A woman in the third trimester has active primary genital herpes lesions. Which single mode of delivery is recommended to reduce neonatal herpes?

Answer: E. Caesarean section

Genital herpes in the third trimester

Neonatal herpes (acquired during vaginal birth through infected secretions) is serious, causing disseminated/CNS disease.

Mode of delivery

• A first (primary) episode of genital herpes in the third trimester, or active lesions at the time of delivery, is an indication for caesarean section to reduce transmission.

Other measures

• Aciclovir for the mother (and from about 36 weeks to suppress recurrence).
• Avoid invasive monitoring (for example fetal scalp electrodes) where there are active lesions, as these breach the skin.

So caesarean section is recommended with active third-trimester lesions.