Rubella for pregnant women in the early stages. Rubella in pregnant women

The only period when rubella is not dangerous to human health and occurs without complications is early childhood. In other cases, this disease leads to a number of complications. It is especially dangerous for pregnant women, or rather, for their unborn children, in the first trimester of pregnancy, when the formation of all vital organs and systems occurs.

Rubella is acute, easily transmitted by airborne droplets from person to person, namely: by sneezing, coughing, talking. But infection requires quite a long and close contact with the patient, for example, caring for a sick child, staying indoors together, etc. The incubation period lasts 15-21 days, and it is very difficult to determine the moment of infection, since at first the infection occurs latently. The rubella virus is sensitive to temperature and chemicals.

Symptoms and course of the disease

In children, the disease begins acutely: a pale pink, small-spotted rash appears on the skin, not rising above the surface of the skin. The size of the spots does not exceed 3-5 mm. First, the rash appears on the face and quickly spreads throughout the body, especially on the back, buttocks, and the inner surfaces of the arms and legs. However, the rash does not appear on the palms. Later, enlargement of the posterior cervical and occipital lymph nodes, a slight increase in temperature, inflammation of the upper respiratory tract and, as a complication, inflammation of the joints may appear.

In adults, the disease is much more severe. Before the spots appear, a person’s body condition may worsen: general malaise, headache, chills with a fever of up to 38°, joint pain, runny nose, sore throat. In addition, there is an increase in lymph nodes, especially in the posterior cervical and occipital. A third of affected adults have damage to the brain and small joints of the hands.

A person with rubella becomes infectious to others already 7 days before the rash appears on the body and remains a source of infection for another 7-10 days after its appearance.

Features of rubella infection during pregnancy

During pregnancy, the virus primarily affects the tissues of the fetus, very easily penetrating the placenta. In the first trimester, this leads to chronic infection of the fetus, disrupting its intrauterine development. The rubella virus often provokes. The shorter the pregnancy period during which the infection occurred, the more often and more severely they develop. For example, infection of a woman in the first 8-10 weeks of pregnancy leads to the development of defects in 90% of cases. Among them:

• heart defects;
• deafness;
• cataract;
• mental development disorder.

In addition to the development of defects in the fetus, other types of pregnancy complications may occur: stillbirth.

We hasten to inform you that infection after 20 weeks has practically no negative effect on the baby’s development.

Treatment of rubella

Rubella does not require specific treatment. Isolation and bed rest are indicated for the patient. In case of complications, analgesics and sulfa drugs are prescribed. In some cases, the doctor also prescribes gargling with antiseptic solutions.

Human gamma globulin is also administered, which alleviates the course of the disease. True, these measures are not taken in relation to pregnant women, since this does not prevent damage to the fetus.

Indications for termination of pregnancy

If infection does occur, the issue of terminating or continuing the pregnancy is considered. If this happened on early stages When the likelihood of complications in the child is maximum, the woman is advised to terminate the pregnancy. At a later stage, the pregnancy is usually left, but if there are confirmed fetal lesions, an abortion procedure is also recommended. If the mother’s infection occurred during pregnancy after the 28th week, she is registered in a high-risk group under constant medical supervision.

Management of pregnant women with rubella virus

If for some reason a woman is not given an artificial termination of pregnancy, she is classified as a risk group and her pregnancy is managed taking into account her condition. In this case, placental insufficiency is also treated, preventive measures and restorative therapy. This helps avoid the worst consequences and prevent miscarriage. It is also taken into account that rubella during pregnancy not only harms the fetus, but can also cause complications directly during childbirth. This may manifest itself in violation labor activity, blood poisoning and bleeding.

In addition, a child with signs of congenital rubella may pose a risk of infection to others for several months after birth.

Signs of congenital rubella in a newborn

As we have already noted, a child born from an infected mother exhibits the following disorders: eye damage, heart defects, deafness, brain damage (encephalitis, meningitis), malformations of the skeleton, liver and spleen, and genitourinary organs. Some children who do not have developmental defects are often born with low body weight and short stature, and subsequently lag behind in physical development.

What should a pregnant woman do if she finds herself in a rubella outbreak?

If a pregnant woman has not had rubella and has not tested or tested her immunity to the rubella virus, but has been in contact with an infected person, she should immediately contact an infectious disease specialist. It is possible to answer the question about the presence or absence of immunity to rubella modern methods research - determination of antibodies of the IgM and IgG classes.

Immunity to rubella

A person gets rubella only once in his life. At the same time, a strong immunity is formed in the body. Therefore, for women who have recovered from the disease (and their unborn children), this infection does not pose any danger. True, one cannot be completely sure that a woman has immunity to rubella, based on the fact that she once had this disease in childhood. This is due to the fact that the symptoms could easily be mistaken for rubella. At the same time, a woman could have had a latent form of rubella, without showing the usual symptoms. To verify the presence (or absence) of antibodies to the virus, it is necessary to conduct a laboratory examination.

