Congenital rubella disease is a rubella disease of the fetus. The infection is transmitted to the fetus via the placenta and causes severe deformities. Vaccination prophylaxis against rubella is strongly recommended before pregnancy.
What is rubella embryofetopathy?
Rubella virus is a human pathogenic virus from the virus genus Rubivirus, which belongs to the togaviruses. It is the only pathogen of this genus. The virus is better known as the causative agent of rubella. In addition to rubella, infection with the virus can cause embryonic rubella disease in the womb if the mother becomes infected during pregnancy. For everything about liver metastases, please visit foodezine.com.
The rubella embryopathy is therefore one caused by transmission of the rubella pathogen to the fetus, as can take place via the placenta. Fetal infection is a major complication of maternal rubella and is also referred to as a major complication of pregnancy. In the meantime, the incidence of congenital rubella disease has fallen significantly and is now only one case in 10,000 births.
The low incidence is due to widespread MMR vaccination and consistent prenatal diagnosis. There is a higher risk of congenital rubella fetopathy in the first trimester of pregnancy than in later stages. If the mother-to-be becomes infected during the first three months of pregnancy, diaplacental transmission occurs in almost one third of all cases. The consequences of a rubella congenital foetopathy are more or less severe malformations of the fetus, which can extend from the central nervous system to the heart.
Causes
If an expectant mother becomes infected with the rubella virus during pregnancy, there can be a generalized spread of the virus in the body. This generalized spread extends to the placenta. The virus can then be transmitted to the fetus via the placenta. The infection causes disturbances in the cell divisions of the fetus.
The differentiation processes of the cells are disrupted and individual tissues do not develop as intended. Depending on the phase of embryonic development, this connection can lead to an abortion, especially if the individual is not viable due to the abnormal development. If no abortion occurs, the infection develops a so-called embryopathy in the form of rubella syndrome.
The pregnant woman can remain completely asymptomatic with an infection, which usually takes a rather mild course. However, this asymptomatic nature of the expectant mother does not allow any statements to be made about the condition of the child. Infections after the third month of pregnancy are relatively rare at ten percent. In the first month of pregnancy, on the other hand, the risk is around 60 percent.
Symptoms, Ailments & Signs
Rubella embryopathy causes a variety of malformations, especially in the organ systems of the central nervous system, the ears and the heart. In addition to [mental disability|mental retardation]], congenital rubella disease often manifests itself in hepatosplenomegaly and hepatitis.
Petechiae, pronounced microcephaly or encephalitis are also present. A particularly common symptom is also the congenital heart defect in the form of a Ductus Botalli apertus, a pulmonary stenosis or a tetralogy of Fallot. Myocarditis is also conceivable.
In addition, the eyes can be affected by congenital functional impairments. This is the case, for example, with glaucoma, which eventually leads to blindness. Cataracts are also often present in the eye area. The same applies to retinal malformations. The ears are also often affected by functional impairments, above all by sensorineural hearing loss or deafness.
Growth retardation is common. Classically, not all of the symptoms mentioned are present, but the patients suffer from a triad of congenital heart defects, cataracts and inner ear deafness. The severity of the malformations differs from case to case. In particularly severe cases, there is no viability and the child dies in the womb.
Diagnosis & course of disease
Prenatal diagnosis is one of the reasons why the incidence of congenital rubella disease is declining. If the mother has an anamnestic indication, the gynecologist will order a detection of the virus in the mother’s blood, urine or saliva. Further diagnostics are only required if there is no evidence that the mother had been vaccinated against rubella twice.
IgM detection in newborns is possible from about the fifth month of pregnancy. A PCR proof can be provided by an analysis of the amniotic fluid. Congenital rubella fetopathy is thus usually diagnosed before the child is born. The prognosis depends primarily on the stage of pregnancy at the time of infection.
Complications
In the worst case, congenital rubella fetopathy can lead to the death of the child. For this reason, this disease must be diagnosed and treated at an early stage. The affected children usually suffer from a heart defect and are therefore dependent on regular examinations throughout their lives in order to avoid sudden cardiac death and other heart problems. Hepatitis can also occur in patients and have a very negative effect on their quality of life.
Sometimes hearing problems or blindness can occur in the course of the child’s development. The patients often suffer from a significantly delayed development and are therefore dependent on the help of other people in their lives. Mental retardation can also occur. In severe cases, the children die immediately after birth because they are not able to survive.
