What is dangerous rubella during pregnancy,prevention and diagnosis when planning

Update: October 2018

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

The virus is transmitted mainly by airborne droplets:
coughing, sneezing, talking. Susceptibility to the disease is very
high, in the absence of rubella immunity, the risk of infection is equal
70-80%. In pregnant women it is possible to transmit the disease through the placenta to
to kid.

The effects of rubella virus on the body

Of all human tissues, the rubella virus prefers the skin,
lymphoid and fetal tissue, with which are the main symptoms
diseases. After infection, the virus quickly spreads through the blood,
affecting the walls of small vessels. Typical rubella rash – not that
otherwise, as damaged small capillaries of the skin. Second place
virus habitats are lymph nodes. Almost all patients
rubella they are significantly increased in size.

In severe cases, the virus infects nerve tissue, causing a very
dangerous conditions – rubella meningitis and encephalitis. The most
dramatic development of events – the defeat of the rubella virus in
pregnancy embryo tissue. In the first weeks of pregnancy, all
the cells of the little man are intensively divided, forming new organs and
tissue. The virus slows down this division process, causing severe malformations.
fetal development. And the sooner viral particles penetrate to the fetus,
the greater the risk of serious violations.

Symptoms of rubella

Most rubella sick in childhood. Unvaccinated children suffer
rubella is pretty easy, but the danger is formidable
complications of infection: meningitis and encephalitis. Due to the large
vaccination coverage, these manifestations are rare.

General malaise

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

Rash

Rash появляется сначала на лице, через несколько часов
descends below, spreading to the arms, body and legs. Most
rashes on the back, buttocks and extensor surfaces of the hands.
Rashes are small spots (2-4 mm) of pale pink.
color, round clear shape. After 1-3 days the rash disappears completely,
leaving no marks and scars.

Lymphadenitis

The second significant symptom of the disease is lymphadenitis.
(inflammation of the lymph nodes). Nodes enlarged, often –
painful in palpation. This condition lasts up to 2 weeks.
after rashes. In pregnant women, a characteristic rash is often absent, and
here lymphadenitis is a reliable symptom of rubella.

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

Diagnosis of rubella

In the period of the characteristic rash diagnosis can be confirmed
following methods:

General blood analysis:

  • decrease in the number of leukocytes
  • decreased neutrophil count and lymphocyte increase
  • large number of monocytes

Determination in the blood of antibodies to rubella using ELISA. In response to
any acute infection the body produces Igm, which is quite
disappear quickly. For long-lasting immunity are responsible IgG. With
rubella:

  • Igm appear 1-2 weeks after the rash and persists in
    blood up to 3 months
  • IgG appear after Igm and persist throughout
    of life.

Rubella testing (M and G immunoglobulins) should be done to everyone.
pregnant women and women planning a pregnancy in the near
the future.

How is rubella prevention performed?

All children are vaccinated against the disease at the age of 1 and 6 years.
Girls 12-13 years old are recommended to hold a third vaccination in order to
By the time of pregnancy planning, the risk of rubella was
minimized.

Immunity to the disease develops in 9 out of 10 vaccinated children. Usually
A sufficient level of protective antibodies persists for 15 years.
Therefore, if the child was vaccinated only in 1 year, then by
18–20 years the risk of contracting rubella (including during
pregnancy) is quite large. In rare cases, the disease can
occur in vaccinated people. But such reinfection proceeds
much easier, and transfer from mother to fetus is practically
is impossible.

Prevention of the disease in pregnant women

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

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

Depending on the antibody titer, the result is considered positive.
negative or doubtful. Each analysis should be
the quantitative value of Ig and the norms of a particular laboratory.

