Rubella in Pregnancy

Question 1

Epidemiology

Answer 1

More common in unvaccinated countries

Question 2

Transmission

Answer 2

Respiratory droplets

Question 3

Type of organism

Answer 3

RNA virus, togavirus

Question 4

Another name for rubella

Answer 4

German measles

Question 5

Incubation days

Answer 5

12-21 days

Question 6

Infectious period

Answer 6

7 days before symptoms appear, up to 4 days after onset of rash!

Question 7

Symptoms

Answer 7

Coryzal prodrome for 1-5 days; cold-like symptoms, fever, malaise
Arthralgia, rash

Soft palate lesions

Lymphadenopathy - tender, postauricualar, cervical, suboccipital

Then you get a fine, maculopapular rash on face and trunk

Question 8

What percentage are asymptomatic?

Answer 8

50%

Question 9

Another name for the soft palate lesions

Answer 9

Forschheimer spots

Question 10

Describe the maculopapular rash

Answer 10

Starts behind the ears, spreads to the head and neck and then the rest of the body

Question 11

What is the risk to baby if a woman gets pregnant and develops rubella?

Answer 11

If before 16 weeks - severe congenital rubella syndrome

• cardiac abnormalities - PDA, pulmonary stenosis

Question 12

CRS what is the triad

Answer 12

Cataracts, cardiac disease and sensorineural deafness

Question 13

Infection before 12 weeks GA - foetal abnormalities

Answer 13

90 percent microcephaly

20 percent miscarriage

Question 14

Infection between weeks 12 and 20 - foetal abnormalities

Answer 14

Deafness, chorioretinitis, cataracts

Question 15

Infection after 20 weeks

Answer 15

Low risk

Question 16

Investigations

Answer 16

PCR testing
Blood serology - check IgG / IgM titre
USS screen for foetal abnormalities

Question 17

What level of IgG is indicative of past infection?

Answer 17

Four fold increase in the IgG titre

Question 18

Management

Answer 18

For mother:
Rest
Fluids
Paracetamol

For baby:
If under 16 weeks, offer TOP

If 16-20 weeks, RT-PCR on amniotic fluid sample

Question 19

What do you then do if the RT-PCR comes back positive?

Answer 19

USS surveillance for CRS or TOP

Question 20

Other aspects of management

Answer 20

Notify the Health Protection Unit as this is a notifiable disease

Avoid work and other pregnant women for 4 days after initial development of the rash

Question 21

When can you give the MMR vaccine?

Answer 21

ONLY IN POST NATAL PERIOD AS IT IS A LIVE VACCINE

Question 22

Risk to mother

Answer 22

Pneumonia
Miscarriage
ITP
Encephalopathy
Arthropathy

Question 23

What is ITP and how do you manage?

Answer 23

immune thrombocytopenic purpura
depletion in platelets
oral pred