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Rubella (German measles) is a mild viral infection that is trivial in children, more severe in adults. One attack confers immunity. Maternal rubella infection in early weeks of pregnancy causes fetal damage (commonly multiple defects) in up to 90% of infants. Congenital rubella syndrome (CRS) is a major cause of developmental abnormalities including blindness and deafness. Generally presents with macular facial rash that spreads to trunk and limbs, fading within 4 days; also cervical lymphadenopathy, fever and myalgia. Spread is by airborne droplets. Vaccine given in childhood as part of the triple MMR (measles, mumps and rubella) vaccine.
Midwives should check the woman's rubella immune status as part of routine antenatal care. This is determined by measuring the rubella antibody titre. Women who are not immune should be advised to avoid contact with anyone with rubella, and may wish to discuss termination of the pregnancy if they have already been exposed. Exposure in the first trimester can result in spontaneous abortion. Infection occurring within 11 days of the last menstrual period is unlikely to result in intrauterine infection, and proven infection occurring later in pregnancy (after 16th week) is less likely to result in severe fetal sequelae.
Babies born with CRS are highly infectious and should be isolated from other infants and pregnant women, but not their own mothers.
Vaccination should be offered during the puerperium, and subsequent pregnancy avoided for at least 3 months.