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The woman was ill with rubella during pregnancy. Rubella vaccination in the postpartum period: implications. How does the virus affect the fetus

»» №2 1998 At the end of last year, Moscow hosted a scientific and practical conference of the final courses of obstetric departments of medical schools "Actual problems of infection in obstetrics."

We bring to your attention the material prepared by one of its participants, a 4th year student of MMU No. 30 OLGA BOLOTOVA.

The clinical picture of rubella

Rubella is an acute infectious disease caused by a virus of the togovirus family. The main clinical signs of rubella are small-spotted skin rash, enlargement of the occipital and posterior cervical lymph nodes, moderate general intoxication and hematological reaction. The rubella virus is unstable in the external environment, very sensitive to the effects of temperature and chemicals.

The transmission of infection occurs by airborne droplets. For infection, a sufficiently long and close contact with the sick person is required (caring for a sick child, staying together in a room, etc.), but since rubella often proceeds latently, when exactly the contact occurred, it may not be known.

Rubella refers to childhood infections, but adults also get sick with it - especially during periodically recurring (especially in spring) epidemic outbreaks.

The incubation period lasts 15-21 days. In children, the disease is relatively easy. 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, quickly spreads throughout the body, especially many elements on the back, buttocks, extensor surfaces of the arms and legs. There is no rash on the palms. Later, an increase in the posterior cervical and occipital lymph nodes, minor fever, catarrh of the upper respiratory tract and, as a complication, polyarthralgia may join.

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

The most common complication in adults is the defeat of the small joints of the hands in the form of arthralgias and polyarthritis, which occurs in a third of patients. The most severe, albeit rare, complication is damage to the central and peripheral nervous system - encephalitis, peripheral neuralgia.

A laboratory study of blood is characterized by the presence of neutrophilic leukocytosis and the appearance of specific plasma cells. 2-3 days before the appearance of the rash, the rubella virus can be isolated from the nasopharynx, and at the end of the rash or after its disappearance, the presence and growth of specific antibodies in the blood serum, which is determined by a special serological reaction. A specific antigen LqM is released from the blood - such studies are carried out abroad.

Rubella is not a highly contagious disease, and until recently in most developed countries, approximately 20% of women reached childbearing age without, according to serological research, traces of a previous illness. Pregnant women who have not had rubella who are in contact with a large number of children (for example, workers in child care facilities, schools, hospitals), among whom there may be patients with rubella, including those with a latent course, are at great risk of infection.

The effect of rubella on the fetus

For many years this disease did not attract the attention of obstetricians. Only in the early 1940s, Australian doctors, based on a number of observations, determined that rubella viruses can cause congenital malformations of the fetus and a number of other serious complications of pregnancy, such as spontaneous abortion, stillbirth, etc. Later, these data were confirmed. Currently, the disease of pregnant women with rubella and its negative impact on the fetus has become a serious problem in modern obstetrics.

There are two forms of the disease - congenital and acquired. They have significant differences - primarily in the mechanism of infection.

The virus can be transmitted in two ways: horizontal - from sick to healthy by contact and vertical - from mother to fetus.

With the horizontal form of transmission, the pathogen penetrates by airborne droplets into the mucous membrane of the upper respiratory tract, then into the blood and spreads throughout the body, affecting mainly the capillary network and lymphatic tissue. During pregnancy, the virus has a selective tropism for young embryonic tissue, causing in the first three months of pregnancy a chronic infection of the embryo that disrupts its intrauterine development, or the so-called infectious embryopathy, and later after the formation of the placenta, infectious fetopathy.

In the first weeks of pregnancy, damage to the embryo occurs through the mother's blood and chorion during the total viraemia of the pregnant woman. Later, after the formation of the placenta (14 weeks of pregnancy and later), the transplacental nature of infection prevails.

The rubella virus through the mother's blood during general viremia from the intervillous space quickly penetrates the fetal vessels, then into the umbilical vessels and quickly reaches the endocardium, from where the necrotic masses containing the active virus are hematogenously spread throughout the body, infecting various organs and tissues of the fetus.

Rubella in pregnant women can have the following consequences for the fetus:
- no effect on the fetus;
- infection of only the placenta;
- infection of the placenta and fetus, and the effect of the virus on the fetus can manifest itself in a variety of ways - from the defeat of many systems to an asymptomatic course;
- fetal death, spontaneous abortion and stillbirth.

The frequency and extent of fetal involvement is largely determined by the gestational age at the time of infection. The shorter the gestational age at which a woman fell ill with rubella, the more often and more significantly the teratogenic effects of the virus appear. The most dangerous is the first trimester of pregnancy, during the period of organogenesis, apparently because the embryo does not yet have a protective reaction. At 9-12 weeks of gestation, teratogenicity is 20-25%, and infection is 35-40%. At 13-16 weeks teratogenic danger - 10-15%, infection - 25%.

It is believed that after the third month of pregnancy, the risk of fetal infection is significantly reduced. So, in the 4th month it is 5-6%, in the 5th and later - about 1-1.7%.

