A 5 month pregnant woman has rubella in her baby. What is Rubella in pregnant women

Rubella is a viral disease that usually occurs in childhood. Its symptoms are a rash spreading throughout the body and enlarged lymph nodes in the neck. However, in adults it often goes unnoticed. This disease, which in itself is harmless, becomes dangerous during pregnancy - not for the expectant mother, but for the fetus. Exposure to rubella in the first trimester of pregnancy can lead to premature birth or to fetal malformations such as cataracts, cardiac anomalies, deafness, and psychomotor retardation. Effective treatment Rubella does not exist, and vaccination is contraindicated during pregnancy. All that remains is preventive measures.

Causes of rubella during pregnancy

The rubella virus is volatile, unstable, and dies very quickly in the external environment. The source of infection is a sick person within 5-7 days from the onset of the rash. The disease is transmitted by airborne droplets (coughing, sneezing, etc.), as well as through the placenta to the fetus; the disease is highly contagious. Children of all ages are predominantly affected; rubella is very dangerous for pregnant women, especially in early stages pregnancy. According to the classification, congenital and acquired rubella with mild, moderate and severe course are distinguished.

The causative agent of rubella is a special Rubella virus.

Symptoms and signs of rubella during pregnancy

Young women of reproductive age who have not had rubella in childhood are at risk of contracting it during pregnancy. During acquired rubella, there is a latent period from the 11th to the 21st day, then the height of the disease begins. At this time, the woman complains of fever, weakness, headache, lack of appetite, nasal congestion, and the appearance of a small, spotted pink rash located throughout the body (the rash is especially dense on the nasolabial triangle, back, buttocks, and extensor surfaces of the extremities). The rash stays on the body for 1-4 days and then disappears without a trace. In adults, rubella is more severe than in children; very often, young women experience joint pain and swelling as a result of the disease. The immunity of a person who has had the disease is quite stable, and it is impossible to get sick a second time. No special drugs have been developed to treat the disease.

The main symptoms of rubella, which are difficult to miss, are a pinpoint rash on the body, fever, swelling and tenderness of the lymph nodes. General malaise is also possible.

Consequences of rubella during pregnancy

A pregnant woman who has had rubella must wait until the fifth month of pregnancy to find out if her baby is infected. Only at this stage is it possible to do a fetal blood test, and only this test allows you to check whether the fetus is infected. The consequences of infection depend on the period at which the woman had rubella.

At the beginning of pregnancy there is big risk fetal malformation (from 50 to 90%). In this case, therapeutic termination of pregnancy is possible. You can also wait until the fifth month to do a fetal blood test.

In the middle of pregnancy, the risk of congenital deformity decreases, but does not disappear: in 15% of cases, the disease affects the development of the child. At this time, a fetal blood test can be done: it will allow you to find out whether the child was infected, but will not provide information about the consequences past illness. In this case, you need to contact a specialized service to determine further actions. If you decide to continue the pregnancy, regular ultrasound examinations are required.

Infection with rubella at the end of pregnancy does not have a risk of abnormal fetal development. The only threat remains a lung infection, which will require long-term monitoring of the newborn.

Exists preventive treatment, namely mandatory vaccinations against rubella (girls aged 12 years are required to be vaccinated). The problem of congenital rubella is currently quite pressing, since a pregnant woman who has not had rubella is not protected from infection. The rubella virus is very dangerous for the fetus. This happens due to the teratogenic (affecting the development of the fetus) action of the pathogen, which results in various deviations in the development of the embryo. If the gestation period is 3-4 weeks, the frequency of violations physical development child is 60% of cases, if the period is 5-6 weeks - 3.5%, up to 12 weeks - 20% and 14-16 weeks - 5%. Children born from sick mothers develop diseases such as congenital pneumonia, purulent inflammation of the umbilical wound (omphalitis), abscess, rhinitis, sepsis (severe disease with the presence of bacteria in the blood, healthy people have sterile blood), lack of movement in newborns (paresis and paralysis), inflammation of the spinal cord (meningitis). Such serious illnesses very often lead to the death of the newborn. In the most favorable cases, children experience a special infection syndrome: the child’s low body weight, lack of oxygen, swelling of the body, arms and legs, yellowish skin persists long time(jaundice), increased body temperature. Such a child needs especially careful and special care in neonatal intensive care units.

Epidemics (the occurrence of a large number of cases of the disease) of rubella are always very serious, for example, during such an epidemic in the USA in 1965, about 50 thousand women were ill, and as a result, 20 thousand children were born with congenital deformities. As early as 1942, a triad of signs most often found in rubella was described: cataracts, heart defects and deafness (“classic rubella syndrome”). Currently, the concept of “extended rubella syndrome” has been introduced, which includes: microcephaly (small volume of the newborn’s skull), brain damage, pneumonia, enlarged liver and spleen, hepatitis, malformations of the skeleton and genitourinary system. Most often, newborns with rubella develop thrombocytopenic purpura (large bluish-red bluish-red blotchy rashes on the body), it is detected immediately after birth, is most intense during the first week of life, and disappears by the end of the second week, sometimes lasting 2-3 months. Very often, newborns experience enlarged liver and spleen, hepatitis, jaundice, hemolytic anemia, pneumonia, damage to tubular bones (hip, shoulder, lower leg), which is clearly visible on x-rays in the form of areas with increased or decreased content bone tissue. Such changes can lead to frequent fractures and bending of bones. Among the heart defects, the most common are: patent ductus botallus, narrowing of the right and left pulmonary arteries. With rubella, there is also damage to the aortic valve, defect of the interventricular and interatrial septa, transposition (opposite position) of the aorta and pulmonary trunk. It is believed that if a child does not die in the first years of life, then the immediate threat to the life of a child with a heart defect has passed. A small proportion of children have very serious heart defects, leading to death within the first six months. The most typical damage to the organ of vision with rubella is cataracts, which can be unilateral or bilateral, often accompanied by microphthalmia ( small size eyes). As a result of cataracts, the lens of the eye becomes cloudy and complete blindness occurs if left untreated. Rarely, children with congenital rubella develop glaucoma - high blood pressure V eyeball leading to blindness. Almost all children have high myopia, which requires early correction. However, the most common defect with rubella is deafness. It can be mild or severe, unilateral or bilateral. Mild cases of deafness often escape attention in the first years of a child's life and become apparent later in life. This vice is combined with a violation vestibular apparatus(manifests itself in the form of fainting, dizziness, intolerance to shaking, riding, turning and other active movements).

