Prevention of rubella during pregnancy - Its management and prevention

Declining incidence: Between 1982 and 1994, the incidence of rubella infect ions during pregnancy in France declined iom 45 to 9 cases per 100,000 birt hs. The incidence of congenital rubella declined from 5 to 0.85 per 100,000 births. These results are the fruit of systematic vaccination of 1-year-ol d children in France. Eradication of congenital rubella has been achieved i n Sweden and requires further efforts to be obtained in our country. Serology: Physicians must systematically check rubella serologies in all wo men desiring pregnancy and/or of reproductive age even ii they have been va ccinated, Rubella serology must be checked in ail pregnant women even ii th ey were seropositive during a prior pregnancy. In case of exposure or eruption during pregnancy: Serology must be obtained as early as possible in case of suspected rubella infection during pregnan cy with a second serology 3 weeks later. The IgM titre should be obtained i n case of suspected exposure with significant rise in IgC in successive ser ologies, ii specific IgC titre is elevated after an eruption if die first s erum sample was taken late after suspected exposure, and finally ii a syste matic serology early in pregnancy is positive after a previously negative s erology. Antenatal diagnosis: PCR on amniotic fluid or fetal blood is indicated if a seroversion occurs before 18 weeks gestation, therapeutic termination of p regnancy should be proposed ii fetal infection is certain. After 18 weeks, there is nearly no risk for the fetus: an antenatal diagnostic sample is no t required and ultrasound surveillance is sufficient.