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Rubella during pregnancy

The rubella disease of pregnant women is fraught with serious consequences for the unborn child.

Cause
Rubella is caused by a virus that is transmitted by airborne droplets. The source of the virus is more likely to be children, so the likelihood of catching a rubella of a pregnant woman who already has one child increases. Especially if the child goes to kindergarten, sports section or school.

What’s happening?
When a woman is infected in the first week of pregnancy, fetal damage occurs in 80% of cases, at 2-4 weeks – in 60%, at 5-8 weeks – in 30% and at 9-12 weeks – in 10% . With infection at a later date, the likelihood of developing congenital malformations is reduced, but even at 5 months there is still such a danger for 1 out of 10 children.

The danger of the rubella virus is that it is almost always transmitted from mother to fetus and damages it. Congenital rubella can damage any organ of the child, but the most common triad is cataracts, deafness and heart disease. There are also possible consequences in the form of blood disorders (hemolytic anemia, thrombocytopenia), pneumonia, low body weight and short stature at birth.

Adverse effects of rubella on the fetus are also manifested by spontaneous abortions (30%), stillbirth (20%), death in the neonatal period (20%). The stillbirth rate is about 10% for a woman in the first trimester, 5% for the disease in the second, and 2% in the third trimester. Congenital rubella is the cause of death in 20% of all deaths from intrauterine infections; it also often leads to the need to choose between abortion and maintaining the infection when the mother is infected during pregnancy.

How to recognize
A woman who has had rubella in childhood or has been vaccinated against rubella may not worry that her child will become infected because she has immunity. If the pregnant woman does not know whether she was sick with rubella or not, and did not get the vaccine, then she needs to get a blood test for antibodies to rubella.

The presence of antibodies of class Ig G indicates a previous infection with rubella virus. The height of the titer of antibodies to rubella virus class IgG does not matter, the main thing is that they are. This means that rubella immunity is present in the body and the fetus will be protected from possible rubella virus infection during pregnancy. An exception is the titer of IgG antibodies below the reference value indicated in the form (normal indicator), which means the absence of immunity to rubella. In this case, a rubella vaccine before a planned pregnancy is a must. Vaccination immunity is produced through a weakened, but still primary infection, therefore, it is necessary to protect yourself within 3 months after vaccination (until the disappearance of IgM).

Reference values ​​for the titer of antibodies of the IgM class should also be indicated on the form of the laboratory in which the study is performed. An IgM antibody titer below a threshold value (negative) in combination with a low IgG antibody titer means no rubella immunity. In this case, it is necessary to vaccinate against rubella before a planned pregnancy. If the titer of antibodies of the IgM class is higher than the permissible values, this indicates that the disease is in the early (acute) stage, and it is necessary to find out in which trimester of pregnancy the infection occurred. This is the most dangerous option for pregnancy, since in this case the virus can penetrate the placenta and damage the health of the child.

Importance of IgM IgG Results
There is no immunity to rubella virus. It is necessary to vaccinate. – –
Rubella immunity has been developed. No vaccination is needed at this time. – +
Acute rubella, early period. + –
Acute rubella. +++
What to do?
If a pregnant woman who did not have rubella and was not vaccinated had contact with a rubella patient, then she needs to see an infectious disease doctor. It will give direction to a blood test for antibodies to rubella in dynamics. A gynecologist will give a referral for a detailed ultrasound and recommend a triple test. ” If these tests indicate any disadvantage in the development of the child, they can prescribe an amniocentesis procedure. Further, according to the results of all examinations, the issue of the presence of congenital malformations and termination of pregnancy will be decided.

Prevention
As a prevention of rubella, a few months before conception (no later) is recommended to be vaccinated. After vaccination, it is advisable to pass a control blood test for rubella antibodies, and make sure that immunity has developed.

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