As a rule, congenital rubella disease can be prevented with the help of medication before pregnancy. There are no particular complications. With the help of regular examinations, the disease can also be detected early during pregnancy and treated immediately. This completely avoids the discomfort.
When should you go to the doctor?
Congenital rubella fetopathy should always be evaluated and treated by a doctor. In the worst case, this can lead to the death of the child or serious deformities that can lead to further complications. The earlier the rubella fetopathy is detected, the higher the probability of a complete cure of this disease. A doctor should be consulted if the affected person contracted hepatitis during pregnancy. Heart problems can also indicate this disease and should be examined by a doctor.
In children, congenital rubella disease manifests itself as delayed growth and problems with vision or hearing. In some cases, it can also lead to complete deafness or blindness. If these symptoms occur, a doctor must be consulted in any case. Congenital rubella fetopathy can be diagnosed by a pediatrician or general practitioner. For further treatment, however, visits to a specialist are necessary. It cannot be generally predicted whether congenital rubella disease will lead to a reduced life expectancy.
Treatment & Therapy
After a diaplantar transmission of the rubella infection to the fetus has already taken place, a causal therapy is no longer possible. Prevention is the key moment in congenital rubella disease. Maternal vaccination protection should be secured. Before each planned pregnancy, a rubella titer must be determined.
In the case of insufficient vaccination protection, revaccinations must be ordered. Ideally, women who are already pregnant should not be vaccinated. The live vaccine can infect the unborn child. Nevertheless, in an emergency, pregnant women are sometimes given a booster shot. Infection by the vaccine virus is the lesser evil compared to rubella embryopathy. As a rule, the vaccine virus itself does not lead to embryopathy.
Pregnant women should not come into contact with people infected with rubella. If contact cannot be avoided, passive immunization is induced. If the mother has IgG antibodies, there is presumably immunity from a previous vaccination or illness.
The affected person should be checked regularly for fresh infections at least until the end of the fourth month of pregnancy. If the mother becomes infected before the fourth month of pregnancy and the parents-to-be cannot accept the foreseeable deformities in the child, an abortion can be considered.
Prevention
The most effective prevention of congenital rubella disease is vaccination of the mother against rubella. The measles, mumps and rubella vaccination is given for the first time in the first year of life and again in the fifth year of life. The titer for rubella antibodies is ideally determined before each planned pregnancy in order to be able to carry out booster vaccinations if necessary.
Aftercare
Since congenital rubella fetopathy is a congenital malformation syndrome, there are no direct follow-up recommendations. The problems can only be treated symptomatically but not causally. In connection with a desire to have children, detailed genetic counseling makes sense. Comprehensive, loving care is important for those affected.
The parents should prepare themselves for permanent care and the other family members can also participate. With intensive care, the course of the syndrome can be alleviated somewhat, and fewer complications occur as a result. This positive influence is further promoted by regular medical check-ups.
The doctor responsible can detect possible further damage to the organism at an early stage and act in good time. Due to the psychological stress on the affected patients and their families, it is advisable to seek professional psychotherapeutic help if necessary. Talking to family and close friends can also ease the difficulties.
In self-help groups or through the doctor treating them, the families come into contact with other victims. The exchange that takes place here enables all those involved to talk about the problem and to discuss solutions that make everyday life easier. Incipient depression or serious psychological difficulties can be dealt with quite well in this way.
You can do that yourself
Pregnant women must be informed about possible risks, dangers and influencing factors of pregnancy. One’s own behavior is to be optimized and should be designed in the interests of the unborn child.
For this reason, environments and contact with people suffering from rubella should be avoided completely. The disease is considered highly contagious and can lead to serious complications during pregnancy. Therefore, the expectant mother should find out in good time what diseases are present in her immediate environment. Places where people with diagnosed rubella have stayed should be avoided at all costs. At the first signs or irregularities, it is also mandatory to consult a doctor.
Self-help measures are not enough to alleviate the symptoms or to achieve healing. Only precautionary measures can be taken before the viral disease. It is advisable to work with a doctor even before planning the offspring. If there is a desire to have children, the doctor can assess the mother’s state of health at an early stage and, if necessary, administer a possible vaccination. In addition, the consultation provides timely information about special situations with certain risks. Since a woman who is already pregnant cannot be vaccinated, taking the preliminary measures is particularly important and advisable.
