-Congenital Rubella Syndrome.

Congenital Rubella Syndrome

Aetiology:-
Maternal infection by rubella leads to Maternal viremia which lead to transplacental spread of the virus to the fetus causing fetal viremia whcih in turn leads to infection invloving many fetal organs and hence congenital anomalies.

N.B:- Newborn discharge virus in his secretions for 12-18 months after birth so he is infectious.
Incidence:-
*In the 1st trimester:- 15-20%.
*In the 4th month:- 5%.   
C/P :-
Intrauterine rubella may be followed by:-
1-Abortion.
2-Stillbirth.     
3-Live-born infant with manifestations of Cong. rubella Syndrome.
4-Normal infant(Clinically normal with +ve serology).

*Manifestations of Cong. rubella Syndrome:-
*early:-
-Throbocytopenic purpura “transient” the most frequent symptom. MCQ
-CHD:VSD, PS, PDA.
-Eye defects:-cataract,retinopathy,micro-ophthalmia,glaucoma.
- HSM,neonatal jaundice (d.2 hepatitis or haemolytic aneamia).
- Interstitial pneumonia.
- LBW.
-increase area of bone translucency .
-Deafness:may be the only manifestation(Uni or bilateral).
-CNS:-
Microcephaly,MR,Encephalitis,bulging ant.fontanel,spastic diplegia.
*Late
May be asymptomatic  at birth and presents later with :-
-Deafness.
-Cataract,glaucoma.
-MR.
-increase incidence of DM,thyrotoxicosis.
Diagnosis:-
1-careful history :- of maternal rubella during pregnancy is suggestive.
2-Virology examination.
Prevention:-
MMR vaccine and hyper immune serum Ig.

How to manage pregnant woman exposed to rubella?
1-prophylaxis:- avoid exposure of the pregnant woman to rubella.
2-If exposed during the 1st 3-4 months:-
-If +ve HI test:-assurance and continue pregnancy.
-If -ve HI test:-
a- If abortion C.I or refused:give hyper immune serum Ig immediately after exposure.
b- If abortion is available and not refused:Do it.

Dr Ibrahim

Return to list of medical syndromes here