Rubella and pregnancy

KABERA René MD
PGY I - Resident Family and Community
Medicine
OBS - GYN DEPT UTH - B
Dec 2009
 Definition
• Rubella : Also called 3 day measles or German
measles is a d isease caused by rubella
virus .
• Genus : Rubivirus .
• Family : Togaviridae .
• Togavirus virus group .
• Transmission via airborne droplets .
• Incubation period of 2 - 3 weeks .
• Rubella virus causes minor infections in the
absence of pregnancy .
• People who have had rubella disease or
vaccine are protected
• During pregnancy , however , it has been
directly responsible for severe congenital
malformations .
 Diagnosis
•Clinical
• Adult infection occurs in mucosa of upper
respiratory tract and spread to the
cervical lymphnodes .
• Viremiadevelops after 7 - 9 days , lasts 13 - 15
days and leads to development of
antibodies .
• The appearance of malaise , fever , and
anorexia , rash , posterior auricular ,
cervical , and sub occipital
lymphadenopathy .
• 20 - 50 % cases of primary infection are
subclinical .
• Complications : arthritis , thrombocytopenia
and encephalitis .
•Paraclinical:

• Detection of Rubella - specific immunoglobulin

( Ig ) M antibody using enzyme - linked
 Management
Prevention
•

• Rubella virus vaccine live [ MERURAX II ]

is used to stimulate active immunity to
rubella ( German measles ).
• Contra indicated in pregnancy .
• Infection during 1 st trimester result in
85 % of fetal abnormalities .
• Infection in 2 nd trimester result in 16 %
fetal abnormalities .
• > 20 weeks fetal defects are uncommon .
• If there is susceptibility of disease in
pregnancy → Serology
• Rates of Antibodies :> 1 / 20 previous
immunity ,< 1 / 20 no immunity give Specific
Gamma - globulines 10ml / d / 4d and 10ml
/ wk / 3wks .
 Management
•Prevention ( c ’ t )
•If seroconversion

• 1 st trimester : Interruption of pregnancy .

• After 1 st trimester : amniocentesis ( PCR ), fetal
blood sampling >>> if the fetus is
affected >>> medical interruption of
pregnancy .
• Children born to infected mothers who have
measles in the last week of pregnancy or
first week postpartum should be treated
with immune globulin ( 0 . 25 mL / kg IM ).
• Susceptible women are vaccinated routinely
postpartum .
•Treatment

• Symptom - based treatment is given for

manifestations such as fever , arthralgia ,
 References
• Williams Obstetrics . Section VIII . Medical and
surgical complications in pregnancy . Chap 58
Infections , 22 nd ed . 2005
• Harrison ’ s Principles of Internal Medicine .
Chap 186 Rubella . 17 th ed . 2008
• Guide de therapeutique . Leon Perlemuter et
coll . Gynecologie - Obstetrique , Grossesse et
Rubeole . page 670 . 4e ed . 2006
• Mosby's drug consult . Measles virus vaccine
live . 14 th ed . 2004
• Rudolph ’ s pediatrics . Infectious diseases ,
viral infections , rubella . 21 st ed . 2002 .
•