Rubella is a harmless childhood infection, which in children, as a rule, is mild and ends with complete recovery, leaving behind immunity for life. This infection is dangerous only for pregnant women: their infection in the first trimester of pregnancy with a probability of 80-90% leads to a miscarriage or the birth of a child with congenital rubella syndrome: multiple deformities, congenital heart disease, enlarged liver and spleen, deafness, blindness, various rashes on the skin.

Later, if the child remains alive, he has a lag in physical and mental development(up to 40%), cataracts or glaucoma (34%), hearing loss (up to 90%). Such children are more likely to develop swamps immune system.

In the 60s and earlier, when almost all children, without exception, began to attend nurseries at the age of 1-2 years, they managed to get sick from this infection in early childhood and by school time they were immune to rubella. Nowadays, children begin to attend preschool institutions later, since mothers were allowed to extend parental leave to 3 years. As a result, nurseries are closing en masse. All this has led to the fact that the peak incidence of rubella began to shift to older ages, and every year everyone becomes pregnant more women who do not have immunity to rubella.

At the Research Institute of Pediatrics of the Scientific Center for Children's Health of the Russian Academy of Medical Sciences, a long-term thorough virological examination of children with congenital malformations was carried out. The results of the study made it possible to link the occurrence of developmental defects in the vast majority of children examined with rubella contracted by mothers during pregnancy. The most alarming result of this study is the fact that the diagnosis of rubella by typical clinical symptoms(characteristic rash, swollen lymph nodes, fever) was diagnosed in only 2% of examined mothers whose children were born with congenital rubella syndrome. In the rest, the disease was interpreted as an acute respiratory infection, food or drug allergy, or was asymptomatic. Such a variety of clinical forms of rubella in adults, with an increase in the number of people who do not have immunity to this infection, taking into account the high infectiousness (out of 100 people who were in contact with a person with rubella and did not have immunity, 90 get sick) creates a serious danger for pregnant women.

If there is no immunity, the woman needs to be vaccinated against rubella. This vaccine has been used for many years in developed countries in Europe and America, which has led to a sharp reduction in cases of congenital rubella.

In our country, vaccination against rubella has become available only in last years, however, the vast majority of parents of teenage girls, and even young women of childbearing age, still have not realized the danger of rubella and the need to vaccinate expectant mothers to give birth to healthy offspring. The vaccination can be done without a preliminary examination (vaccination will not cause harm to those who have previously had rubella), the only requirement is the absence of pregnancy and protection from it for 3 months after vaccination.

Rubella is one of the “fears” of expectant mothers because it is dangerous for the baby. The virus is transmitted through the placenta to the baby and can cause various pathologies development, especially if the expectant mother fell ill with rubella in the first trimester of pregnancy (damage to the cardiovascular system, damage to internal organs, deafness, damage to the ocular apparatus). If a pregnant woman falls ill with rubella after the 16-17th week of pregnancy, then the probability of congenital malformations is only 1-7%.

It is believed that after a person has had rubella, he has a strong lifelong immunity, i.e., he can no longer get sick again through contact with sick people. Therefore, even before pregnancy, it is useful to find out if you are immune to rubella by taking the appropriate blood test. It is called “IgM and IgG antibodies to rubella pathogens.” Often women do not remember whether they had rubella in childhood or not. This analysis will help you find out. If you are already pregnant, you need to beware of places where children gather (schools, children's parties, etc.), where rubella is most common, until at least the 16th week of pregnancy

If a pregnant woman becomes ill with rubella in the first 3-4 months of pregnancy, she is recommended to have an abortion for medical reasons.

Diagnosis of rubella during pregnancy

The incubation period for rubella is 14-21 days. If a pregnant woman has been in contact with a child with rubella, she should have a serological blood test done within ten days. A negative result does not allow us to make a final conclusion that the woman is healthy. After 15-20 days it needs to be done reanalysis, and only by its result can one say whether a woman is infected or not. Both analyzes should be performed in the same laboratory to avoid interpretation errors. A serological blood test is also required in case of unexplained skin rashes.

Treatment and prevention of rubella during pregnancy

Since rubella is very dangerous for pregnant women, it is very important to examine women planning to have a child for the presence of antibodies to rubella in order to find out whether they had this infection in childhood.

Rubella is a disease that occurs in a fairly mild form. It manifests itself in small rashes (red dots) on the face and in the folds of the skin of the body. However, rubella is very dangerous for pregnant women. She is providing harmful influence on the fetus, especially if the disease occurs in the first three months of pregnancy. If the disease occurs in the 6th week of pregnancy, it leads to ocular abnormalities in the fetus, namely cataracts; in the 9th week - to deafness; between the 5th and 10th weeks - to vices of cardio-vascular system; between the 6th and 9th weeks - to no proper development teeth.

To prevent rubella, women who do not have immunity are vaccinated before pregnancy. You should be protected from conception for 3 months after the vaccine is administered.