Vaccination against rubella

If a woman does not have immunity to rubella, she will be offered vaccination to avoid the risk of infection. Moreover, this must be done at least three months before pregnancy. If there is a person with rubella in the house, then it is too late to vaccinate.

Contraindications for rubella vaccination

This vaccination should never be given during pregnancy, since the virus, even if weakened, damages the fetus.

In addition, rubella vaccination should not be given to people with immune system disorders (in particular: leukemia, lymphoma, malignant diseases, congenital immunodeficiencies).

Vaccination is also contraindicated for those taking corticosteroid drugs or undergoing chemotherapy and radiation.

If a woman has previously had an allergic reaction to taking the antibiotic neomycin, then vaccination is also not carried out. Another contraindication is an increase in body temperature to 38°C.

Especially for- Olga Pavlova

Rubella is an acute infectious disease caused by a virus. The main manifestations of rubella are: finely spotted skin rash, enlarged occipital and posterior cervical lymph nodes, fever, headache, muscle pain. The rubella virus is unstable in the external environment and is very sensitive to temperature and chemicals.

Transmission of infection occurs through airborne droplets (sneezing, coughing, talking). For infection, a fairly long and close contact with a patient is required (caring for a sick child, staying indoors together, etc.), but since rubella often occurs latently, when exactly the contact occurred may be unknown.

Rubella is a childhood infection, but adults also suffer from it, especially during periodically recurring (especially in the spring) epidemic outbreaks.

The incubation period lasts 15–21 days.

The course of rubella in children

In children, the disease is relatively mild. It begins acutely, with the appearance on the skin of a pale pink, small-spotted rash that does not rise above the surface of the skin, up to 3–5 mm in size. The rash first appears on the face and quickly spreads throughout the body, especially on the back, buttocks, and the inner surfaces of the arms and legs. There is no rash on the palms. Later, enlargement of the posterior cervical and occipital lymph nodes, a slight increase in temperature, inflammation of the upper respiratory tract and, as a complication, inflammation of the joints may occur.

Course of rubella in adults

In adults, the disease is usually much more severe. The rash may be preceded by symptoms in the form of general malaise, headache, chills with an increase in temperature to 38°, joint pain, runny nose, sore throat and, as a rule, a general enlargement of the lymph nodes, especially the posterior cervical and occipital ones.

The most a common complication in adults there is damage to the small joints of the hands, which occurs in a third of patients. The most severe, although rare, complication is brain damage - encephalitis.

Rubella is not a very contagious disease, but pregnant women who have not had rubella in the past and who are in contact with a large number of children (for example, employees of child care institutions, schools, hospitals), among whom there may be patients with rubella, including those with a latent course, expose themselves to high risk of infection.

The effect of rubella on the fetus

During pregnancy, the virus in the mother's blood infects the tissues of the fetus, causing chronic infection of the fetus in the first three months of pregnancy, disrupting its intrauterine development, often leading to spontaneous abortion (miscarriage).

The frequency and extent of fetal damage is largely determined by the gestational age at the time of infection. The shorter the pregnancy period during which a woman becomes ill with rubella, the more often and more severely malformations develop in the fetus. The most dangerous is the first trimester of pregnancy (from conception to 12 weeks). During this period, the development of all important organs of the fetus occurs.

Damage to the fetus by the rubella virus is varied, and the degree of damage does not depend on the severity of the disease in the pregnant woman.

Signs of congenital rubella in a newborn:

• Eye damage.
• Heart defects.
• Deafness.
• Brain damage.
• Skeletal malformations.
• Malformations of the liver and spleen.
• Malformations of the genitourinary organs.

Damage to the nervous system is not always diagnosed at birth, as it can manifest itself much later in the form of seizures and mental retardation.

Children infected with rubella, even without developmental defects, are often born with low body weight and short stature, and subsequently lag behind in physical development.

In addition to the development of defects in the fetus, other types of pregnancy complications may occur: miscarriage, stillbirth.

With rubella, complications during childbirth may occur: labor disturbances, bleeding, sepsis (blood poisoning).

Diagnosis of rubella

With typical clinical picture, confirmed by a specific contact, diagnosing rubella does not present any special difficulties.

Of great importance is the contact of women who have not had rubella and were not vaccinated before pregnancy with rubella patients (care of pregnant women for sick children, work in children's groups during an outbreak of infection).

