Diagnose: IgG antibody increase after 1 to 2 weeks and/or IgM antibodies demonstrated. IgM antibodies disappear 4-8 weeks after the acute phase. Examination: Exposition for rubella before 18 weeks of gestation. Rash in mothers with serological verified rubella (look for Parvovirus as well) Incubation time: 14-21 days Interpretation: No antibodies = never have had rubella. Repeat after 2 weeks if suspicion of recent exposure. Diagnosis should not be made on IgM antibodies alone. Disappear after 4-8 weeks. Increase in IgG and IgM antibodies equal to actual rubella infection. In very few occasion IgG develops before IgM. 80-90% of mothers in first trimester transfere rubella to the foetus and 50% in the second trimester. Risk: 0-12 weeks of gestation, severe malformation (cataract, deafness, heart malformation, mental retardation) 50-85%. 13-16 weeks of gestation, hearing loss and/or mental retardation. 16-18 weeks of gestation, only hearing loss in few %. More than 18 weeks of gestation, no malformation described but child can excrete virus several years after delivery. Fetal Diagnosis: Should be based on risk assessment as the necessary virological technique for fetal investigating is not fully validated. However, CVS with PCR seems to be better than amniocentesis and fetal blood sampling. Postnatal Diagnosis: 0-3 months IgM indicates intrauterine infection. Prophylaxis: Pregnancy is not advised 1 months after vaccination but damage has not been described even after accidental vaccination in the first trimester. No risk post partum and breastfeeding no contraindication. References: (1) MacLean A, et al. Infection and Pregnancy, RCOG Press 2001. (2) www.Infpreg.com (3) UpToDate 2005, Online 13.3
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