You have been in contact with someone who has rubella. You should not be afraid if you were vaccinated as a teenager. If you have already had rubella before, then you also have nothing to fear. In both cases, you have developed immunity. If you have doubts about this, you can undergo serodiagnosis based on an immunological study of blood serum.

If you have developed immunity, this means that there are antibodies in the blood that will immediately respond to the penetration of pathogens, such as rubella viruses. Antibodies protect your body from reinfection.

If you are not immune and have had contact with someone who has rubella, which may well happen if you work in an educational setting, please notify your doctor immediately. The incubation period, that is, the time from the moment of infection to the appearance of the rash, is 15 days. This means that if you do nothing, you risk getting rubella two weeks later. The first two weeks of pregnancy are a very important period. At this time, the organs of the unborn child are laid. To avoid the development of the disease, the doctor will prescribe you gamma globulins (a fraction of blood plasma immunoglobulins with antibodies), which are active during the incubation period and block the development of the disease.

You should know that in case of rubella in the first four months of pregnancy, abortion is indicated.

The rubella vaccine is given at least 2-3 months before possible pregnancy!

Prevention of rubella during pregnancy

At your first consultation at the beginning of your pregnancy, your doctor will give you a blood test (serodiagnosis) to check if you are immune to rubella. If you have already had it or were vaccinated against it, then your body should have produced protective antibodies, in which case a blood test will reveal them.

If you are not immune to rubella, you will need to avoid contact with children who may be carrying the virus. Therefore, you should vaccinate your children.

Congenital rubella

Rubella is a contagious viral infection. We are talking about a non-dangerous effect on a child and an adult, but a very dangerous effect on the fetus: if a woman gets rubella during the first months of pregnancy, her child risks getting a serious developmental defect.

Until the 3rd month of pregnancy, congenital rubella provokes malformations of the brain, heart, vision and hearing in the fetus. After the 3rd month it may cause a delay intrauterine development fetus, hepatitis, lung and bone disease... Therefore, at the beginning of pregnancy, the doctor always checks whether the woman is vaccinated against rubella. If not, he warns her that she must avoid contact with people who carry the virus.

A pregnant woman who has not been vaccinated against rubella should have her first blood test done after 10 days after contact with a sick person; the second - after 15 or 20 days. It is the latter that will allow you to find out whether it was infected or not.

Only possible treatment- this is prevention and vaccination of children. Every woman of childbearing age who is not sure whether she has had the disease or been vaccinated against rubella should have her immunity checked. If she is not resistant to the virus, she should get vaccinated. Vaccination is contraindicated during pregnancy.

– 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.

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 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 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 recommended to be completely isolated 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 the group high risk on development congenital anomalies 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 as if passing through natural birth canal, and 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. As 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 ends during pregnancy 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 interruption. Nonspecific prevention of rubella during pregnancy involves eliminating contact with possible carriers of the infection and strengthening the immune system.

Rubella is a childhood disease, as it most often affects unvaccinated children aged 2-9 years. The nature of the disease is acute, viral. The causative agent is Rubella virus, transmitted by airborne droplets.

Rubella, which is harmless to a child, becomes extremely dangerous during pregnancy. During this period, it poses a serious threat, as it causes severe systemic fetal defects.

Historical fact

The year 1960 became a fatal test for America. The population was struck by a severe epidemic. More than twenty million people in the United States have had rubella. The nation felt the real scale of the disaster only 9 months later. Exactly then American doctors understood how rubella during pregnancy affected children. Two million newborns infected with the virus in mother's womb, serious mental and physical abnormalities were observed.

Rubella symptoms

Once the virus enters, the incubation period lasts two to three weeks. After this, symptoms reminiscent of a cold occur:

• fever up to 38 °C;
• sore throat;
• redness of the eyes;
• signs of intoxication (nausea, weakness, etc.);
• aching joints;
• soreness of the occipital and cervical lymph nodes;
• conjunctivitis.

Two days later, a flat, pale pink rash appears that does not protrude above the skin surface. It is preceded by a rash on the palate, gradually moving to the tonsil area.

Nature of the rash

Localized small spots no more than 3-5 mm. In adult patients, including pregnant women, the spots tend to merge with each other. Initially, the rash appears on the face, then quickly spreads over the entire surface of the body: to the back, buttocks, stomach, legs and arms, with the exception of the palms.

The rash is usually not accompanied by itching and lasts from two to four days. IN in rare cases up to seven days. Then it disappears without residual marks or peeling.

Types of rubella

• Classical- all of the listed symptoms and periods of the disease are clearly expressed.
• Erased the form is characterized by partial manifestations. With elevated temperature and inflammation in the throat, the rash may not be observed.
• Asymptomatic, in which all typical signs are absent. Despite this, the rubella virus leaves lifelong immunity, just like in the classic version.

The last two forms are the most dangerous for others, since infected people do not suspect that they are the source of infection.

Some colds and allergic diseases, as well as measles and scarlet fever, have similar symptoms. Only an infectious disease specialist can make a reliable diagnosis, taking into account laboratory diagnostic data. If a woman has not had rubella, she must notify her doctor during the pregnancy.

Rubella during pregnancy: risks and complications

The Australian doctor N. Gregg first described the abnormal consequences for the fetus of rubella infection in the mother in 1941. The insidiousness of the rubella virus lies in the fact that it easily passes through the placenta. At the same time, it inevitably affects the fetus, adversely affecting its development.

It is most dangerous if a woman becomes infected in the first trimester, at the stage of embryo formation. This is the most unfavorable period, since the rubella virus damages the most important systems of the embryo. The most common triple lesion is called Gregg's triad. At the same time, in 95% of cases, a newborn has heart defects, in 85% - eye cataracts, in 22% - deafness.