However, these data are not entirely reliable, since recently many researchers believe that in the first trimester of pregnancy, the risk of infection approaches 100%, and infection of the fetus can follow infection of the mother at any time of pregnancy - up to the third trimester.

According to some reports, in women who become ill 6-12 months before conception, intrauterine infection of the fetus may also be noted; this is obviously due to the long-term persistence of viruses and their angigens in the mother's blood.

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

There is a classic syndrome of congenital rubella, the so-called Greg triad (an ophthalmologist from Australia, who was the first to describe the most typical developmental anomalies in fetuses born from mothers who have had rubella). These are: 1) cataract - 75%; 2) heart defects - 50%; 3) deafness - 50%.

In addition to the classic syndrome, there is an extended congenital rubella syndrome, which is characterized by many anomalies:
1. Microcephaly, microphthalmia.
2. Expansion of fontanelles.
3. Glaucoma.
4. Brain damage.
5. Damage to the vestibular apparatus.
6. Malformations of the skeleton.
7. Hepatosplenomegaly.
8. Malformations of the genitourinary organs.
9. Other damages and their combinations. Damage to the nervous system is not always diagnosed at birth, since it can manifest itself much later in the form of seizures, paresis, mental underdevelopment - from insignificant to idiocy.

Rubella-infected children, even without malformations, are often born with low body weight and short stature, and subsequently lag behind in physical development. Apparently, this is due to general intracellular intoxication.

In addition to the teratogenic effect of the virus on the fetus, other types of pregnancy complications may occur: miscarriage (10-40%); stillbirth (20%); early neonatal mortality (25%); general underdevelopment, sepsis.

Probably, this pathology is due to general intoxication, hyperthermia, placental insufficiency as a result of infection of the placenta and metabolic disorders.

With rubella, a purely obstetric pathology during childbirth can occur: an anomaly of labor, bleeding, septic complications.

Based on the analysis carried out by the circle members - students of our school, on the basis of the maternity wards of the 1st and 2nd city infectious diseases hospitals, the following results were obtained. In just 3 years, 30 births complicated by rubella in late pregnancy, which is 7% of all births complicated by infections. In 8 cases, complications were noted during pregnancy and childbirth, including:

1. Malformations of the fetus and newborn - 1 case (cleft palate).

2. Antenatal fetal death - 1.

3. Miscarriage, abortion - 2, premature birth - 1.

4. Septic complications in puerperas - 1 (endometritis).

5. Septic complications in a newborn - 1; intrauterine infection of the gastrointestinal tract, as a result of which one child died in the neonatal period.

It turned out to be impossible to analyze the consequences of rubella diseases in pregnant women in the early stages of pregnancy, since in all these cases the pregnancy was terminated for medical reasons within 16 weeks and later in general maternity hospitals.

In three cases, women from another group of complicated pregnancies gave birth to children with signs that do not exclude congenital rubella. However, the mothers did not report any illness or exposure to rubella during pregnancy, possibly due to the asymptomatic course of rubella in the contacts. The results of further examination of these children, confirming or denying the diagnosis of congenital rubella, are unknown to us.

Rubella diagnostics

With a typical clinical picture, confirmed by a specific contact, the diagnosis of rubella does not present any particular difficulties.

The epidemiological history is of great importance, that is, the contact of women who did not have rubella and who were not vaccinated before pregnancy with patients with rubella (caring for pregnant women for sick children, working in children's groups during an outbreak of infection).

Rubella is suspected, especially during an epidemic, when a typical rash, conjunctivitis and pharyngitis appear, as well as an increase in the ear and cervical lymph nodes, arthralgia, and polyarthritis. The rash must be distinguished from the rash with measles, enterovirus, drug allergies. Therefore, clinical symptoms alone are not enough to make a diagnosis. To confirm rubella infection, you need:
- Isolation of the virus from the nasopharynx, usually 2-3 days before the rash by sowing on a nutrient medium;
- a positive serological reaction of blood with rubella antigen, in which there is a sharp increase in antibodies in dynamics, for which the reaction should be carried out with an interval of 2-14 days;
- isolation of rubella-specific antigen LqM from the blood.

When interpreting serological and bacterial test results, the following factors should be considered:

1. The incubation period - from the moment of contact until the appearance of a rash or receiving antibodies - is 14-21 days.

2. The rash lasts for 2-7 days and disappears after the formation of antibodies, and the virus is detected in a swab from the nasopharynx for about 2 weeks, so the total infectious period for the fetus reaches 4 weeks.

3. When evaluating a serological test, it should also be taken into account that a pregnant woman can be immunized before pregnancy, in which case she will be seropositive.

The introduction of human gamma globulin for prophylactic purposes in pregnant women after contact, according to most experts, is inappropriate, since it can change the clinical manifestations of the disease, delay the appearance of antibodies in the blood serum and thereby delay the time for making the correct diagnosis.

