A term pregnancy with a history of genital herpes but no active lesions presents at 37 weeks. Which delivery plan is most appropriate?

• A. Amniotomy and vaginal delivery
• B. Vaginal delivery is safe in the absence of active lesions
• C. Delay delivery until after 38 weeks
• D. Cesarean delivery is required regardless of lesions

Answer: (A)

Neonatal herpes risk is driven by active maternal infection at the time of delivery. If there are no active lesions (and no prodromal symptoms), a vaginal delivery is appropriate even with a history of genital herpes. At term, allowing labor to proceed and using augmentation if needed—such as gently rupturing membranes (amniotomy) to facilitate progress—aligns with minimizing risk to the baby while avoiding unnecessary cesarean delivery. Cesarean is reserved for presence of active lesions or prodromal symptoms at labor onset. If lesions or prodrome develop during labor, a cesarean would be indicated to protect neonatal health.