Other adverse effects on the fetus include:

• change in blood formula;
• liver and spleen defects;
• congenital deformities;
• body weight is below normal;
• disorders nervous system.

Mental disabilities do not appear immediately. Developmental delays become noticeable only as the child grows older.

Except intrauterine defects There are also other complications, in particular, miscarriage and frozen pregnancy. After the twentieth week the situation changes dramatically. At this stage, rubella rarely has a negative effect on the baby.

Probable methods of infection

The rubella virus is extremely contagious, especially through casual contact at home or in children's groups. The susceptibility of unvaccinated people is estimated at 90%, so if rubella is detected, quarantine is declared. A person releases the virus several days before the rash forms, throughout the entire period of illness, and for another week after recovery.

People are most likely to become infected through close contact with an infected person, for example, when living together in an apartment. The maximum likelihood of disease is observed during off-season periods. Epidemic outbreaks are recorded approximately once every 5 years.

At the same time, the rubella virus is highly sensitive to environmental influences and quickly dies when the temperature rises, in sunlight, or when disinfected with chlorine-containing agents.

In most cases, the source of infection is small children. Therefore, the risk of contracting rubella increases in pregnant women, those with younger children, or those in contact with children's groups at work. Especially when the baby and/or woman attend kindergarten, clubs, and sports clubs.

Diagnostics

After suffering from rubella, lifelong immunity remains in the body, preventing secondary infection. If a woman has already had rubella or been vaccinated, there is nothing to worry about during pregnancy.

If you do not have accurate information about childhood diseases, then you need to donate blood for rubella antibodies. However, you should not trust the memories of relatives. Viral diseases in childhood are often accompanied by a rash and have similar symptoms. The only true criterion can be the diagnosis recorded in the medical record.

IN Lately Doctors quite often note the asymptomatic and mild course of rubella, which makes it difficult to make accurate diagnoses. If there is no entry in the card, it is possible that the woman could have had the disease in an erased form, without pronounced symptoms. There is a small chance that symptoms of another disease may have been mistaken for rubella.

To dispel all doubts, a blood test should be performed for specific antibodies. It is best to do this at the planning stage of pregnancy.

Decoding the results

A positive result for Ig G titers indicates a previous history of rubella. This means that the fetus is 100% guaranteed to be protected from contracting this disease during pregnancy.

Vaccination

Rubella is a controlled infection, the spread of which is regulated by routine vaccination. Specific vaccinations are included in the immunization schedule in many countries. If Ig G is not detected in the blood, rubella vaccination is strictly indicated before a planned pregnancy. Moreover, it should be done no later than the three-month period before conception.

Children are usually vaccinated with the MMR vaccine. Women who do not have Ig G antibodies are administered a specially developed monovaccine, Rudivax.

Contraindications to vaccination

It is prohibited to vaccinate against rubella under the following conditions:

• malignant processes;
• immunodeficiency states;
• while taking corticosteroids;
• allergy to the drug Neomycin and other vaccinations;
• temperature increase.

What to do?

If a pregnant woman who has not previously had rubella and has not been vaccinated finds herself in a hotbed of infection, she should immediately consult an infectious disease specialist. The doctor will write a referral for laboratory testing of rubella virus titers.

Antibodies Ig M- these are specific markers of rubella. They begin to be produced in the blood at the moment of injury. After two to three weeks, their concentration reaches the maximum, and after two months Ig M is eliminated from the body. If Ig M is detected in the blood, then the woman is in the acute phase of the disease. This is the most unfavorable option for pregnant women. To assess the likely risks, it is necessary to find out how long the infection occurred.

If the result is positive before the 17th week, the pregnancy is terminated. Such an exceptional measure is justified even in the absence of symptoms, since in any case the virus will penetrate the placenta and cause dire consequences for the fetus.

At 16-28 weeks, a comprehensive examination is carried out, including ultrasound, genetic analysis, collection of amniotic fluid. Based on the research results, the question of the presence of fetal anomalies and the need for artificial termination of pregnancy is being considered.

Management of pregnant women with rubella

If the disease is detected after the 28th week, the woman is placed on special medical registration. In this situation, doctors carry out therapeutic measures to maintain fetal health.

Immunoglobulin therapy is indicated. At the same time, measures are being taken to prevent placental insufficiency and prevent miscarriage. Adequate medical care They are usually provided in a hospital setting. It helps prevent adverse consequences and avoid miscarriage.

Doctors take into account that rubella during pregnancy can cause complications during childbirth. In particular, there is a risk of abnormal labor. In addition, the born child poses an infectious danger to others for a long period after birth.

Precautionary measures

A woman expecting a child, as well as her children and relatives, should avoid crowded places, especially crowds of children. The “black list” includes clinics, kindergartens, schools, large stores, theaters, attractions, etc.

If you get rubella youngest child pregnant woman, his care should be entrusted to third parties, and it is best to temporarily isolate him to eliminate the risk of infection.

Leading obstetricians and gynecologists admit that the listed measures do not provide a 100% guarantee of safety. Therefore, they insist on mandatory testing for rubella titers before pregnancy. And in the absence of immune bodies - on routine vaccination.

After vaccination, stable immunity occurs in almost 100% of cases and persists for twenty years. Maternal antibodies are transferred to the newborn and protect him from infection for the first six months of life.

Rubella during pregnancy is dangerous due to intrauterine infection of the fetus, which threatens the development of congenital deformities. Every year, up to 300 thousand newborns with congenital rubella syndrome (SLE) are born around the world. In Russia, among all children born with deformities, 15% are deformities associated with this disease. The situation is aggravated by the fact that about 90% of all cases of rubella occur without visible symptoms. The frequency of fetal damage depends on the stage of pregnancy. Vaccination against rubella in adolescent girls and young women who do not have immunity will help minimize the birth of children with SLE.