So, the indicators of recently transferred rubella are:
- Isolation of rubella virus from the nasopharynx and blood;
- increase in antibody titer (four times or more) in dynamics in two portions of serum taken with an interval of 2-14 days;
- the presence of a specific antigen LqM in the blood, which is determined only 4 weeks after the onset of the disease.

If the diagnosis of rubella remains doubtful, especially in cases where contact took place early in pregnancy, then amniocentesis can be performed at 14-20 weeks and try to isolate the virus from the amniotic fluid, although negative results do not exclude infection of the placenta and fetus. since the virus may disappear by this time.

Diagnosis of congenital rubella

The suspicion of congenital rubella in children may be based on:
- the presence of one or more clinical signs (see above) in a newborn;
- confirmed or suspected maternal rubella infection during pregnancy;
- isolation of the virus from the contents of the nasopharynx, urine, cerebrospinal fluid, especially in the first three months of life;
- Isolation of the rubella-specific antigen LqM from the blood of the umbilical cord shortly after birth, which indicates intrauterine infection;
- the presence of antibodies to rubella at the age of 6 months, especially against the background of the corresponding clinical manifestations, since a freshly acquired infection does not occur in early childhood.

Rubella treatment and obstetric management

Uncomplicated rubella does not require specific treatment. Shown is isolation, bed rest. In case of complications, appoint:
- analgesics;
- sulfa drugs;
- according to indications, antibiotics, gargling with antiseptic solutions;
- salicylates.

Confirmed data - epidemiological, clinical, serological - on the incidence of rubella in the first trimester and even up to 16 weeks, regardless of the severity of the disease, are an indication for artificial termination of pregnancy up to 16 weeks.

When a woman who is not immunized before conception has a contact with a patient with rubella, sowing for the virus is shown 14-21 days after contact and a double serological study of blood serum for antibodies. With positive bacteriological and serological results, pregnancy is terminated for up to 16 weeks, even in the absence of clinical data, given the possible latent course of the disease.

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 facilitates the course of the disease.

If a disease is detected or a fetus is suspected of being infected, if the pregnant woman fell ill for a period of more than 16 weeks (confirmed by bacterio-serological studies), termination of pregnancy up to 28 weeks is indicated.

In case of rubella disease after 28 weeks, the pregnant woman is taken on a special account in the high-risk group. In the future, preventive measures are taken to protect the fetus, treatment of placental insufficiency, prevention and treatment of intrauterine fetal hypoxia, miscarriage, septic complications by conventional methods.

Childbirth should be carried out as threatening abnormalities of labor, bleeding, septic complications, newborn asphyxia.

If signs of congenital rubella in a child are detected or suspected, a thorough examination (serological, neurological, audiological, ophthalmological) should be carried out as soon as possible. In the future, the child should be constantly monitored by the appropriate specialists.

It should be borne in mind that infected children, unlike adults, continue to shed the rubella virus for several months after birth and pose a potential danger to other pregnant women in the maternity hospital.

Prevention of rubella in pregnant women

An important role in the prevention of rubella in pregnant women belongs to midwives and doctors of antenatal clinics of the departments of pathology of pregnant women, as well as district and adolescent doctors.

Sanitary and educational work on this issue is the most important responsibility of these workers.

It is necessary to know that in women who have had rubella, persistent and long-term immunity is formed. Pregnant women who were not immunized before pregnancy should avoid contact with patients with rubella, especially for workers in child care facilities, in cases of caring for a sick child in a family, etc. , clinics, etc. Until recently, active immunization against rubella was not carried out on the territory of the CIS, including Russia. Currently, in various countries, including Russia, certain age contingents are allowed and recommended to use several different types of live attenuated rubella virus vaccines, which differ in the degree of weakening, immunogenicity and the frequency of side effects. These are: monovalent vaccine "Rudivax", bivalent vaccine "Rudy-ruvax", trivalent vaccine "Trimovax".

The degree of protection afforded by vaccinations is generally lower than with natural infection, and the level of antibodies decreases over the years.

Serological studies of the vaccinated have shown re-infection in 50% of immunized persons, however, re-infection is almost always asymptomatic, and the presence of the virus in the blood is extremely rare.

There are two approaches to the problem of routine immunization against rubella in the world.

So, in the UK, Australia and most European countries, all teenage girls 8-14 years old are vaccinated. The disadvantage is that many have already had rubella by this time; in childhood and have acquired immunity. The rest, presumably, develop immunity for the period of childbearing age, but this cannot be prevented from epidemics and seronegative women can get sick again in 50% of cases, including during pregnancy.

In the USA and Canada, they use a different approach - rubella vaccinations are given to all boys and girls at the age of 12-15 months in order to prevent epidemics and reduce the risk of infection in general, including pregnant women. But this approach is fraught with the risk of a decrease in immunity to the period of reproductive age, and, therefore, the danger of illness during pregnancy is not excluded.

The use of both approaches makes it possible to immunize women selectively - before a planned pregnancy, as well as in the postpartum period on the basis of individual serological studies in order to prevent infection during subsequent pregnancy.