Interpretation of tests for women planning
pregnancy:

Igm IgG Decryption
positive negative, positive или doubtful Most likely, at the moment a woman is suffering an acute phase.
diseases. Planning pregnancy after rubella is not recommended.
earlier than 3-6 months, with repeated blood tests on
antibodies.
negative negative Such data means the absence of strong immunity (female
did not suffer from rubella and most likely was not vaccinated).
Recommended vaccination and pregnancy protection for
3-6 месяцев с повторным исследованием крови на antibodies. Highly
it is important to have a rubella vaccination before pregnancy,
and not during it (since vaccination during pregnancy is
indication for its interruption)
negative positive As a result of an illness or vaccination in the body
присутствуют antibodies. You can safely plan and carry
pregnancy without fear of getting infected.

Interpretation of tests for pregnant women:

Igm IgG Decryption
negative negative In situations where a woman has not passed the tests when planning, and
during pregnancy, immunoglobulin titers are negative,
careful monitoring of its condition is necessary, since the risk
getting infected with a virus is pretty high. Повторные анализы на Igm и IgG ,
as well as the exclusion of contacts with rubella patients – necessary
measures to prevent congenital abnormalities in
fetus.   
negative positive Most often this means strong immunity after vaccination or
rubella, you can safely bear pregnancy
positive any This is the worst result for women in the early stages.
of pregnancy. If the re-analysis results are saved,
or antibody titers to rubella IgG are increasing – we are talking about
перенесенной во время беременности diseases.

Most often with the latest test result and signs
rubella (recent rash, fever and malaise) doctors
recommend abortion of small duration. With отказе от
abortion is necessary to carry out the following activities:

  • periodic blood test for rubella antibodies
  • Ultrasound in the period of 16 weeks to detect fetal malformations
  • cordocentesis for a period of 17-18 weeks

If during cordocentesis the virus in cord blood is not found, then
возможно дальнейшее вынашивание of pregnancy. Woman injected
specific anti-rednic immunoglobulin for the speedy expulsion
virus from the body.

The question of abortion may occur again when
detection of severe fetal malformations (anencephaly, lethal
heart defects and TP).

If a pregnant woman has had rubella for a period of 16 weeks or more,
and the fetus is without visible abnormalities, then medical abortion is not
shown, since the risks of serious complications are much lower.

Congenital rubella

The frequency of congenital rubella infection depends on the measures
taken in each specific country. With проверке крови на
antibodies before and during pregnancy, as well as mass vaccination
girls puberty the frequency of this pathology tends to
zero (see rubella in children).

The risk of developing congenital abnormalities with rubella during
pregnancy:

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

Congenital rubella syndrome combines three major
manifestations:

  • Cataract (and other pathologies of vision: glaucoma, underdevelopment
    eye)
  • Heart defects (non-constriction of the arterial duct, stenosis
    pulmonary artery and aortic valve, Fallot’s tetrad, coarctation
    aorta)
  • Deafness (occurs in 90% of children with congenital rubella)

In addition to these pathologies, there is hydro and microcephaly,
anomalies of occlusion, dysplasia of organs, damage to the skin and blood vessels. These
Signs occur when a child is infected at a later date. With
infection of the fetus 4 out of 10 pregnancies are interrupted and whether
end with fetal death of the child.

Early signs of congenital rubella:

  • thick hemorrhagic rash (bruises) on the background of a decrease
    platelet count
  • hepatitis
  • interstitial pneumonia

Further development of a child with congenital rubella
late mental retardation autism and others
pathology of the nervous system. Given the serious consequences for life
and fetal health, it is very important to prevent rubella infection during
время of pregnancy. Therefore, when preparing for conception
neglect the diagnostic tests that are taken throughout
modern world.

What can be confused with rubella?

Even the classic course of rubella is similar to many viral
allergic diseases and rashes. And since
rubella during pregnancy often atypical, then
it is quite difficult to distinguish between some states. In many cases
помогают выявить краснуху positive результаты анализов.
Similar manifestations occur when:

  • measles
  • infectious mononucleosis
  • drug allergy
  • scarlet fever
  • erythema infection

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