Rubella takes leading place among airborne infections of a viral nature. The disease is characterized by symptoms such as a small-spotted rash and enlarged cervical lymph nodes (often occipital). Most often, the disease affects children 3–9 years old. In recent years, there has been an increase in incidence among adults.

Rice. 1. The photo shows congenital rubella. Cataract is one of the common manifestations of SLE.

Why is rubella dangerous during pregnancy?

• Developing fetus during the first trimester of pregnancy, she is most vulnerable to rubella viruses if the pregnant woman does not have immunity to the disease. Viruses can enter the fetal blood through the placenta and cause many serious developmental defects.
• Rubella in pregnant women causes miscarriages and stillbirths in 15% of cases.
• With congenital rubella, the viruses in the child’s body persist for 1 to 2 years, and therefore the newborn poses an epidemic danger to others even if there are protective antibodies in the blood.

How dangerous is the rubella virus during pregnancy?

The rubella virus is transmitted to pregnant women in two ways: from a sick person and from a sick pregnant woman to the fetus.

• Viruses are transmitted by airborne droplets, which contributes to the rapid spread of infection in organized groups. The disease occurs only with close and prolonged contact, Unlike chickenpox and measles.
• Rubella viruses during pregnancy are able to penetrate through the placenta into the blood of the fetus, damaging its genetic apparatus and destroying cells. In women who suffered from rubella while in the 3rd to 4th week of pregnancy, from 50 to 85% of cases of birth of children with congenital deformities are registered.
• Rubella viruses in newborns who have had the disease in utero are released into the external environment through nasopharyngeal mucus, feces and urine for many months. The child poses a great epidemiological danger to others.
• Rubella viruses during pregnancy begin to be released into the external environment from the patient several days before the appearance of the rash and continue to be released for a week after its appearance.

Rice. 2. Rubella during pregnancy in the first trimester poses a great danger to the fetus.

Rubella in pregnant women: symptoms of the disease

Rubella during pregnancy occurs in typical, atypical (without rash) and inapparent (asymptomatic) forms. Asymptomatic forms account for up to 90% of all cases of the disease. The only way its detection is to carry out serological reactions, when an increase in antibody levels can be detected.

Currently, there is an increase in the number of cases of the disease in adults, in whom rubella in its typical course has a number of features.

Symptoms of rubella in pregnant women:

• The incubation period for the disease lasts 11 - 24 days. During this period, viruses that have entered the body multiply intensively in the cells of the mucous membranes of the upper respiratory tract and lymph nodes, which enlarge towards the end of the prodromal period (usually occipital). With rubella, the groups of occipital and posterior cervical lymph nodes most often enlarge. Their size reaches a large pea or more, they are of medium density, painful on palpation. As the rash disappears, the lymph nodes decrease in size.
• Rubella in pregnant women is often severe, with high (up to 39 o C) body temperature, severe headache, severe muscle and joint pain, and lack of appetite.
• Catarrhal phenomena of the upper respiratory tract and inflammation of the conjunctiva of the eyes are significantly expressed.
• Rash in pregnant women tends to merge. When merging, extensive spots are formed.
• The most common complication in pregnant women is polyarthritis.

Rice. 3. The photo shows rubella during pregnancy. A rash and enlarged lymph nodes are the main symptoms of rubella in pregnant women.

Rubella during pregnancy: consequences

• In women who suffered from rubella while in the 3rd to 4th week of pregnancy, from 50 to 85% of cases of birth of children with congenital deformities are registered.
• Long-term suppression of the immune system during illness leads to the development of sore throats, otitis media, bronchitis and pneumonia.
• Sometimes arthritis or arthralgia are recorded. The joints of the fingers and wrist become inflamed more often. Sometimes the knee joints become inflamed. Arthritis and arthralgia last no more than a month after the rash appears.
• Encephalitis and meningitis develop very rarely.

Of particular danger is the development of rubella in the fetus in the case of an involuntary (asymptomatic) form of the disease in a pregnant woman.

Rice. 4. The photo shows congenital rubella. Deafness is one of the common manifestations of SLE.

How does intrauterine infection of the fetus develop?

Rubella virus during pregnancy affects embryonic tissues early stages pregnancy, when active formation of fetal organs and systems occurs. Fetal growth slows down and normal organ formation is disrupted.

In 10 - 40% of cases, pregnancy ends in spontaneous abortion, in 20% - in stillbirth, in 10 - 25% - in the death of the newborn.

Viruses penetrate from mother to fetus during the period of viremia (release of viruses into the blood). This period begins a week before the rash appears and continues for some time after the rash appears. There is an assumption that rubella viruses first infect the epithelium covering the chorionic villi and capillaries of the placenta. Next they go to circulatory system fetus The resulting chronic infection causes the development of congenital deformities.

• Viruses inhibit the miotic activity of cells. Organ cell populations slow down in growth. They become incapable of differentiation, which interferes with the proper development of organs.
• The ability of rubella viruses to destroy cells manifests itself only in the cochlea of ​​the inner ear and the lens of the eye, causing congenital deafness and cataracts.

Rice. 5. The outer part of the fetal membrane of the embryo is called the chorion (6th week of pregnancy in the photo).

Viruses cause maximum harm to the fetus when infected in the first trimester of pregnancy (first 12 weeks). At the 13th week and later, fetal development defects develop less frequently. The danger persists until the 3rd trimester.

Rice. 6. The photo shows the fetus (6th and 10th weeks of pregnancy).