It is advisable to distinguish a group of so-called increased risk among girls of prepubertal and pubertal age who have not previously had rubella. They should be advised of active immunization, especially in the period leading up to the planned pregnancy. First of all, this applies to vocational school students, female students.

In order to identify a high-risk group, members of our midwifery circle conducted a survey of female students of our school and female students of grades 9-10 of two nearby schools, in which we conducted vocational guidance. 520 people were interviewed. Of these, according to unspecified data, 46 people have had rubella, or 9% of the respondents, did not have rubella or 478 people do not know about it. None of them underwent immunization.

We attributed these individuals, most of whom were probably not immunized, to a high risk group for rubella in future pregnancy, given the young age of the subjects. They were interviewed about the possible risk of rubella during a future pregnancy and were delicately told about the possible consequences. Recommendations were given to decide, together with parents and district doctors, the issue of the expediency of immunization against rubella.

Summing up, it should be said that the issue of rubella, from an obstetric point of view, especially when it comes to methods for diagnosing intrauterine infection, remains not fully understood and needs further research.

Rubella is an airborne disease. If it passes in childhood, it practically does not affect the body. But rubella during early pregnancy is very dangerous for the fetus: through the mother's blood the virus gets to the child and affects the processes of its development, leading to serious tissue and skeletal pathologies. Mom may feel great, but that's not encouraging. What is the cause of the disease? How to protect yourself from it?

Read in this article

Where does rubella come from?

The disease spreads by airborne droplets. The virus enters the mother's body mainly from children. That is why it is especially dangerous to bear a child in a family where there is another baby visiting the garden or other places with a large number of children.

The mechanism of penetration into the body is as follows:

  1. The penetration of the virus through the respiratory tract.
  2. Reproduction of rubella in the lymph nodes.
  3. Penetration into the blood a week after infection.
  4. Increased vascular permeability, tissue edema.
  5. , cough, runny nose, rash, vascular lesions of the skin.
  6. The formation of antibodies from the third day after the onset of the rash.
  7. Persistent and long-lasting immunity.

Why is the disease dangerous to the fetus

Rubella and early pregnancy are a terrible combination. In 80%, this leads to damage to the child, as a result of which it is possible (in 30% of cases) (in 20% of cases), as well as the death of a newborn (20% of cases). In case of survival, cataracts, deafness and heart disease are noted, and often all three diseases at the same time, and they are called the Greta triad. Quite often, pneumonia in a newborn, problems in the circulatory system, spleen, bone tissue, low body weight and small stature are noted. Later, in children with congenital rubella, mental retardation, paralysis, increased nervous irritability, convulsions, hyperkinesis, etc. are noted.

Duration of the mother's infection Consequences for the child
2-7 weeks Fetal death and abortion
2-6 weeks Glaucoma, cataract, microphthalmia, retinopathy
5-7 weeks Heart defects, congenital deformities
5-12 weeks Inner ear and hearing impairment
8-9 weeks Malformations of milk teeth

In 60% of cases, organ damage occurs at the period from 2 to 4 weeks of pregnancy, in 30% - at the period from 5 to 8 weeks, in 10% of cases - at the period from 9 to 12 weeks. That is why it is especially dangerous to catch an illness in the first trimester. From the second, the likelihood of getting such serious consequences decreases, however, even at 5 months, the disease will not pass without a trace for 1 in 10 children. The organ that develops most actively at this stage will suffer the most. In 70% of cases, the disease gives an echo to the hearing organs.

It is worth noting that the transferred rubella during pregnancy in the late stages can negatively affect labor in the form of bleeding, blood poisoning, weakness of labor.

If the virus is damaged after 20 weeks, then the risk of manifestations of pathologies in the fetus is significantly reduced, but not completely excluded. In the future, disorders of the nervous system and damage to the hearing organs are possible. After 28 weeks, doctors will not recommend to terminate the pregnancy, but they will make every effort to exclude placental insufficiency. Additionally, the mother will be prescribed antiviral therapy and a vitamin complex. The pregnant woman will be registered as a woman at risk.

Doctors also state the fact that until 2001 in Ukraine, for example, they temporarily did not vaccinate against this disease. Therefore, about 30% of women of childbearing age can potentially transfer it while carrying a child. Unfortunately, if the mother's doctors diagnosed the symptoms of rubella during early pregnancy, she will have to make a choice - either, or hope that everything will work out.

Rubella symptoms and manifestations

Pregnancy and rubella, the symptoms of which may go unnoticed in some cases, are still incompatible. The disease will not pass without a trace for the child, unfortunately. How the virus manifests itself in the body will be influenced by the state of the mother's immunity, as well as the type of virus.
The disease develops within 5 to 25 days from the moment of infection without symptoms, and only after a rash appears. Much less often, but already from the first days, pregnant women may begin to complain about:

  • frequent;
  • deterioration;
  • weakness, feeling unwell;
  • runny nose;
  • redness of the pharynx.

A few days after the onset of the disease, the temperature may slightly rise, and already with the appearance of the rash, it will rise to 39 C. Also, the sick person will have enlarged lymph nodes (behind the ears, on the neck and in the back of the head), and when you press them, the pregnant woman will feel pain.

