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.
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GENERAL HEALTH
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