Rubella in pregnant women: consequences for the child

In 1941, the Austrian researcher N. Gregg described anomalies in newborns whose mothers had rubella during pregnancy. Cataracts, deafness and heart defects are called Congenital Rubella Syndrome (CRU). Subsequently, the list of these vices expanded significantly.

Congenital rubella syndrome: timing and frequency of development

• Between 3 and 11 weeks of pregnancy, defects of the central nervous system develop. At 4–7 weeks of pregnancy, defects of the heart and visual organs develop. The incidence of malformations in the 3rd - 4th week of pregnancy is 60%.
• Between 7 and 12 weeks, hearing defects develop. The incidence of malformations during this period is 15%.
• The incidence of malformations at 13–16 weeks of pregnancy is 7%.

Rice. 7. Congenital rubella. Eye cataract.

Congenital rubella: list of fetal development defects

Congenital rubella syndrome today usually includes:

• Malformations of the heart, which manifest themselves in the form of patent ductus arteriosus, ventricular septal defect, pulmonary stenosis.
• Eye malformations manifest as corneal opacities, chorioretinitis, cataracts, microphthalmia, glaucoma and retinopathy.
• Deafness is one of the most common congenital defects.
• Malformations of the central nervous system manifest themselves in the form of defects in the formation of the skull and brain (microcephaly), accompanied by mental retardation.
• Hypotrophy and intrauterine growth retardation.
• Malformations of internal organs: bone damage, enlarged liver and spleen, myocarditis, interstitial pneumonia, thrombocytopenic purpura, hemolytic anemia, dermatitis, etc.

TO late developmental defects include thyroiditis, diabetes and progressive subacute panencephalitis.

To more rare malformations include malformations of the skull, bone skeleton, genitourinary organs and digestive system.

Difficult to recognize during the newborn period, such defects as deafness, pathology of the heart and visual organs (congenital glaucoma, high degree of myopia).

Chronic meningoencephalitis is difficult to recognize in a newborn. Lethargy, drowsiness or increased excitability and convulsions are its main symptoms.

It is difficult to recognize thyroiditis and diabetes mellitus in a newborn.

Rice. 8. Deafness, cataracts and heart defects make up the classic congenital rubella syndrome.

Tests for rubella during pregnancy

Modern diagnostics of rubella allows you to quickly make the correct diagnosis and prescribe adequate treatment, which can significantly alleviate the patient’s condition and carry out timely preventive actions, preventing infection of others and contact persons. The causative agents of the disease (viruses) contain substances (antigens) that can cause an immune response in the body of an infected person (the formation of antibodies). Antibodies and antigens are detected and studied using serological reactions. They are based on the body's immune reactions.

Testing for rubella during pregnancy using a serological research method is fundamental in diagnosing the disease and in identifying the level of protective antibodies in the blood that appear after vaccination in the past.

Antibodies to rubella during pregnancy are detected using the neutralization reaction (RN), complement fixation (RSF), hemagglutination inhibition (HAI), latex agglutination, radial hemolysis reaction (RHR), immunoblotting technique and “trap” ELISA. All of the above methods are inexpensive, sensitive and reliable.

Rice. 9. Set of reagents “BioScreen-Rubella-IgG”, which is used for quantification specific antibodies (immunoglobulins).

Antibodies to rubella during pregnancy

Antibodies formed as a result of vaccination or after previously suffering from rubella penetrate the placenta and with mother's milk, protecting the fetus from infection and rubella during the first year of the unborn child's life. If a pregnant woman unprotected from rubella comes into contact with a patient, a disease may develop in which viruses can penetrate the fetus and cause the development of many malformations. Antibodies to rubella during pregnancy are determined using serological tests.

If a woman planning a pregnancy does not remember whether or not she was previously vaccinated against rubella, it is necessary to do an immunological test for the presence of anti-rubella antibodies in the blood.

Tests for rubella in pregnant women and their interpretation

• Analysis "Anti-Rubella-IgM positive during pregnancy" means that the pregnant woman has rubella. Antibodies - class M immunoglobulins are produced in the body of a pregnant woman during illness within 1 - 3 days.
• "Anti-Rubella-Ig In a patient with rubella, they appear 3 to 4 weeks after the disease or their titer increases. This analysis helps to retrospectively assess the situation. An increase in antibody titer by four times or more indicates the severity of the disease.

Tests for rubella when planning pregnancy and their interpretation

• "Anti-Rubella-IgG positive during pregnancy" in a healthy woman means that anti-rubella antibodies are present in the blood. Positive analysis confirms a previous history of rubella or previous vaccination against the disease.
• If the level of anti-Rubella-IgG is less than 10 U/ml, this means that the amount of antibodies in a person’s blood is insufficient to protect against the disease. When the concentration of anti-Rubella-IgG is more than 10 U/ml, we can talk about the presence of immunity to infection.
• « AntiRubella-IgG negative during pregnancy" means absence IgG antibodies. In this case, vaccination is indicated 2 months before the planned pregnancy.

Rice. 10. Cataract is one of the most common congenital defects associated with rubella.

Measures to take if a pregnant woman comes into contact with a person with rubella

If a pregnant woman comes into contact with a patient, a serological blood test is performed to determine antibodies to Rubella virus.