To confirm rubella infection, laboratory testing is necessary:

• isolation of the virus from the nasopharynx, usually 2–3 days before the rash by inoculation on a nutrient medium;
• positive blood reaction with rubella antigen.
• isolation of rubella-specific antigen LqM from the blood.
• If the diagnosis of rubella remains doubtful, especially in cases where exposure occurred early in pregnancy, amniocentesis can be performed at 14–20 weeks and an attempt is made to isolate the virus from the amniotic fluid.

Diagnosis of congenital rubella

Suspicion of congenital rubella in children may be based on:

• the presence of one or more signs (see above) in the newborn;
• confirmed or suspected maternal rubella disease during pregnancy;
• isolation of the virus from the contents of the nasopharynx, urine, cerebrospinal fluid, especially in the first three months of life;
• the release of rubella-specific antigen LqM from the umbilical cord blood shortly after birth, indicating intrauterine infection;
• the presence of antibodies to rubella before the age of 6 months, especially against the background of appropriate clinical manifestations, since a newly acquired infection in the early childhood does not occur.

Treatment of rubella

Rubella does not require specific treatment. Isolation and bed rest are indicated. For complications, the following is prescribed:

• analgesics;
• sulfa drugs;
• according to indications, antibiotics, gargling with antiseptic solutions.
• The administration of human gamma globulin to pregnant women after possible contact in order to prevent infection of the fetus is not recommended, since this does not prevent damage to the fetus, but only alleviates the course of the disease.

Indications for termination of pregnancy:

• Confirmed data on the incidence of rubella in the first trimester and even up to 16 weeks of pregnancy, regardless of the severity of the disease, is an indication for artificial termination of pregnancy up to 16 weeks.
• If laboratory tests are positive, pregnancy is terminated at up to 16 weeks, even in the absence of clinical manifestations, taking into account the possible latent course of the disease.
• If a disease is detected or infection of the fetus is suspected, if the pregnant woman becomes ill at a period of more than 16 weeks, termination of pregnancy up to 28 weeks is indicated.
• If a pregnant woman develops rubella after 28 weeks, she is specially registered as a high-risk group. In the future, preventive measures are taken to protect the fetus, treatment of placental insufficiency, prevention and treatment of miscarriage.
• If signs of congenital rubella are detected or suspected in a newborn, a thorough examination should be carried out as quickly as possible. In the future, the child should be constantly monitored by appropriate specialists.

Prevention of rubella in pregnant women

You need to know that women who have had rubella develop stable and long-lasting immunity. Pregnant women who have not had rubella before pregnancy should avoid contact with people with rubella, especially for workers in child care institutions, when caring for a sick child in the family, etc. During an epidemic outbreak of rubella, you should generally avoid visiting children's groups and crowded places: cinemas, clinics, etc.

Until recently, active immunization (vaccination) against rubella was not carried out in the CIS, including Ukraine. Currently, in various countries, including Ukraine, certain age groups are allowed and recommended to use several various types live attenuated rubella virus vaccines.

If you have not had rubella, that is, you are not 100% sure of this (only documentary evidence can give such confidence), then the vaccination must be done 2-3 months before the start of the planned pregnancy. All modern rubella vaccines are 95–100% effective, and the immunity they create lasts for more than 20 years. Vaccination consists of only one shot, since the vaccine is a live virus, i.e. immunity is formed immediately and for a long time. Another positive effect of vaccination is the transfer of antibodies against rubella through mother's milk.

This vaccination should under no circumstances be given during pregnancy due to the theoretical, but still possibility of damage to the fetus by the vaccine virus. After vaccination, it is necessary to protect yourself from pregnancy for 2–3 months and only after this period plan to conceive.

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The combination of “rubella and pregnancy,” according to doctors, turns out to be dangerous not so much for the expectant mother as for the baby developing in the womb. This disease is tolerated relatively easily only in early childhood. For adults, especially pregnant women, infection with rubella is extremely undesirable. The effect of the virus on the embryo is especially destructive in the first trimester of pregnancy, when all vital organs and systems are just being formed.

Causes of rubella in pregnant women

The route of transmission of the rubella virus is airborne. The expectant mother is at risk of infection if she is in the same room or vehicle with sneezing and coughing people, as well as when long-term communication with a carrier of the disease, when the incubation period is still ongoing and the virus has not manifested itself in any way. Often pregnant women get rubella after prolonged contact with a child who has kindergarten or there is an outbreak at school.

Signs of rubella in expectant mothers

Symptoms of the disease in pregnant women are completely identical to those in adults infected with rubella. It can proceed either practically unnoticed or with a significant deterioration in well-being. The first signs of this viral infection usually appear 15-24 days after infection. These include:

1. The appearance of skin rashes pale Pink colour in the form of small spots that do not rise above the surface of the epidermis. Their diameter does not exceed 3-5 mm. The peculiarity of rubella is that the rash first covers the face, gradually spreading to the back, buttocks, and inner surfaces of the limbs, with practically no spots on the palms.
2. Enlarged lymph nodes in the neck and back of the head, often accompanied by fever.
3. Inflammation of the joints.
4. Inflammatory processes in the upper respiratory tract, resulting in bronchitis, tracheitis, runny nose, sore throat.

