Rubella embryofetopathy is a rubella disease of the fetus. The infection is transmitted to the fetus via the placenta and causes severe malformations. Vaccine prophylaxis against rubella is strongly recommended before pregnancy.
What is rubella embryofetopathy?
Rubella virus is a human pathogenic virus from the viral genus Rubivirus, which belongs to the togaviruses. It is the some pathogenic agent from this genus. The virus is better known as the causative agent of rubella. In addition to rubella, infection with the virus can cause rubella embryopathy in the fetus if the mother becomes infected during pregnancy. Consequently, rubella embryopathy is one caused by transmission of the rubella pathogen to the fetus, as can occur via the placenta. Infection of the fetus corresponds to a serious complication of maternal rubella and is also referred to as a severe pregnancy complication. Meanwhile, the incidence to rubella embryopathy has decreased significantly and is now only one case per 10,000 births. The low incidence is due to the widespread MMR vaccination and consistent prenatal diagnostics. There is a higher risk of rubella embryofetopathy in the first trimester of pregnancy than in later stages. If the expectant mother becomes infected during the first three months of pregnancy, diaplacental transmission occurs in almost one-third of all cases. The consequence of rubella embryofetopathy is more or less severe malformations of the fetus, which may extend from the central nervous system to the heart.
Causes
When an expectant mother becomes infected with rubella virus during pregnancy, there may be a generalized spread of the virus throughout the body. This generalized spread extends to the placenta. Transmission of the virus to the fetus can eventually occur via the placenta. The infection causes disturbances in the cell divisions of the fetus. Cell differentiation processes are disrupted and individual tissues do not develop as intended. Depending on the stage of embryonic development, this relationship can cause an abortion, especially if the maldevelopment fundamentally prevents the individual from being viable. If no abortion occurs, a so-called embryopathy in the form of rubella syndrome develops as a result of the infection. The pregnant woman may remain completely asymptomatic during an infection with a usually rather mild course. However, this asymptomatism of the expectant mother does not allow any conclusions to be drawn 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, however, there is about a 60 percent risk.
Symptoms, complaints and signs
Rubella embryopathy causes a variety of malformations, most notably in the organ systems of the central nervous system, ears, and heart. In addition to [mental retardation|mental retardation]], rubella embryofetopathy is especially often manifested in hepatosplenomegaly and hepatitis. In addition, petechiae, marked microcephaly, or encephalitis are present. In addition, a particularly common symptom is congenital heart defect in the form of ductus botalli apertus, pulmonary stenosis, or tetralogy of Fallot. Myocarditis is also a possibility. In addition, the eyes may be affected by congenital functional impairment. This is the case, for example, with glaucoma, which leads to blindness in its course. Furthermore, cataract is often present in the eye area. The same applies to retinal malformations. The ears are also often affected by functional impairments, especially sensorineural hearing loss or deafness. Growth retardation is common. Classically, not all of the above symptoms are present, but patients suffer from a triad of congenital heart defect, cataract, and inner ear deafness. The severity of the malformations varies from case to case. In particularly severe cases, there is no longer viability and the child dies in the womb.
Diagnosis and course of the disease
Prenatal diagnosis is one of the reasons for which the incidence of rubella embryofetopathy is in decline. If the mother provides anamnestic evidence, the gynecologist orders detection of the virus in the mother’s blood, urine, or saliva.Further diagnostics are only required if there is no evidence of the mother having been vaccinated twice against rubella. IgM detection in the newborn is possible from about the fifth month of pregnancy. PCR detection can be obtained by analysis of the amniotic fluid. Rubella embryofetopathy is thus usually diagnosed before the birth of the child. The prognosis depends primarily on the stage of pregnancy at infection.
Complications
In the worst case, rubella embryofetopathy can lead to the death of the child. For this reason, this disease must be diagnosed and treated early. Affected children usually suffer from a heart defect, making them dependent on regular checkups throughout their lives to prevent sudden cardiac death and other heart conditions. Hepatitis can also occur in the patients and have a very negative impact on the quality of life. Sometimes hearing difficulties or blindness can occur as the child develops. The patients often suffer from significantly delayed development and are thus dependent on the help of other people in their lives. Furthermore, mental retardation may also occur. In severe cases, the children die immediately after birth, as they are not capable of survival. As a rule, rubella embryofetopathy can be well prevented with the help of medication before pregnancy. No particular complications occur. With the help of regular examinations, the disease can be detected early and treated directly even during pregnancy. As a result, the symptoms are completely avoided.
