VIRUS INFECTIONS DURING PREGNANCY: TREATMENT OF MATERNAL RUBELLA

Offering a woman a legal termination of the pregnancy may solve the short-term problem. But on the wider horizon, much can now be done for women in general.

The ready availability of rubella vaccination has changed the entire picture. The most satisfactory form of protection is for a girl to have an attack of rubella during childhood. This gives excellent protection from subsequent attacks. In many countries school-children in the age group when pregnancy is least likely are now offered rubella vaccination. This confers excellent immunity. It is by no means 100 per cent effective (as was originally believed), but it is certainly far better than no protection at all.

Older women who have not been vaccinated may receive vaccination provided pregnancy does not occur within the following three (or preferably four) months. With the universal availability of contraceptive methods these days, this is usually not difficult. If by some misfortune conception does occur within the three-month limit, then the foetus runs a certain risk, but it is much less. In 1981, a check on 100 pregnant women in America who were vaccinated during the first three months, showed no congenital defects at all. Officially the risk for defects is between 0 and 5 per cent. This contrasts sharply with between 20 and 25 per cent in completely non-immunized women who developed rubella in the first three-to-four months of pregnancy.

Because many women are completely unaware whether they have contracted rubella or not during their younger life, a specific test to check on this is available. It is known as the H.A.I, test, short for Haem-agglutination Inhibition test, and is readily and accurately carried out by pathological laboratories. It measures the body’s level of rubella “antibodies,” specific elements that confer protection. So, if there is a high level of antibodies, then the woman is fairly safe from subsequent attack.

If the infection occurs during pregnancy, and there is doubt about her antibody state, a check with the H.A.I, test may be made at once. It is then repeated two to three weeks later. If there is a sudden subsequent rise in “titre,” then it is presumptive evidence that rubella infection has occurred, and the risks can be outlined to the patient, and the correct advice offered to her.