These symptoms are sometimes accompanied by chills with a sharp rise in temperature to 38 degrees, general weakness, and headaches. In especially severe cases, damage to the small joints of the upper extremities or inflammation of the brain is diagnosed. A woman with rubella can infect others within 7 days before the rash appears on the body and is a source of infection for 7-10 days after the first spots appear.

The most dangerous periods for pregnant women with rubella

Doctors believe that rubella is most dangerous for expectant mothers in the early stages: the lower it is, the more likely the fetus is to develop developmental abnormalities. At 3-4 weeks, the baby is diagnosed with pathology in 60% of cases, at 9-12 weeks - in 15% of cases, and from 13 to 16 weeks the disease will affect his health in only 7% of cases.

Rubella during pregnancy is a direct threat

Expectant mothers need to do everything possible to prevent rubella infection while carrying a baby. The disease virus circulates freely in the blood for at least two weeks, and the placental barrier is not a barrier to it. Therefore, it is impossible to avoid infection of the fetus in more than 90% of cases, which can lead to the following pathologies in the baby:

• severe diseases of the central nervous system such as meningitis, encephalitis, microcephaly and hydrocephalus, which can in the future cause mental and mental retardation physical development(up to incurable mental disorders such as idiocy, which often manifests itself in children at an older age);
• heart defects;
• abnormal development of the liver, kidneys, spleen;
• disturbances in the functioning of the sensory organs - deafness and visual impairment to varying degrees, as well as improper functioning of the vestibular apparatus;
• Greta triad - a combined lesion of the nervous system, which is expressed in the development of cataracts, deafness and some kind of heart defect (most babies with this diagnosis do not live longer than a few years);
• congenital pneumonia;
• disorders of the hematopoietic system (thrombocytopenia, hemolytic anemia);
• low weight and short stature at birth.

What are the consequences of complicated rubella for an expectant mother?

If the disease is severe, even with constant medical supervision, a pregnant woman often experiences complications such as:

• intrauterine fetal death;
• complicated childbirth, as a result of which the mother or child may die due to intense bleeding and/or sepsis;
• the appearance in newborns of movement disorders, decreased or increased tone, convulsions, hyperkinesis, paralysis.

In 30% of cases, expectant mothers who contract rubella have a miscarriage, and in 20% of cases, the child is stillborn or dies soon after birth. If a woman falls ill during the first trimester, the risk of stillbirth is 10%; in the second and third trimester it decreases to 5%.

Diagnosis of rubella

At the slightest suspicion of a disease, a pregnant woman should undergo a full laboratory examination. It includes:

• isolation of the specific rubella antigen LqM from blood plasma;
• a swab from the nasopharynx, which is usually taken 2-3 days before the appearance of the rash: this allows you to determine the virus by inoculating on a nutrient medium;
• positive blood test for the interaction of blood cells with rubella antigen;
• at 14-20 weeks they often resort to amniocentesis - analysis of amniotic fluid.

In newborns, rubella is diagnosed based on analysis of cerebrospinal fluid, urine, bacterial culture from the nasopharynx (it is advisable to conduct an examination in the first 3 months of life), the presence of antibodies to the disease in the blood, especially with pronounced clinical symptoms, and the isolation of a specific typical antigen from umbilical cord blood.

Features of the treatment of rubella in pregnant women

There is no specific antidote to such a virus. A pregnant woman needs to stay in bed, drink a lot and remain isolated while there is a risk of infection for others. In case of complications, the doctor prescribes antibacterial, painkillers and sulfa drugs, as well as gargling with antiseptics.

If the diagnosis is confirmed by clinical studies at 16 weeks, the attending physician will recommend that the woman terminate the pregnancy to prevent the birth of an affected child. Even if, according to the examination, she has a normal pregnancy, rubella can cause serious consequences for the health of the child in the distant future.

If future mom fell ill with rubella at a period of 16 to 28 weeks and experts suspect possible infection of the baby, artificial birth will also become the best solution. If the pregnancy is over 28 weeks, the pregnant woman is included in the risk group and the development of pregnancy is carefully monitored and preventive therapy is prescribed aimed at preventing premature aging placenta and early birth. If necessary, examinations such as cordocentesis, amniotic fluid testing, chorionic villus biopsy and ultrasound are performed.

Prevention of rubella

A woman who had rubella as a child cannot get it a second time. However, to make sure of this, it is worth visiting the laboratory 3 months before the start of pregnancy planning and donating blood for antibodies to the virus of this disease. If they are absent, it is recommended to get the appropriate vaccination. However, during pregnancy, vaccination is strictly contraindicated, as in the following conditions.