How is the presence of a virus diagnosed?

It is worth noting that if the expectant mother had rubella in childhood, then the likelihood of re-infection is extremely small, since antibodies are produced in the body. The same goes for moms who did from the virus before pregnancy. Everyone else will be advised to take an analysis for TORCH infections, according to the results of which immunoglobulins (IgG and IgM) will be identified.

In this case, IgM is an index of the presence of a virus, which manifests itself from the moment the disease begins and reaches its maximum amount by the third week. If antibodies were not detected, then this may indicate that either the pregnant woman did not have rubella and is not sick now, as well as that she suffered the disease a very long time ago. More detailed information in this case will be given by the second IgG immunoglobulin. It is a lifelong indicator of the presence of antibodies in the body. If it is not detected in the blood, then the woman has not yet encountered the disease. If a pregnant woman has contracted the virus, the maximum rate will be a month later.

When, after the analysis, the presence of IgM without IgG is established, then in this case I state the onset of the disease. If high levels of both antibodies are detected, then the virus is in full swing. To understand whether there is rubella during pregnancy is easier from the table:

Significance of results IgM IgG
No immunity to rubella virus — —
There is immunity to rubella — +
Acute rubella, early period + —
Acute rubella + +
Vaccination required — —

What to do if there are first signs of illness

If the expectant mother was in contact with patients or found out that the child fell ill a week after communication, she must definitely visit an infectious disease specialist and a gynecologist. The first will send to donate blood for analysis, and the second - for ultrasound, and will also advise you to undergo a "triple test" (from the second trimester). Based on the results obtained, a decision will be made to maintain or terminate the pregnancy.

In the first trimester, it usually ends with an abortion. After 28 weeks, doctors will inject mom with immunoglobulin (20-30 mg), as well as carry out a set of procedures aimed at protecting the fetus, preventing placental insufficiency and maintaining pregnancy.

Rubella Virus Prevention

Even in the case when a woman has already suffered a disease, it is still recommended to carry out preventive methods. After all, reduced immunity can provoke re-infection. To do this, doctors insist, even at the planning stage, on the delivery of an analysis to identify antibodies to the virus and, in their absence, on vaccination.

The vaccine to be administered to the expectant mother is based on live bacteria. Its effectiveness is 100%, and protection lasts for 20 years from the moment of introduction. However, there are contraindications for routine vaccination:

  • long-term treatment with hormonal drugs;
  • immunodeficiency;
  • recent radiation therapy;
  • individual intolerance to neomycin;
  • pregnancy.

It is worth noting that after the introduction of the vaccine, it is not recommended to plan a child for three months. Additionally, it is recommended to pass tests to confirm the production of antibodies. However, in the event that pregnancy has occurred, then it will not be interrupted, since the risk of fetal damage is possible only in 2% of cases.

Useful video

See in this video about the dangers of rubella during pregnancy:

Rubella is an acute illness caused by a virus, manifested by a skin rash, swollen lymph nodes. Rubella during pregnancy leads to fetal damage in many affected women.

Causes and development of the disease

The disease is caused by an RNA-containing Rubivirus. At a temperature of 56 °, it retains its activity in the external environment for 1 hour. When frozen, its disease-causing ability lasts for years.

The incidence of rubella increases in waves every few years and predominates in winter. In closed collectives, epidemic outbreaks can occur. Most often, children are sick from one to seven years. Babies up to one year old only get sick if their mother did not get rubella before pregnancy and did not transfer her antibodies to the child.

A person becomes infected by airborne droplets. The patient becomes contagious 10 days before the first elements of the rash and remains a source of the virus for another 2-3 weeks after the rash. Healthy virus carriers are also contagious. Babies with congenital rubella can be infected until 2 years after birth.

After the illness, persistent immunity remains. So if the expectant mother suffered rubella before pregnancy, she should not worry - she will not get sick again.

How does the disease manifest in pregnant women?

Rubella symptoms during pregnancy are more pronounced than in a sick child. Usually, the first symptom of the disease is a skin rash, which is found 2 weeks after contact with an infectious person. The general condition worsens quite strongly: the body temperature rises to 38 ° and above, headaches and muscle pains disturb.

The rash occurs on the face, then quickly captures the entire surface of the skin, grouping on the extensor surfaces of the joints, back and buttocks. It looks like small pink spots that do not rise above the surface of the skin and do not merge with each other. The skin around the elements of the rash is not changed. The rash is usually not profuse, it is round and does not itch.

Simultaneously with the rash, so-called catarrhal phenomena appear: a small runny nose, cough, redness of the eyes without discharge from them, loosening of the tonsils, enanthema - white-pink spots on the mucous membrane of the cheeks and lips.

A characteristic symptom of rubella is swollen lymph nodes. In pregnant women, it is more pronounced than in children. First of all, the occipital and posterior cervical lymph nodes are enlarged. They can be felt on their own around the hairline at the back and parallel to the spine along the neck. They can grow to the size of a bean and be a little painful. Swollen lymph nodes occur before the rash and persist after it disappears.

