Rubella Infection in Pregnancy Flashcards
What is rubella?
A single stranded RNA virus
What has happened to the incidence of rubella in the UK?
It has reduced dramatically
Why has the incidence of rubella in the UK reduced dramatically?
Because of the introduction of the MMR vaccination programme
What is the result of the dramatic reduction in the incidence of rubella in the UK?
The antenatal screening programme that used to be performed was stopped in 2016
Why is rubella in pregnancy still an important issue in healthcare?
It is still a big problem worldwide
How is the rubella virus transmitted?
Via the respiratory route
Where does the rubella virus replicate?
Nasopharynx and lymph nodes
What happens to the rubella virus after it replicates in the body?
It is found in the blood 5-7 days after the infection, and spreads throughout the body
Why is rubella infection a problem in pregnancy?
It has teratogenic properties, and is capable of crossing the placenta and infecting the fetus
What are the risk factors for rubella infection in pregnancy?
- Incomplete immunisation
- Exposure to infectious contact
- International travel
What is the most common presentation of maternal rubella?
Often asymptomatic
What the symptoms of maternal rubella, if present?
Non-specific, and include;
- Malaise
- Headache
- Coryza
- Lymphadenopathy
This can be followed by a diffuse fine maculopapular rash
What investigation is done when maternal rubella infection is suspected?
ELISA
What is the purpose of ELISA in maternal rubella infection?
Can measure rubella specific IgG and IgM
What is found on ELISA in acute rubella infection?
IgM antibody
What is found on ELISA following rubella infection or vaccination?
IgG antibody
How is maternal rubella managed?
Rubella infection itself is self-limiting, and so there is no treatment, but anti-pyretics can be given for fever
What should a woman with rubella be informed of regarding her infectivity?
She is infective from 7 days prior to the onset of symptoms to 4 days after
What determines the risk of vertical transmission of rubella and the likelihood of developing congenital rubella syndrome?
Gestational age at the time of infection
What is the risk of vertical transmission of rubella if <12 weeks gestation?
90%
What is the risk of congenital rubella syndrome if <12 weeks gestation?
90%
Are single or multiple defects likely with rubella infection <12 weeks gestation?
High likelihood of multiple defects
What is the risk of vertical transmission of rubella if 12-16 weeks gestation?
55%
What is the likelihood of congenital rubella syndrome if 12-16 weeks gestation?
20%
Are single or multiple defects likely with rubella infection 12-16 weeks gestation?
Single
What is the risk of vertical transmission of rubella if 16-20 weeks gestation?
45%
What is the likelihood of deafness if contract rubella at 16-20 weeks gestation?
20%
What is the risk of vertical transmission of rubella if >20 weeks?
45%
What is the risk of developing congenital rubella syndrome if >20 weeks gestation?
None?
What is the recommended management for rubella infection <12 weeks gestation?
Termination
What is required when there is rubella infection at 12-20 weeks?
Prenatal diagnosis of rubella infection
How is a prenatal diagnosis of rubella infection made?
RT-PCR on amniotic fluid samples
What are the management options if a prenatal diagnosis of rubella infection is made at 12-20 weeks?
- Termination of pregnancy
- Ultrasound surveillance to identify features of congenital rubella syndrome
What is the management of rubella infection at >20 weeks gestation?
No action required