Update: October 2018

Rubella is an acute infection caused by an RNA virus. The only source of the disease is the infected person. A week before the rash and for 1-2 weeks after, a person with rubella can infect others.

The virus is transmitted primarily through airborne droplets: coughing, sneezing, talking. Susceptibility to the disease is very high; in the absence of immunity to rubella, the risk of becoming infected is 70-80%. In pregnant women, transmission of the disease through the placenta to the child is possible.

Impact of the rubella virus on the body

Of all human tissues, the rubella virus prefers skin, lymphoid and embryonic tissue, which is associated with the main symptoms of the disease. After infection, the virus quickly spreads through the blood, affecting the walls of small vessels. The characteristic rubella rash is nothing more than damaged small capillaries of the skin. The second habitat of the virus is the lymph nodes. In almost all patients with rubella they are significantly increased in size.

In severe cases, the virus attacks the nervous tissue, causing very dangerous conditions - rubella meningitis and encephalitis. The most dramatic development of events is the destruction of embryonic tissue by the rubella virus during pregnancy. In the first weeks of pregnancy, all the cells of a small person rapidly divide, forming new organs and tissues. The virus slows down this division process, causing severe fetal malformations. And the earlier viral particles penetrate the fetus, the greater the risk of serious disorders.

Rubella symptoms

Most often, rubella occurs in childhood. Unvaccinated children tolerate rubella quite easily, but the danger is posed by serious complications of the infection: meningitis and encephalitis. Due to the high vaccination coverage of the population, these manifestations are rare.

General malaise

2-3 weeks of the incubation period are replaced by general malaise. Fever, cough, runny nose and swollen lymph nodes are very similar to the usual “cold” symptoms. But in addition to the prodromal symptoms, the main symptom of rubella immediately appears: a rash.

Rash

The rash first appears on the face and after a few hours goes down, spreading to the arms, body and legs. Most rashes occur on the back, buttocks and extensor surfaces of the arms. The rashes are small spots (2-4 mm) pale pink in color, round with a clear shape. After 1-3 days, the rash completely disappears, leaving no marks or scars.

Lymphadenitis

The second most important sign of the disease is lymphadenitis (inflammation of the lymph nodes). The nodes are enlarged and often painful when touched. This condition persists for up to 2 weeks after the rash. In pregnant women, the characteristic rash is often absent, but lymphadenitis is a reliable symptom of rubella.

Fever in pregnant women is usually not pronounced; the temperature rarely rises above 38 degrees. Therefore, the atypical course of the disease (without fever and rash) is very easy to miss.

Diagnosis of rubella

During the period of characteristic rashes, the diagnosis can be confirmed by the following methods:

General blood analysis:

• decreased white blood cell count
• decrease in the number of neutrophils and increase in lymphocytes
• a large number of monocytes

Determination of antibodies to rubella in the blood using ELISA. In response to any acute infection, the body produces IgM, which disappears fairly quickly. IgG is responsible for long-term immunity. For rubella:

• IgM appears 1-2 weeks after the rash and remains in the blood for up to 3 months
• IgG appears after IgM and persists throughout life.

A rubella test (immunoglobulins M and G) should be performed on all pregnant women and women planning pregnancy in the near future.

How is rubella prevented?

All children are vaccinated against the disease at the ages of 1 and 6 years. Girls at the age of 12-13 are recommended to receive a third vaccination so that by the time they plan pregnancy, the risk of getting rubella is minimized.

Immunity to the disease develops in 9 out of 10 vaccinated children. Typically, sufficient levels of protective antibodies persist for 15 years. Therefore, if a child was vaccinated only at 1 year of age, then by the age of 18-20 the risk of contracting rubella (including during pregnancy) is quite high. In rare cases, the disease can occur in vaccinated people. But such reinfection is much easier, and transmission from mother to fetus is almost impossible.

Prevention of disease in pregnant women

All women planning pregnancy must donate blood for immunoglobulins G and M for TORCH infections dangerous to the fetus:

• To – Toxoplasma (Toxoplasmosis)
• R – Rubella (Rubella)
• C – CMV (Cytomegalovirus)
• H – Herpes (Herpes types 1 and 2)

Depending on the antibody titer, the result is considered positive, negative or doubtful. Each analysis must contain a quantitative Ig value and the norm of a specific laboratory.