The course of the disease is favorable; it does not pose a particular danger to a woman's health. So why is rubella dangerous during pregnancy? This disease, spreading through the placenta to the fetus, causes severe, often irreversible health consequences for the unborn child. Therefore, rubella is classified as a so-called TORCH infection, which emphasizes its danger.

How the congenital form develops

The consequences of rubella during pregnancy for the fetus:

  • congenital malformations;
  • congenital rubella;
  • spontaneous termination of pregnancy;
  • intrauterine fetal death.

Almost all children whose mothers fell ill with rubella in the first 2 months of pregnancy have one or another developmental defect. The risk of fetal infection in the first trimester is 80%, at 13-14 weeks - 54%. In the second trimester, the likelihood of intrauterine infection is 25%.

In the future, the risk of pathology decreases, but the danger of the child's illness remains if the expectant mother has had rubella at 4-5 months (5% probability). If infected in late pregnancy, there is a greater likelihood of having a healthy baby.

The pathogenesis (development mechanism) of congenital rubella is rather complicated. During pregnancy, the rubella virus enters through the vessels of the placenta during the period of viremia - the time when the virus particles circulate in the maternal blood. This interval begins one week before the appearance of a skin rash in a woman and in the first days of the rash. We see that a woman who does not yet feel sick is already becoming a source of infection for her child.

The virus infects the cells lining the chorionic villi and the smallest vessels of the placenta, there it turns into small blood clots and spreads through the vessels of the fetus to all tissues. Chronic infection leads to congenital malformations.

In the lens of the eye and the cochlea of ​​the inner ear, the virus has a cytodestructive effect, that is, it directly destroys cells. In other organs, it inhibits cell division. Cells that have stopped dividing interfere with the normal development of the organ. Affecting the body in the early stages of pregnancy, the rubella virus causes a developmental disorder of the organ that is currently being laid.

Manifestation of a congenital form

Congenital rubella syndrome as a combination of cataracts, deafness and heart defects was described in 1942. Later it was found that the disease is accompanied by mental retardation, underdevelopment of the eyes (microphthalmia), skin inflammation (dermatitis), low birth weight.

Some developmental defects do not appear immediately, they may be absent at first. Other disorders are difficult to diagnose immediately after birth. These include deafness, retinal damage, myopia, congenital glaucoma, heart defects.

Brain pathology is often manifested by chronic meningoencephalitis: the child is lethargic, drowsy or, on the contrary, excitable, constantly crying. Sometimes there are seizures.

Microcephaly (small brain size) gradually builds up, the lens becomes cloudy, and intraocular pressure rises.

The early manifestation of congenital rubella is multiple hemorrhagic rashes that resemble bruises. They arise due to a reduced content of platelets in the blood, and persist for about 2 weeks.

Less commonly, there is hepatitis, jaundice, enlarged spleen, pneumonia, and bone damage. Malformations of the bones of the skull and skeleton, urinary tract, intestines and others can be observed. There is no doubt that the fetus is most vulnerable to infection in the first trimester.

After birth, a child is contagious to others for a year or more.

Diagnostics

Disease recognition is based primarily on the enzyme-linked immunosorbent assay, which detects two types of antibodies: IgM, reflecting an acute infection, and IgG, reflecting the presence of immunity (for example, after a previous illness or vaccination).

Rubella antibodies during pregnancy are determined if there is a threat that a woman has contracted rubella.

The following combinations can be found:

  1. If neither IgM nor IgG antibodies are detected, this means that the body is neither immune to disease nor acute infection. A woman should exclude possible contact with a patient and retake tests after 2 weeks. If again antibodies are not detected, after 14 days the examination is repeated a third time. In the absence of antibodies, the suspicion of rubella is removed. The woman is warned that she can get infected at any time. After the end of breastfeeding, she is recommended to get vaccinated.
  2. IgG positive, IgM negative: the body has immunity due to vaccination or a previous illness, this is the norm. The tests are repeated after 2 weeks. If the amount of IgG does not increase and IgM does not appear, the diagnosis of infection during pregnancy is ruled out.
  3. Increased antibodies to rubella during pregnancy, both IgG and IgM: risk of congenital pathology. Analyzes are repeated after 2 weeks with determination of IgG avidity. If IgM persists, there is a low IgG avidity, the woman is asked to consider terminating the pregnancy.
  4. IgM positive, IgG negative: recent infection, there is a risk of fetal infection. Repeated studies are carried out, with an increase in the IgG titer, an abortion is suggested.

Deciphering a blood test for rubella during pregnancy is carried out only by a specialist, other consultant doctors are involved, since the decision to terminate a pregnancy is made only collectively and only with the consent of the child's parents.

Therapeutic tactics and prevention of intrauterine infection of the fetus

When a fetus is infected with rubella within 11 weeks, the probability of congenital malformations and miscarriages is more than 90%. At a later date, the child is likely to be deaf. If the infection occurred in the 2nd trimester, the child develops a chronic infection with damage to the liver, blood, nervous system, teeth. At the same time, the placenta suffers, as a result, the fetus does not receive the necessary nutrients.

