A mother with active genital herpes lesions in labor should deliver by what route?

• A. Vaginal delivery with antiviral prophylaxis
• B. Cesarean delivery to prevent neonatal herpes
• C. Induction of labor at 37 weeks
• D. Spontaneous vaginal delivery with no interventions

Answer: (B)

When a mother has active genital herpes lesions at the time of labor, the baby is at high risk of acquiring herpes during birth because the virus is shed from the genital tract as the infant passes through the birth canal. Delivering by cesarean section removes the infant from exposure to the infected birth canal, significantly reducing the chance of neonatal herpes and its serious complications, such as skin, eye, and mouth infections or more severe disseminated disease involving the CNS and organs.

Antiviral therapy during late pregnancy can help suppress outbreaks, but it does not eliminate the risk of transmission when lesions are present at labor, so vaginal delivery is not the safest option in this scenario. Inducing labor or allowing spontaneous vaginal birth would still expose the newborn to the virus. In contrast, with no active lesions or prodromal symptoms, vaginal delivery may be considered with antiviral prophylaxis, but the presence of active lesions at labor makes cesarean delivery the recommended route.