to the patient and especially the infant, cesarean section is employed more often in recent times, e.g., in the case of midpelvic disproportion with failure of cervical dilatation and descent of the vertex with an adequate trial of labor. Under these circumstances and with the head possibly very tightly compressed within the midpelvis, a maneuver has been very successfully employed for dislodging the head upward into the pelvic inlet and consequently facilitating its delivery. With the lower uterine segment opened transversely, this is accomplished by placing the operator’s index fingers curved over each shoulder of the fetus and exerting steady, firm traction. This releases the head sufficiently to allow delivery without undue pressure from the delivering hand. This step can be carried out far more quickly and conveniendy than via the vaginal route, with less pressure on the fetal head and with gratifying results. Romulo C. Valdez, M.D., F.A.C.A. Maple Street Randolph, Vermont 05060

Herpes simplex encephalitis

in pregnancy

To the Editors:

In the recent article by Dr. Robert L. King (AM. J. GYNECOL 135: 1114, 1979) an alleged case of herpes simplex encephalitis in pregnancy was reported but Dr. King completely failed to document that this case of encephalitis was caused by herpes simplex virus. Viral cultures were admitted to be negative, there was no serologic evidence that herpes simplex infection occurred, and there was no clinical description of skin lesions of the face, vulva, or any other part of the body caused by herpes simplex virus. Since there are many causes of viral encephalitis, it is inappropriate to assume that this case was caused by OBSTET

herpes simplex virus. It is very disturbing to note thaw this patient was counseled about the effects of hel~pc~ simplex virus on her fetus without evidence that herpe\ simplex virus was the etiologic agent. James H. Harger;

M.D.

Department of Obstetrics and Gynecology University of Pittsburgh School of Medicine Forbes Avenue and Halket Street Pittsburgh, Pennsylvania 15213

Reply to Dr. Harger To the Editors:

Dr. Harger’s statements concerning the documentation of herpes etiology in this case of encephalitis are all correct. As stated in the article, attempts were made to document the presence of the herpesvirus, but this can be very difficult to do. In this case, the attending internist, neurologist, and neurosurgeon were convinced that the patient had encephalitis. Beeson and McDermott’s Textbook of Medicine (ed. 14, Philadelphia, 1975, W. B. Saunders Co., pp. 691-693) stated that at that time the only method of certain diagnosis was a cerebral biopsy, and the patient’s clinical condition, of course, did not merit this procedure, Dr. Richard Baringer also stated in the above reference that cultures of herpesvirus from cerebrolspinal fluid and complement-fixation tests can be negative in those patients who survive. He also stated in the reference that most adult encephalitis is probably due to herpes simplex virus and usually occurs in previously normal adults with no history of herpetic skin lesions. In his treatise, the other conditions which he states must be differentiated from herpes encephalitis were obviously not present. Based on this evidence, those of us who were involved in this patient’s case felt that the most probable clinical diagnosis was herpes encephalitis. Dr. Terry Hayashi, Chairman of the Department of Obstetrics and Gynecology of the University of Pittsburgh School of Medicine, was consulted. He stated that he had no experience with this type of case but agreed that with the evidence we had we were probably dealing with herpes encephalitis. When it was evident that the patient would survive, it then became necessary to counsel her regarding the possible effects of this virus on her fetus. It was Dr. Hayashi’s advice that we followed in counseling the patient. Robert L. King, M.D. Department of Obstetrics and Gynecology North Hills Passavant Hospital Pittsburgh, Pennsylvania 15237