The question of maintaining such a pregnancy is decided at a medical council, the desire of the child's parents to terminate the pregnancy or leave it is necessarily taken into account.

If a woman has not had rubella and has not been vaccinated, she is vaccinated three months before the planned pregnancy. The rubella vaccine is not given during pregnancy. A woman who has not been previously vaccinated should avoid any contact with patients with skin rashes, especially young children.

If the disease still occurs before 16 weeks, it is recommended to terminate the pregnancy.

When infected in the 3rd trimester, the tactics are individual. It is important to determine if the fetus has had an intrauterine infection. To do this, examine the IgM of the umbilical cord blood (cordocentesis), conduct a virological or PCR study of the amniotic fluid obtained with.

In case of confirmation of fetal infection, pregnancy is recommended to be terminated. However, if a woman wants to keep the pregnancy, prophylaxis is carried out with a specific IgG antibody against the rubella virus. Its effectiveness is low.

Disease prevention

There is a specific rubella prevention, that is, a vaccine. Vaccination is carried out with a complex vaccine containing inactivated rubella, measles and mumps viruses at 1 and 6 years of age. In addition, adolescent girls and women are often vaccinated additionally when planning pregnancy, especially if they are at risk for rubella. Mass vaccination of the population with coverage of at least 80% helps to minimize the incidence of congenital rubella.

How not to get rubella if a woman is still not vaccinated? It is necessary to monitor your surroundings: when symptoms of rubella appear in someone close to you, you should be isolated from it for at least 10 days. It is also worth limiting your stay in crowded places, especially preschool children.

The prevention of infection of others is the isolation of the sick child for 5 days from the moment the rash appears.

Rubella is a viral infection that is usually mild and does not cause complications in adults or children. However, during pregnancy, the rubella virus is very dangerous, as it can cross the placenta and affect the fetus. Rubella infection during pregnancy can result in pregnancy termination or in the birth of a child with serious abnormalities.

Fortunately, rubella during pregnancy is not so common lately. Children are vaccinated against rubella, and many adults have had it in childhood and have earned lifelong immunity. In countries where a small part of the population is covered by vaccinations, there are higher rates of morbidity among pregnant women, for example, in Africa, Southeast Asia.

However, the risk of contracting rubella during pregnancy still exists, especially among those women who deal with children, for example, work in kindergartens, clinics, schools. The susceptibility to rubella is quite high and therefore the risk of getting sick upon contact with a sick person is high.

Can you get rubella again during pregnancy? There is such a risk, but it is negligible. In medicine, there have been cases when a woman, having been ill or having been vaccinated against rubella, contracted this infection again.

But in this case, the probability of transmission of the infection to the unborn child is ten times lower than if the woman had no immunity at all. However, doctors advise avoiding contact with rubella patients during pregnancy, even if they are immune to rubella.

Rubella during pregnancy: symptoms.

Rubella infection occurs through airborne droplets. From infection to the appearance of the first signs, it can take from 11 to 24 days.

Rubella during pregnancy is manifested by the following symptoms: fever, runny nose, cough, rash, enlargement of the cervical and occipital lymph nodes, redness of the eyes. The rash with rubella is pink, small, appears first on the face, but within a few hours spreads throughout the body.

The rash lasts no more than three days, then passes without leaving traces. Sometimes rubella during pregnancy proceeds without rashes, and is very similar to the usual acute respiratory infections, so it is not always possible to diagnose it only by symptoms.

If a pregnant woman has signs of infection or has had contact with a patient with rubella, then an urgent visit to a doctor is necessary. In some cases, immunoglobulins are injected, which reduces the risk of fetal injury.

Rubella in pregnancy: implications.

Rubella during pregnancy can have fatal consequences for the unborn baby. The rubella virus, crossing the placenta, infects embryonic tissues.

Infection of the fetus in the first trimester in most cases leads either to its death, that is, miscarriage, or to the development of congenital rubella syndrome (CRS). CRS is manifested by severe developmental defects - deafness, blindness, heart and brain defects, mental retardation, cerebral palsy.

In early pregnancy, there is an 80% chance of fetal infection. After 12 weeks of pregnancy, the risk is reduced to about 25%. If you get rubella during pregnancy after 20 weeks, the probability of having a child with abnormalities is practically zero.

If rubella infection occurred several weeks or even days before conception, then this does not pose a danger to the unborn child.

Is termination of pregnancy obligatory in case of rubella infection during pregnancy? In Soviet medicine, rubella disease in the first and second trimester of pregnancy was considered an indication for abortion. But at present, some doctors believe that even if the mother shows signs of rubella, this does not mean that the pregnancy should be terminated.

There are certain diagnostic methods that allow you to assess the condition of the fetus and, possibly, avoid the termination of the desired pregnancy. Of course, the longer the pregnancy, the more chances of a favorable outcome. Rubella during pregnancy poses the greatest danger to the unborn child for up to 16 weeks.

