Gynecology And Obstetrics-

Rubella during pregnancy

introduction

Rubella is caused by the parvovirus B19 and is mainly transmitted by droplet infection in the form of sneezing or saliva.

If an infection with the pathogen has occurred, it can either go unnoticed by the person concerned or lead to flu-like symptoms. The diagnosis is determined by the typical garland-shaped reddish rash that develops after about a week. In the event of an infection, pregnant women run the risk of transmission to the child, which in principle can but does not necessarily lead to developmental disorders in the unborn.

Symptoms of rubella during pregnancy

A pregnant woman will only notice an infection with rubella from the characteristic rash.

The other symptoms of the illness, such as weakness and a rise in temperature, are too unspecific and more likely to suggest flu. But it is important to know that it is precisely these unspecific symptoms of the disease that are often the only indications of the infection. The rash doesn't always have to manifest itself. However, if a pregnant woman observes the rash, this is a clear indication of an illness.

What is specific about rubella is that the rash first spreads to the face on the cheeks. In English, people often speak of the so-called "slapped cheek", because at the beginning it looks like someone has been slapped. The reddening is limited to the cheeks and may remind one or the other of a butterfly shape when looking a sick person in the face. In the following days, the rash also shows up on the arms and legs until it can be seen almost all over the body. Here the redness is more like a garland and can make the skin appear rougher in the affected areas. Usually there is no itching or oozing.

How can you tell yourself if you have rubella?

It is best for a pregnant woman to watch her body carefully and identify any skin changes at an early stage. Unfortunately, this is the only safe way to diagnose rubella yourself. Without the skin changes, the diagnosis cannot be made reliably and makes a viral infection by influenza viruses (flu pathogens) much more likely.

In the case of unspecific flu-like symptoms, a gynecologist should always be consulted.

Does the rubella spread to the unborn baby?

If a pregnant woman has rubella, the pathogen can also be transmitted to the unborn baby. But this does not always have to be the case.

In addition, there is no clear relationship between the severity of the mother's disease and the probability of transmission. In other words, an infected but symptomless mother can transmit the virus to the child in the same way as a mother who shows clear symptoms and the typical skin rash. If a transmission has taken place, in a pregnant woman it took place via the bloodstream through the placenta and thus also via the umbilical cord.

How dangerous can the disease be for the baby?

It is difficult to say how often an infection with rubella causes serious developmental defects in the unborn child.

Experience has shown that infections are particularly dangerous for the baby in the first twenty weeks of pregnancy. Almost every illness after this point in time only causes mild symptoms. A full picture of the disease in the mother however, in the worst case scenario, it can lead to the death of the baby. In the technical language one speaks of a "Hydrops fetalis". It describes a generalized water retention in the child, which is not compatible with life. Such cases are, however, isolated cases. Many pregnant women carry out their pregnancy without serious complications. Much more common is temporary anemia, which returns to normal on its own.

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Pregnancy complications

What does rubella do to my child?

In the unborn child, the infection with rubella causes exactly the same symptoms as in the child or adult.

This means that in this case too the virus can attack the red blood cells and in the worst case it can cause severe anemia. The greatest risk of a pronounced course of the disease is in the first twenty weeks of pregnancy. This is where the unborn child's greatest leaps in development take place, as the organs are created and the body is properly formed during this time. If the virus then causes a lack of supply in the child - since the child has too few red blood cells to supply him with oxygen - development disorders can occur. These can then manifest themselves in a slight growth retardation or, in the worst case, lead to fruit death.

In most cases, however, an infection only causes mild symptoms in the unborn child. A clarification with the gynecologist must always provide certainty here. In addition, if an infection is detected, the course for mother and child can then also be closely observed.

Therapy for rubella during pregnancy

The treatment is purely symptomatic of an infection with rubella, as it is a viral disease. So antibiotics against bacteria do not work here.

There is also no vaccination against the virus that could prevent the disease. A sick pregnant woman should primarily take care of herself physically and keep a light bed rest. But it depends entirely on how much the pregnant woman feels sick. Medicines should be avoided during pregnancy if possible, as their risk of harming the unborn child is too great. However, if the complaints of the pregnant woman are too burdensome, taking medication can also be useful after consulting the gynecologist. Selected painkillers or antipyretic drugs such as paracetamol can then be used here.

Experience has shown that the severity of the illness in pregnant women is rather low and is more like a mild flu-like infection with weakness and fatigue. In addition, the rash is often the only reason to see a doctor.

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What should I do if, as a pregnant woman, I had contact with a sick person?

Not every contact with a sick person means infection with the virus.

The risk of transmission from another person is highest when you have been in contact with someone's saliva or other secretions. If this is the case, great emphasis should be placed on hygiene. This means washing your hands carefully after contact and possibly changing clothes if, for example, you sneezed. It is also best to avoid any further contact with the sick person, if possible. For working pregnant women, this also means a professional ban in the first 20 weeks of pregnancy if there is an increased risk of infection (e.g. for kindergarten teachers). Otherwise you have no choice but to pay careful attention to any symptoms. If the characteristic rash occurs, an appointment should be made with the gynecologist for further clarification.

Incubation period for rubella virus

The incubation period for the virus only lasts a few days and quickly leads to unspecific symptoms, such as those present with a cold.

The typical rash doesn't develop until about 1-2 weeks after infection. Before that, however, there is already a risk of infection. This means that one remains contagious from the onset of unspecific symptoms until the rash subsides. As a result, rubella is often transmitted and spread unconsciously, as those affected do not even know that they have it at the onset of the disease.

Can I determine my immune status before pregnancy?

Anyone who has had rubella once in their life has developed enough antibodies that a second infection with the virus is extremely unlikely.

So there is lifelong protection after an infection. It is not part of the standard tests during or before pregnancy to determine the antibody titer. This is carried out if a disease is suspected and should also be reserved for this special case. However, a check is also indicated in the context of maternity leave for occupations that are particularly at risk of contact.

Ringworm pathogen

The causative agent of rubella is the parvovirus B19. It only leads to infections in humans, so transmission is only possible from person to person.

In the case of an infection with the typical disease characteristics, doctors speak of an "erythema infectiosum", which means nothing other than that a pathogen-specific reddish rash manifests itself on the skin. It is characteristic of the virus because it takes on a garland-shaped form. However, the rash is considered harmless. The effect of the virus on the sick person's blood cells is much more dangerous. In the worst case, it can lead to anemia by affecting and destroying red blood cells. As a rule, however, it remains with purely flu-like symptoms.