• Antibodies to rubella of the IgG class are always present in the blood of a person who has previously had the disease or has been vaccinated. They provide protection to the body from re-infection. The absence of antibodies means that the pregnant woman is not protected from the disease and there is a risk of infection if she comes into contact with a sick person.
• In case of contact with a patient and in the absence of IgG antibodies in the blood of the pregnant woman, the test is repeated after 4 - 5 weeks. In case of a positive result ( « AntiRubella-IgG positive" during pregnancy) it is recommended to terminate the pregnancy. When negative analysis the test is repeated after 1 month. Negative test ( « AntiRubella-IgG negative" during pregnancy) indicates that upon contact with the patient, infection of the pregnant woman’s body did not occur and the pregnancy can be maintained.
• If, after contact with a patient, 2-4 weeks later, IgM antibodies and low-avidity IgG are detected in the blood of a pregnant woman, this indicates that infection has occurred. If infected in the first trimester, the pregnancy must be terminated. If infected at 14-16 weeks of pregnancy, the issue of terminating or continuing the pregnancy is decided at a medical consultation.

The absence of symptoms of rubella in a pregnant woman after contact with a sick person does not exclude the absence of the disease. The asymptomatic form of rubella poses the same danger to the fetus as the manifest form.

Rice. 11. Malformations of the central nervous system in congenital rubella manifest themselves in the form of defects in the formation of the skull and brain (microcephaly), accompanied by mental retardation.

Treatment of rubella in pregnant women

When treating the disease, only symptomatic therapy methods are used, since specific (etiotropic) therapy for this infection is limited this moment not developed.

It is not recommended to administer immunoglobulin to prevent the disease during pregnancy. The administration of immunoglobulin is permitted if a woman, after contact with a person with rubella, insists on continuing the pregnancy. However, birth healthy child in this case it is not guaranteed.

Rubella vaccination and pregnancy

Vaccination against rubella before pregnancy is carried out 2 months before the planned pregnancy.

Rice. 12. The photo shows mono-vaccines.

Rubella vaccine before pregnancy

If there are no IgG antibodies in the blood, the woman is vaccinated two months before the planned pregnancy. In the Russian Federation, a monovaccine is used for these purposes. Rudivax(France), Rubella vaccines(India and Croatia).

• Before pregnancy, the rubella vaccine is administered intramuscularly into the shoulder area in a volume of 0.5 ml.
• Immunity after vaccination develops after 15-20 days and lasts for 15-25 years.

Rice. 13. Vaccination against rubella before pregnancy will prevent the birth of a sick child.

Vaccination against rubella during pregnancy

Although random rubella vaccination during pregnancy has no effect negative influence on the fetus, pregnancy today is a contraindication for vaccination.

According to the latest data (more than 1000 pregnant women were studied), when pregnant women who denied pregnancy were vaccinated, infection of the fetus with vaccine viruses was quite often observed, but this did not in any way affect its development. Occasional rubella vaccination during pregnancy is not an indication for termination of pregnancy.

Rubella vaccine after pregnancy

If a pregnant woman is unvaccinated, she is vaccinated after childbirth, but only after an immunological examination. A woman is vaccinated in the absence of IgG antibodies in the blood after childbirth ( « AntiRubella-IgG negative").

Vaccination against rubella for pregnant women who have previously had the disease

When the rubella vaccine is administered to people who have previously had the disease, nothing bad will happen. Antibodies in the blood will block vaccine viruses.

Repeated vaccination (re-vaccination) before pregnancy

Repeated vaccination (re-vaccination) when vaccinated before pregnancy is not carried out.

Consequences of the rubella vaccine

Rubella vaccination before pregnancy: consequences

• Reactions to rubella vaccination are rarely recorded.
• It may manifest as local tenderness, fever, and enlarged occipital lymph nodes.
• Transient acute arthritis and arthralgia appear 1 to 3 weeks after vaccination. More often the knee and wrist joints are involved in the process. The complication is registered in girls and young women.
• Vaccine reactions such as anaphylactic reaction and thrombocytopenia have been reported rarely.
• A reaction to a vaccine can develop as a result of errors that occur during immunization: administration of an increased dose of the vaccine, violation of the route of administration of the drug, violation of antiseptic rules.

Rubella vaccination during pregnancy: consequences

According to the latest data (more than 1000 pregnant women were studied), when vaccinating pregnant women who denied pregnancy, infection of the fetus was quite often observed, but this did not in any way affect its development.

Vaccination against rubella in the postpartum period: consequences

Reactions to vaccination carried out in postpartum period and after 7 days from the start monthly cycle are observed extremely rarely.

Rice. 14. In one month the baby will be born (in the photo the fetus is at the 36th week of pregnancy).

Articles in the section "Rubella"Most popular

Rubella is an acute viral disease that usually affects children if they have not been vaccinated. The disease can also affect adults. Children tolerate the infection easily and acquire stable immunity to the pathogen. In adults, the disease is more acute and often causes serious complications. Rubella is especially dangerous in early pregnancy.

Causes of rubella during pregnancy

Rubella is transmitted by contact and airborne droplets, so it is easy to become infected with the disease. The causative agent of the disease is RNA-containing Rubivirus. It is easily and quickly introduced into the human body, but outside a living organism it dies within an hour. The virus does not survive in conditions of intense ultraviolet radiation, temperatures above 56 degrees and when exposed to various antiseptics. When frozen, it can be stored for years.

The likelihood of becoming infected from a sick person occurs 2 days before the first symptoms appear. The virus affects those with weakened immune systems especially quickly, so a woman during pregnancy only needs to meet an infected person once to get sick.

In the first weeks of pregnancy, the expectant mother’s body begins to rebuild: the activity of the immune system decreases, changes hormonal background. As a result, a pregnant woman's susceptibility to various pathogens increases.

The virus threatens not so much the woman as the fetus. The most unfavorable period of pregnancy in terms of rubella infection is the first and second months. Rubivirus penetrates through the placenta into the blood of the embryo and affects almost all its organs.

How does the disease manifest?

