Objective.-To assess the effect of cesarean delivery on neonatal and maternal morbidity and mortality and their associated costs for two populations of women presenting with genital herpes lesions at delivery: those with and those without a history of genital herpes.

Data Sources.-MEDLINE (search for herpes simplex virus and neonatal, cesarean, and mortality) and recognized experts.

Data Extraction.-The quality of the overall data used for baseline values was graded using a predetermined scale.

Results.-The practice of cesarean delivery for women with a history of genital herpes lesions that recur at delivery results in more than 1580 excess cesarean deliveries performed for every poor neonatal outcome prevented, a cost per neonatal herpes case averted of $2.5 million and a cost per quality-adjusted life-year gained of $203 000.