The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Rubella relates to infectious diseases. Rubella is not present any particular risk or for sick children or for pregnant women, but it is fraught with formidable complications for the fetus, so measles is on the list of dangerous infections during pregnancy (TORCH infections).
The danger of rubella during pregnancy
It was found that the smaller the gestational age, the much more frequent and severe teratogenic effects of the virus on the fetus (effects, leading to the development of gross vices).
The most dangerous is infection of women with rubella during the first trimester, because in this period there is a bookmark fetal organs, and it has no immune defenses.
teratogenicity frequency is:
- 0-1 week 80%;
- 3-4 weeks 60%;
- 5-8 weeks 30%;
- 9-12 weeks - 20-25%, and fetal infection risk of 35-40%;
- 13-16 weeks - 10-15%, the risk of infection of 25%;
- after 17 weeks - 4-5%.
However, these data do not differ significantly as a woman can be infected in the first trimester, and fetal infection can occur in the later stages of pregnancy, including third trimester.
It is also believed that intrauterine infection may occur in the fetus, even if the woman had been ill with rubella 6-12 months ago, that is before pregnancy. This is due to the long persistence of virus and antigens in the bloodstream of women.
Fetus rubella virus differ diversity and do not depend on the severity of the clinical manifestations of the mother.
Diagnostics
If you suspect that a woman infected with rubella are conducted laboratory studies. First appointed virological method - a fence of nasopharyngeal swab and taking blood and planting material in the culture medium. Then assigned to PCR to isolate RNA from the blood of women.
The most important is the serological study, in which blood revealed either no antibodies to rubella virus 2 classes the immunoglobulins IgM and IgG. Moreover, serological blood tests carried out twice, with an interval of 10-14 days. acute about speak at elevated antibody titer in 4 times or more.
- Immunoglobulin class M, which are determined only after 4 weeks after exposure, indicate recent illnesses.
- The presence of IgG and IgM talks about undergoing acute rubella outbreak and development of immunity against it.
- If the antibodies of class M are absent, but there are immunoglobulin class GIt means that the fetus is not threatening infection, because the mother has immunity (or after vaccination, or after suffering earlier, before pregnancy, disease).
At unsatisfactory results of serological blood tests pregnant in the first trimester, it is stored in a high-risk group, and 16-20 weeks of it in terms sent to amniocentesis (Study of amniotic fluid) and cordocentesis (A study of umbilical cord blood) for virus isolation from the obtained biological materials.
transmission path
Rubella infected pregnant woman can during close contact, or contact with an infected person. That is, the disease is transmitted by airborne droplets or contact, for example, when caring for patients.
The virus enters the upper respiratory tract, where it enters the bloodstream and lymphatic system, and then infects the embryo / fetus. Due to the vertical transmission of rubella belongs to dangerous infections.
What to do when infected
In the case of clinical and laboratory confirmation of the diagnosis of acute rubella woman is necessary to isolate and prevent all contact with patients with rubella.
Pregnant women are prescribed bed rest, drink plenty of liquids, antipyretics and vitamins (no specific treatment). With the development of complications is shown antibiotics, sulfonamides, and pain medication. Further prolongation or termination of pregnancy depends on the length of gestation.
This confirmed the epidemiological, clinical and serological data in a period up to 16 weeks of pregnancy artificially interrupt. Also interrupt the pregnancy if the woman had no immunity before the conception and contact in gestation to 16 weeks to patients with rubella had.
The basis for therapeutic abortion are positive serological and bacteriological data twice study (14-21 days) in the absence of clinical manifestations.
If a woman is infected in the period from 16 to 28 weeks, regardless of the presence / absence of positive symptoms and rubella bacteriological and serological results, pregnancy is also recommended to interrupt (taking into account the desires of the woman, and ultrasound data Prenatal Diagnostics).
In the case of infection of pregnant gestation of 28 weeks or more, it put on record in the high risk group, carry out preventive courses treatment of placental insufficiency, intrauterine fetal hypoxia and delays development and postnatal development of septic complications. Births are both threatened by the development of anomalies tribal forces and obstetric hemorrhage.
rubella consequences of the child
The most common consequence of rubella in pregnancy is the development of the newborn congenital rubella syndrome - Greta triad:
- cataracts and blindness - 75%;
- heart defects up to 84%;
- Deafness - 50%;
In addition to the classical syndrome in 72% of children have disorders of brain (microcephaly, mikrooftalmiya, enlarged fontanelles).
Other manifestations include:
- glaucoma, a violation of the vestibular apparatus;
- vices skeletal development;
- hepatosplenomegaly;
- damage to the organs of the urinary system.
If no gross malformations, it is noted a small weight and height have rubella virus infected children, retarded physical and mental development.
Other complications of rubella in the mother:
- miscarriage - 40%;
- dead fetus - up to 20%;
- Death in childbirth and after - up to 25%.
In pregnant woman increases the risk of abnormalities of tribal forces and bleeding during childbirth and postpartum septic complications ...
Some studies in pregnancy
- Smears in pregnancy
- Analyzes during pregnancy trimesters
- Ultrasound in pregnancy
- Urinalysis in pregnancy
- coagulation
- Installing pessary
- glucose tolerance test
- Homocysteine in pregnancy
- Anesthesia during childbirth
- Fetal CTG (cardiotocography)
- cordocentesis
- Epidurals in labor
