Rubella

Question 1

Define rubella in pregnancy.

Answer 1

Infection caused by the rubella virus

Question 2

What is the aetiology of rubella in pregnancy?

Answer 2

Transmission by aerosol route

Vertical (transplacental)

Question 3

What are the risk factors of rubella in pregnancy?

Answer 3

Non-immunity (high rates in ethnic minorities)

Question 4

Summarise the epidemiology of rubella in pregnancy.

Answer 4

Rare – 97% of women are vaccinated in UK

Question 5

What are the symptoms of rubella in pregnancy?

Answer 5

Fever

Malaise

Coryza

Arthralgia

Rash

Question 6

What are the signs of rubella in pregnancy?

Answer 6

Lymphadenopathy

Maculopapular rash (starting behind ears, spread to head and neck, then to rest of body)

Question 7

What are the investigations for rubella in pregnancy?

Answer 7

Bloods: Rubella IgM/IgG

USS: Fetal anomalies

Question 8

What is the management for rubella in pregnancy?

Answer 8

Symptomatic treatment for mother

May offer termination of pregnancy if confirmed infection in first trimester

Question 9

What are the complications associated with rubella? What is the prognosis for rubella?

Answer 9

Maternal: Miscarriage, pneumonia, arthropathy, encephalitis, ITP

Fetal: Death, congenital rubella syndrome (deaf, VSD, PDA, cataracts, CNS defects, IUGR, hepatomegaly, thrombocytopenia, rash)

Highest risk is congenital rubella syndrome in first trimester (90%). 510% risk between 14-16/40, low risk after 20/40.

Rubella and congenital rubella syndrome rare since MMR vaccination in 1988.