Rubella test during pregnancy.

Rubella testing during pregnancy is recommended for all women in the first trimester. Antibodies to rubella (rubella) are of two types: IgG, the so-called mature antibodies, and IgM, antibodies that appear in the blood after the introduction of the pathogen and indicate an active infectious process.

In the absence of symptoms of active infection, only an analysis is taken to determine the level of IgG antibodies to rubella virus in the blood serum. If the result is positive, then the woman has protection against rubella, the risk of re-infection is practically zero.

If the result is negative, contact with sick people should be avoided. The rubella vaccine contains live rubella virus, so this vaccine should not be given during pregnancy! It is necessary to observe preventive measures and consult a doctor for any signs of infection.

Since rubella is more common in children, it is best to avoid walking where babies are. If you have an older child, then there is a high probability that he will bring the virus from kindergarten or school, so it is imperative that the child be vaccinated. After vaccination, the child is not contagious.

Rubella vaccine before pregnancy.

It is best to take care of rubella protection during pregnancy planning. The first thing to do is to find out if you have immunity to this disease. For this, a blood test is taken from a vein for IgG antibodies to the rubella virus. If the result is positive, then you are immune.

In the absence of antibodies to rubella virus, you need to be vaccinated. Modern vaccines contain live rubella viruses, so it is undesirable to become pregnant after vaccination. Most doctors recommend planning a pregnancy 2-3 months after vaccination. But if you accidentally become pregnant earlier, then you should not terminate the pregnancy, the risk is theoretical.

If a woman was vaccinated at the very beginning of pregnancy, not yet knowing about it, then termination of pregnancy is also not recommended. So far, no cases of congenital rubella have been described following accidental vaccination of a pregnant woman.

So, in the case of rubella during pregnancy, it is quite simple to avoid serious health problems of the child and unnecessary worries, but you need to take care of this in advance.

Rubella is a childhood infectious disease characterized by a benign course. However, during pregnancy, the pathogen can cause fetal malformations.

Rubella in pregnant women

If a woman has not received a prophylactic vaccine before conception, she may develop rubella. In some cases, the disease occurs even after vaccination, but it proceeds in a mild or worn out form.

Rubella in childhood usually provides lifelong immunity, although the possibility of reinfection cannot be completely ruled out.

Also, one should not forget about the possibility of a post-vaccination reaction, since the immunological preparation contains a live, albeit weakened, rubella virus. Studies of teratogenic effects on the fetus in mistakenly vaccinated pregnant women have not been identified, but there is a risk of teratogenic effects. Between the vaccination and the planned conception, at least three months should pass, preferably six months.

Infection with the virus during pregnancy causes congenital rubella syndrome (CRS) in the fetus.

Congenital Fetal Rubella Syndrome

Primary infection during pregnancy does not always lead to CRS in the fetus. Intrauterine infection is possible without the formation of malformations. In this situation, class M antibodies to rubella will be detected in the umbilical cord blood, but organ damage in the child is not detected. In rare cases, the mother's illness does not lead to infection of the child.

The most dangerous is primary infection in the early stages. If it occurs before 8 weeks of pregnancy, then 60% of embryos are diagnosed with congenital rubella syndrome.

The disease during this period is very dangerous and with a confirmed diagnosis, doctors recommend the expectant mother to terminate the pregnancy. From 8 to 12 weeks, this risk is reduced to 15%.

In the second trimester, the likelihood of gross malformations is 7% and decreases every week. Lowest risk of CRS in the third trimester.

Rubella at a later date

In the third trimester of pregnancy, the risk of congenital rubella syndrome is about 1%. In the later stages, the child's body is reliably protected by the fetoplacental barrier and external influences are not as dangerous for him as in the first and second trimester.

And yet, in one woman in a hundred, the virus enters the baby's bloodstream and causes congenital rubella syndrome. It is characterized by:

  • Damage or underdevelopment of the eyes.
  • Deafness.
  • Defects of the cardiovascular system.
  • Hydrocephalus, high intracranial pressure.
  • Hyperkinesis (violent movements).

After birth, the development of such children is impaired, they have difficulties in adaptation. Over time, mental retardation becomes noticeable.

Congenital rubella syndrome in 10% of cases leads to miscarriage, in 20% - the child dies in utero.

In a woman, infection leads to a subfebrile temperature, the appearance of a characteristic small-spotted rash, which mostly affects the trunk. Accumulations of elements can be seen on the lower back and buttocks, extensor surfaces of the arms and legs. The disease can proceed without a rash, under the guise of a cold.

Sometimes the expectant mother is diagnosed with complications:

  • Inflammation of the joints.
  • Brain damage.
  • Thrombocytopenia.

They are associated with a weakened woman's immune system in the third trimester.

Although infection with the rubella virus in the later stages is much less likely to cause congenital pathology syndrome, the expectant mother should not get sick during this period. You can protect yourself from infection with the help of vaccination, which is carried out 3-6 months before the intended conception.