Interpretation of tests for women planning pregnancy:

IgM	IgG	Decoding
positive	negative, positive or doubtful	Most likely, the woman is currently experiencing the acute phase of the disease. It is recommended to plan pregnancy after rubella no earlier than 3-6 months later, with a repeat blood test for antibodies.
negative	negative	Such data mean the absence of stable immunity (the woman did not have rubella and most likely was not vaccinated). Vaccination and birth control are recommended for 3-6 months with repeated blood testing for antibodies. It is very important that rubella vaccination is carried out before pregnancy, and not during it (since vaccination during pregnancy is an indication for its termination)
negative	positive	As a result of an illness or vaccination, antibodies are present in the body. You can safely plan and carry a pregnancy to term without fear of infection.

Interpretation of tests for pregnant women:

IgM	IgG	Decoding
negative	negative	In situations where a woman did not undergo testing during planning, and during pregnancy, immunoglobulin titers are negative, careful monitoring of her condition is necessary, since the risk of contracting the virus is quite high. Repeated tests for IgM and IgG, as well as the exclusion of contacts with rubella patients, are necessary measures to prevent congenital pathologies in the fetus.
negative	positive	Most often, this means strong immunity after vaccination or rubella, you can safely bear a pregnancy
positive	any	This is the most unfavorable outcome for women in early pregnancy. If, upon repeated analysis, the results remain the same, or the titers of antibodies to rubella IgG increase, we are talking about a disease suffered during pregnancy.

Most often, with the latest test result and signs of rubella (recent rash, fever and general malaise), doctors recommend termination of a short-term pregnancy. If you refuse an abortion, the following measures must be taken:

• periodic blood testing for rubella antibodies
• Ultrasound at 16 weeks to detect fetal malformations
• cordocentesis at 17-18 weeks

If the virus is not found in the umbilical cord blood during cordocentesis, then further pregnancy is possible. The woman is given a specific anti-rubella immunoglobulin to expel the virus from the body as quickly as possible.

The question of termination of pregnancy may arise again if severe fetal malformations are detected (anencephaly, lethal heart defects, etc.).

If a pregnant woman has had rubella for 16 weeks or more, and the fetus has no visible deviations from the norm, then it is not indicated, since the risks of serious complications are much lower.

Congenital rubella

The incidence of congenital rubella infection depends on the measures taken in each individual country. When checking blood for antibodies before and during pregnancy, as well as mass vaccination of puberty girls, the frequency of this pathology tends to zero (see).

The risk of developing congenital anomalies due to rubella during pregnancy:

• infection in the first weeks of pregnancy - 100% risk of anomalies
• 4-8 weeks - 40-60%
• 9-12 weeks – 15%
• 13-16 weeks – 7%
• late dates – 1-4%

Congenital rubella syndrome combines three main manifestations:

• Cataracts (and other vision pathologies: eye underdevelopment)
• Heart defects (patent ductus arteriosus, pulmonary artery and aortic valve stenosis, tetralogy of Fallot, coarctation of the aorta)
• Deafness (occurs in 90% of children with congenital rubella)

In addition to these pathologies, there are hydro- and malocclusions, organ dysplasia, skin and vascular damage. These signs occur when a child is infected late in life. When the fetus is infected, 4 out of 10 pregnancies are interrupted or end in intrauterine death of the child.

Early signs of congenital rubella:

• thick hemorrhagic rash (bruises) against the background of decreased platelets
• hepatitis
• interstitial pneumonia

Subsequently, the development of a child with congenital rubella is delayed, mental retardation, autism and other pathologies of the nervous system are formed. Given the serious consequences for the life and health of the fetus, it is very important to prevent rubella infection during pregnancy. Therefore, when preparing for conception, one should not neglect the diagnostic tests that are accepted throughout the modern world.

What can rubella be confused with?

Even the classic course of rubella is similar to many viral diseases and allergic rashes. And since rubella during pregnancy often occurs atypically, it is quite difficult to distinguish between some conditions. In many cases, positive test results help identify rubella. Similar manifestations occur with:

• infectious mononucleosis
• drug allergies
• scarlet fever
• erythema infectiosum

Differential diagnosis of rash of infectious origin

	Hidden period	Symptoms	Rash			Period of infectiousness and vaccination
			View	Time and order of appearance	Footprints
Measles	10-12 days	significant increase in temperature dry cough-conjunctivitis and photophobia rash due to high fever	Large maculopapular, bright, may merge	After 3-5 days of illness - behind the ears, along the hair. Then it goes down to the feet (in three days)	Bruises and	4 days before the first rash and up to 5 days after it disappears. Vaccination - at 1 year, 6 years
Rubella	2-3 weeks	slight increase in temperature malaise - sometimes arthritis	Finely spotted, pale pink	On the first day of illness on the face, after 24-48 hours - throughout the body, disappears after 3 days.	Disappears without a trace	Contagiousness during the period of rash, a few days before and after it. Vaccination -12 months, 6 years
Scarlet fever	2-7 days	intoxication, fever-sore throat enlarged lymph nodes bright language	Fine-dot (1-2 mm), bright	Simultaneous rash, intense rash in the folds of the body. Pale nasolabial triangle.	Leaves peeling	contagiousness 10 days from the onset of symptoms, with streptococcus carriage - constant contagiousness
Infectious mononucleosis	Unknown	enlarged lymph nodes enlarged liver and spleen	Diverse in shape and size, does not always occur	On the 5-6th day of illness, sometimes later. More intense on the face, but also present on the body	Disappears without a trace	The virus is low infectivity and is transmitted more often through sharing utensils and kissing
Erythema infectiosum	4-28 days	malaise sometimes arthritis	Red spots	Red spots from the face spread to the entire body, especially to the extensor surfaces. Before disappearing, they take on the appearance of a ring with a white center.	Disappear for a long time, can reappear within 3 weeks under unfavorable conditions	Children are usually not contagious once the rash appears.

