1. Rubella in Pregnancy Max Brinsmead MB BS PhD January 2015

2. Rubella Infection Caused by the pleomorphic RNA virus of the genus Rubivirus Caused by the pleomorphic RNA virus of the genus Rubivirus Infects only human subjects Infects only human subjects In adults and children causes: In adults and children causes: Mild fever & malaise Mild fever & malaise Generalised fine erythematous rash – rarely purpuric Generalised fine erythematous rash – rarely purpuric Cervical lymphadenopathy Cervical lymphadenopathy Arthralgia Arthralgia

3. Rubella in a Pregnant Woman Before 12 weeks pregnancy up to 90% risk of: Before 12 weeks pregnancy up to 90% risk of: Miscarriage Miscarriage Cardiac anomalies Cardiac anomalies Nerve deafness Nerve deafness Cataracts or retinopathy Cataracts or retinopathy Mental retardation Mental retardation Often multiple defects Often multiple defects Fetus somewhat safer in the 2 nd trimester but… Fetus somewhat safer in the 2 nd trimester but… Sensineural deafness is the most common problem Sensineural deafness is the most common problem In the second half of pregnancy In the second half of pregnancy Hepatosplenomegaly Hepatosplenomegaly Failure to thrive, osteitis Failure to thrive, osteitis Diabetes, hypothyroidism and GH deficiency Diabetes, hypothyroidism and GH deficiency Progressive panencephalitis Progressive panencephalitis = The Congenital Rubella Syndrome

4. Prevention of Congenital Rubella Immunise all children at 12 -15m (MMR) Immunise all children at 12 -15m (MMR) Test all women who are pregnant (or plan to conceive) for immunity Test all women who are pregnant (or plan to conceive) for immunity Avoid infection if pregnant Avoid infection if pregnant Spread by nasopharyngeal droplets +/- 7 days from the time of rash Spread by nasopharyngeal droplets +/- 7 days from the time of rash Retest any pregnant woman who is exposed to the virus Retest any pregnant woman who is exposed to the virus Terminate pregnancy for proven infection Terminate pregnancy for proven infection Immunise women postpartum if low titre or non immune Immunise women postpartum if low titre or non immune Immunisation of a pregnant woman with the live virus is not recommended but is also not associated with teratogenesis Immunisation of a pregnant woman with the live virus is not recommended but is also not associated with teratogenesis

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