When should you go to the doctor?
Rubella embryofetopathy should always be examined and treated by a doctor. In the worst case, this can result in the death of the child or severe malformations that can lead to further complications. The earlier the rubella embryofetopathy is detected, the higher the probability of a complete cure of this disease. A doctor should be consulted if the affected person has contracted hepatitis during pregnancy. Heart complaints can also indicate this disease and should be examined by a doctor. In the child, rubella embryofetopathy is manifested by delayed growth and visual or hearing problems. In some cases, this may include complete deafness or blindness. If these symptoms occur, a doctor must be consulted in any case. Rubella embryofetopathy can be detected by a pediatrician or by a general practitioner. However, further treatment requires visits to a specialist. It cannot generally be predicted whether rubella embryofetopathy will result in a decreased life expectancy.
Treatment and therapy
After diaplancentary transmission of rubella infection to the fetus has already occurred, causative therapy is no longer possible. Prevention is the critical moment in rubella embryopathy. Maternal vaccination protection should be ensured. A rubella titer should be obtained before any planned pregnancy. In case of insufficient vaccination protection, follow-up vaccinations should be ordered. Ideally, women who are already pregnant should not be vaccinated. The live vaccine can cause infection of the unborn child. Nevertheless, in case of emergency, pregnant women are sometimes revaccinated anyway. 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 rubella-infected individuals. If contact cannot be avoided, passive immunization is induced. If IgG antibody is detected in the mother, there is probably immunity due to previous vaccination or disease. The affected individual should be screened regularly for fresh infections at least until the end of the fourth month of pregnancy. If infection of the mother occurs by the fourth month of pregnancy and the expectant parents cannot accept the anticipated malformations of the child, abortion may be considered.
Prevention
The most effective prevention of rubella embryofetopathy is maternal vaccination against rubella. Measles–mumps–rubella vaccination is given for the first time in the first year of life and again in the fifth year.Rubella antibody titers are ideally determined before any planned pregnancy so that follow-up vaccinations can be given if needed.
Follow-up care
Because rubella embryofetopathy is a congenital malformation syndrome, there is no direct follow-up recommendation. The problems can only be treated symptomatically but not causally. In connection with a desire to have children, detailed genetic counseling is advisable. For the affected persons themselves, comprehensive, loving care is important. Parents should be prepared to provide long-term care, and other family members can also be involved. By means of intensive care, the course of the syndrome can be somewhat alleviated, and in addition, fewer complications occur as a result. This positive influence is further promoted by regular medical check-ups. The responsible physician can detect possible, further damages of the organism at an early stage and act in time. Due to the psychological strain on affected patients and their families, it is advisable to seek professional psychotherapeutic help if necessary. Talks with the family and close friends can also alleviate the difficulties. In self-help groups or through the attending physician, the families find contact with other affected persons. The exchange that takes place here enables everyone involved to talk about the problem and come up with solutions that make everyday life easier. In this way, incipient depression or serious psychological difficulties can be dealt with quite well.
This is what you can do yourself
Pregnant women are to be informed about possible risks, dangers and influencing factors of pregnancy. One’s own behavior is to be optimized and should be designed with the unborn child in mind. For this reason, environments and contacts with people who have rubella should be completely avoided. The disease is considered highly contagious and can lead to severe complications during pregnancy. Therefore, the expectant mother should find out in time what diseases are present in her immediate environment. Places where people with diagnosed rubella have been should be avoided under all circumstances. Moreover, even at the first signs or irregularities, consultation with a physician is mandatory. Self-help measures are not sufficient to provide relief or cure. Only precautionary measures against the viral disease can be taken. Even before planning to have a child, it is advisable to consult a doctor. In the case of an existing desire to have a child, this doctor can assess the mother’s state of health at an early stage and, if necessary, administer a possible vaccination. In addition, a timely explanation of special situations with certain risks takes place during the consultation. Since an already pregnant woman cannot be vaccinated, taking the preliminary measures is particularly important and advisable.