– a viral infection transmitted by airborne droplets and causing severe malformations in the fetus. The disease is accompanied by enlarged lymph nodes, hyperthermia, cough, and conjunctivitis. 2-3 days after infection, rubella during pregnancy manifests itself as a papular rash; pathological elements initially appear on the face, then spread to the body, arms and legs. To diagnose the disease, serological tests are used to determine immunological markers IgM. There is no specific treatment; in the presence of severe fetal malformations, rubella during pregnancy is an indication for its termination.

General information

Rubella during pregnancy is a viral disease characterized by increased contagiousness. This disease is also known under the outdated names “German measles” and “Rubella”. For the woman herself, the pathology does not pose a particular threat, but in obstetrics it is considered to be a dangerous disease due to the high probability of damage to the embryo. Rubella is rarely diagnosed during pregnancy. This disease primarily affects children, but approximately 20-30% of women of childbearing age remain susceptible to infection due to the lack of antibodies in the blood.

The danger of rubella during pregnancy also lies in the fact that it can occur not only in acute, but also in chronic form, without clinically manifesting itself in any way. In such a situation, there is no opportunity to timely identify risks to the fetus and decide on further pregnancy management tactics, taking into account the presence or absence of congenital pathology baby. Rubella during pregnancy poses varying degrees of threat depending on the period of embryogenesis. Infection in the first trimester, especially in the first weeks, results in malformations in 80% of cases. In the second trimester, the risk of an unfavorable outcome is observed in 75% of babies, after 28 weeks the figure decreases to 50%.

Causes of rubella during pregnancy

Rubella during pregnancy is caused by a pathogen of the genus Togavirus, which is tropic to embryonic and lymphoid tissues. Infection occurs primarily through airborne droplets through close contact with the source of infection. The spread of viruses begins during the incubation period, when there are no obvious signs of the disease, which does not allow contact with infected people to be excluded. Contagiousness persists for 7 days before the rash appears and for 1-2 weeks after its onset. Rubella during pregnancy can also be transmitted through household contact with shared objects that contain traces of biological fluids from an infected person. It has been proven that the pathogen is present not only in nasopharyngeal mucus, but also in blood, urine, and feces.

Rubella during pregnancy is transmitted to the fetus through the vascular bed. Initially, the pathogen penetrates the mother’s lymph nodes, affects the tissues of the respiratory organs, after which it enters the blood, reaches the placenta and enters the baby’s body. The final sequence of the teratogenic effects of rubella during pregnancy has not been studied, but it has been proven that the pathogen provokes chromosomal changes and contributes to a disorder in the mitotic activity of embryonic cells. Frequently occurring hydrocephalus, slowdown in mental and physical development with this diagnosis are due to inhibition and apoptosis of tissues, blood circulation disorders caused by the harmful effects of the virus.

Symptoms of rubella during pregnancy

Rubella during pregnancy, as well as outside it, begins with an incubation period that lasts 11-24 days. Then appears characteristic feature– enlargement and tenderness of the occipital, cervical and parotid lymph nodes. About a third of women suffer from joint pain caused by the penetration of the pathogen into the synovial fluid. After a few days from the onset of these symptoms, rubella during pregnancy manifests itself as a small papular rash of pink color. Elements can merge with each other. Initially they are localized on the skin of the face, then spread to the body and limbs. The rashes disappear in the same sequence.

Rubella during pregnancy is often accompanied by signs of conjunctivitis: pain in the eyes, photophobia, lacrimation. Due to severe intoxication of the body, an increase in body temperature to 38-39˚C, weakness, fatigue, and headache are observed. Less often, patients are bothered by cough, sore throat, rhinorrhea, nasal congestion, redness of the mucous membrane of the pharynx. Rubella during pregnancy increases the risk of spontaneous abortion by approximately four times. Penetrating through the placental barrier, the virus reaches the fetus and provokes severe disorders of intrauterine development, which can be detected by ultrasound scanning. Additional information about the child’s condition and the concentration of the virus in amniotic fluid in case of suspected rubella during pregnancy, it can be judged by amniocentesis.

