Rubella in pregnancy

Question 1

What is Rubella in pregnancy (aetiology, RF)

Answer 1

RNA virus with incubation of 6-21 days - infectious 1w prior to 5 days after rash

transmission by aerolsol route, vertical (transplacental)
RF- non immunity - no vaccines, ethnic minorities
RARE nowadays 97% woman vaccinated

Question 2

Sx of Rubella in pregnancy (mother and child)

Answer 2

Mother - coryzal Sx, arthalgia, rash
Soft palate lesions
Lymphadenopathy
Maculopapular rash - start behind eras then head, nech, body

Congenital Rubella syndrome (CRS)- PDA (ductus arteriosus), VSD, chorioretinitis/cataracts, Sensory Neural Hearing loss, thrombocytopenia

infection <12w GA- CRS, microcephaly (20% misscary)
12w-20w GA- SNHL, Chorioretinitis
Infection >20w - low risk

other- jaundice, splenomegaly, encephilits, LBW, etc

Question 3

Ix of Rubella in pregnancy

Answer 3

Bllood serology - IgG and IgM (active) or 4x igG titre
PCR virus
USS for foetal abnormalities
Screening- not routine, but if screened and no Ig- MMR after pregnancy

Question 4

Mx of Rubella in pregnancy

Answer 4

mother- rest, fluid and paracetamol
offer TOP if <16w

Refer to foetal medicine unit an health protection unit (notifiable condition)
avoid work and preg women

NO MMR vaccine given during (live vaccine)

Compliications - mum- misscariage, pneumonia, encephelitis
Baby -death, Congenital rubella syndrome