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The disease occurs in adults almost the same as in children. The difference is how severe the symptoms are. The main features include:

1. Enlarged lymph nodes on the back of the head and neck. Sometimes there is damage to the inguinal lymph nodes.
2. The appearance of a red rash. First, characteristic rashes appear on the head and neck, then they gradually spread throughout the body. Red spots do not rise above the surface of the skin and do not peel off. Dry and warm to the touch. Appearance the rash can be seen in the photo.
3. High fever, aches, headache, weakness, feeling of heaviness throughout the body.
4. Inflammation of the upper respiratory tract, painful sensations and sore throat.
5. Joint pain. Sometimes rubella causes inflammation of one or more joints.

Diagnostic methods

With the aim of accurate diagnosis In case of infection with a dangerous infection, doctors conduct special studies. These are tests that help detect the presence of antibodies to the disease - IgM and IgG - in the blood of a pregnant woman. If none of the immunoglobulins were detected, experts conclude that the expectant mother has completely no protection against rubella. On initial stage acute rubella, IgM is detected in the blood.

If examinations show that a woman is infected with rubella and has no immunity, doctors carry out laboratory research to determine how the disease affected the condition of the fetus. The consequences depend on the duration of pregnancy and the severity of the disease.

How to treat rubella?

When infected with rubella in the early stages (from 3 to 12 weeks), doctors insist on terminating the pregnancy, since the infection will destroy almost all systems of the child’s body. As a result of this, he will die or be born with severe pathologies.

Recommended for the expectant mother symptomatic treatment, which is no different from therapy for other adults. Paracetamol is prescribed to reduce high fever, and Biseptol is prescribed for sore throat. In order for the body to cope with the virus faster, the patient must remain in bed, drink plenty of fluids, and take vitamins. If the disease is accompanied by bacterial infections, the doctor may prescribe antibiotics.

Possible complications in pregnant women

Rubella during pregnancy can be complicated by joint damage, arthritis, intoxication of all systems, and pathologies of the nervous system. Severe disease can lead to serious illnesses brain - edema, encephalitis, meningitis. Complications occur rarely, mainly due to late consultation with a doctor or self-medication. Rubella affects the condition of the fetus much more severely.

Consequences for the child at different stages

The disease is viral in nature, therefore, after the pathogen enters the body, it instantly spreads to all organs of the body. The fetus is very vulnerable in early pregnancy. In the first trimester, the baby’s basic systems are laid and formed, and any negative impact may cause serious pathologies.

The virus is very aggressive. There are very few cases when it does not affect the condition of the fetus in any way. The severity of the lesions is directly related to the period at which the pregnant woman suffered the infection.

First trimester

If during the first 12 weeks of pregnancy the expectant mother falls ill, the baby may be born with congenital defects of the heart muscle (pulmonary artery stenosis, patent ductus arteriosus), visual organs (glaucoma, retinal damage, cataracts), and hearing organs (congenital one-sided or bilateral deafness). Rubella, which the expectant mother suffered during this period, has severe complications.

In 30% of cases, the disease causes termination of pregnancy, in 20% the child dies at birth or dies almost immediately after birth. If the baby does not die, he is born with congenital rubella syndrome - a pathology that combines a large number of severe disorders. There is no chance to save the fetus after infection in the first trimester, so doctors almost always similar situations they recommend having an abortion.

Second trimester

Rubella during pregnancy in the 2nd trimester is also dangerous to the life and health of the baby. The risk that the fetus will die after birth or be stillborn is about 10%. Most likely consequences diseases for a 4-5 month old fetus:

1. oxygen starvation;
2. abnormalities of the nervous system, leading to a slight developmental delay in the baby;
3. low body weight;
4. weak immunity;
5. increase in the size of the liver and spleen;
6. congenital pneumonia;
7. autoimmune diseases (vasculitis, systemic lupus, etc.);
8. damage to tubular bones;
9. anemia.

If the mother falls ill during pregnancy from 14 to 21 weeks, doctors monitor the condition of the fetus for the rest of the gestation period. Give birth to expectant mother sent to a special center.

Third trimester

From the beginning of the third trimester of pregnancy, antibodies against rubella begin to be produced in the fetus's body, so complications occur less frequently. Babies who were born after their mother had rubella are sometimes diagnosed with the following disorders:

• congenital pneumonia;
• low body weight;
• the appearance of a characteristic rash;
• developmental delay.

Those who have had rubella last trimester pregnancy, may experience complications during childbirth. Another consequence of rubella in later stages is premature birth.

The likelihood of complications developing in a baby is no higher than 5%. In case of infection during this period of pregnancy, the condition of the fetus is carefully monitored using ultrasound, and drug treatment is carried out to eliminate placental insufficiency fetus

After birth, the baby is registered and its development is monitored for 2 years: this is the amount of time the virus continues to live in the body.

Prevention measures

Home preventive measure viral infection is vaccination. The vaccination should be done no later than 3 months before the planned pregnancy. If a woman is already carrying a child, vaccination is contraindicated for her: the risk of developing acute rubella after vaccination in this case is very high.

Stable immunity to the disease is formed in the body after suffering from rubella. Sometimes mom can't remember if she was sick before. In this case, you can be tested for IgM and IgG antibodies - their presence in the blood indicates the body’s resistance to rubella.

If a pregnant woman has not been vaccinated right time before the gestation period, and she does not have immunity, during outbreaks of an epidemic she needs to refrain from visiting places with large concentrations of children, try to avoid communication and proximity with sick people. In case of accidental contact with infected children, a pregnant woman should notify the attending physician - she will be given special immunoglobulins, which will significantly reduce the likelihood of the disease occurring. Rubella is a dangerous disease for an expectant mother, so you should not refuse vaccination.