Rubella during pregnancy is accompanied by multiple embryopathies. On the fetal side, first of all, Gregg's characteristic triad is observed. It includes such defects as deafness, blindness, and heart disease. The development of cataracts cannot be ruled out. Also, rubella during pregnancy causes disturbances in the mental and physical development of the fetus, congenital dystrophy, cerebral palsy, and idiopathic thrombocytopenic purpura. When a woman is affected later During pregnancy, the baby may experience such manifestations as vasculitis, a tendency to pneumonia with constant relapses, and chronic exanthema. In about a third of cases, rubella during pregnancy is fatal for the child.

Even if rubella during pregnancy does not provoke severe congenital defects in the fetus, which is typical for infections in the 2-3 trimester, it can have long-term consequences. In particular, the disease can give long-term manifestations during the child’s puberty and cause panencephalitis, insufficient production of growth hormone. Often, rubella suffered by the mother during pregnancy causes the development of an insulin-dependent form of diabetes mellitus in the child. adolescence. Hearing impairment and thyroiditis of autoimmune origin are also possible.

Diagnosis of rubella during pregnancy

Rubella during pregnancy is diagnosed by performing specific serological tests that indicate the presence of antibodies to the pathogen in the woman’s blood. If symptoms are detected or if the expectant mother is at the source of infection, she should immediately contact an obstetrician-gynecologist and infectious disease specialist to conduct a timely examination and assess the risks to the health of the fetus. Rubella during pregnancy is most often detected using an enzyme-linked immunosorbent assay (ELISA), which shows the level of IgM. Antibodies to the pathogen begin to circulate in the patient’s blood 7 days after the pathogen is introduced into the body and remain there for 1-2 months.

Due to the high risk of rubella during pregnancy for the baby, patients are prescribed PCR (polymer chain reaction method). Its purpose is to confirm the woman’s recent infection by determining the RNA of the virus. As mentioned above, also if rubella is suspected during pregnancy, a blood ELISA is performed to determine the avidity of IgG to the pathogen. Infection is indicated by the presence of a high amount of IgM titer antibodies in the biological substance under study. They are the ones who speak about the acute course of the disease. In this case, it is necessary to establish the probable period of infection, assess the condition of the fetus (mostly cordocentesis is used) and determine the possibility of further management of the pregnancy.

Treatment of rubella during pregnancy

Rubella during pregnancy, occurring before 12 weeks, is an absolute indication for artificial termination, as it provokes the formation of severe malformations in the fetus. When infected at 13-28 weeks of embryogenesis, a council gathers to decide whether it is possible to continue the pregnancy. If it is determined that rubella during pregnancy did not harm the health of the child or the termination was not carried out for any other reasons, the patient is administered immunoglobulin in a dosage of 20-30 ml by intramuscular injection.

Specific treatment for rubella during pregnancy has not been developed. Patients are indicated for complete isolation to prevent the spread of infection and bed rest. If necessary, symptomatic therapy is prescribed. Rubella during pregnancy may require the administration of antipyretic drugs, antispasmodics, and anti-inflammatory drugs. If a decision is made to continue bearing the fetus, the woman is included in a high-risk group for the development of congenital anomalies of the baby. Additionally, treatment is used to prevent placental insufficiency, which involves the use of medicines to normalize blood flow. There are no special features in the management of childbirth or the postpartum period in the case of rubella during pregnancy. The baby can be born either through the natural birth canal or by caesarean section.

Forecast and prevention of rubella during pregnancy

When rubella is diagnosed during pregnancy, the prognosis is extremely unfavorable. Infection in the first trimester in 80% of cases ends in the development of severe defects incompatible with life. If pregnancy continues, stillbirth occurs in 20%. The same number of children born with a congenital form of the disease die in the first month of life. In 30% of women, rubella during pregnancy ends in spontaneous abortion. In 20% of cases of continued pregnancy, intrauterine fetal death is observed. That is why such a diagnosis in the early stages of gestation is an absolute indication for termination.

Specific prevention of rubella during pregnancy consists of studying the serological status of a woman and carrying out vaccination according to individual indications 2-3 months before the planned conception. The same approach is applied if the amount of anti-rubella antibodies in the blood is below 15 IU/ml. To reduce the likelihood of developing rubella during pregnancy up to 16 weeks if the patient gets into the source of infection, immunoglobulin containing antibodies to the pathogen is administered. After conception, vaccination against rubella is contraindicated, although its accidental administration is not a reason for artificial termination. Nonspecific prevention of rubella during pregnancy involves eliminating contact with possible carriers of the infection and strengthening the immune system.