Rubella virus only cause mild rash and systemic effects to the mother but a devastating teratogenic effect on the fetus is noted. The period of greatest risk for teratogenic effects of rubella on the fetus is during the first trimester. If the infection occurred during or between the third and seventh week of pregnancy, the damage usually results to fetal death. Permanent hearing impairment is most often the result if the infection occurred in the early second trimester.
Fetal damage from maternal infection with rubella or most commonly known as German measles are the following:
- Mental and motor challenge
- Cardiac defects – most commonly patent ductus arteriosus and pulmonary stenosis
- Restricted uterine growth or small for gestational age
- Thrombocytopenic purpura
- Dental and facial clefts such as cleft lip and palate
Nursing Diagnosis for Rubella
On the first prenatal check-up, typically, a rubella titer is obtained. If the titer result is greater than 1:8 immunity to rubella is suggested. A titer result of less than 1:8 suggests that a woman is susceptible to viral invasion. A recent infection has occurred if the result of the titer is greatly increased over a previous reading or is initially extremely high.
Immunization to rubella during pregnancy is not allowed because the vaccine causes a live virus that would result to unpleasant effects to the fetus similar to those with a subclinical case. If a woman is immunized with a rubella vaccine she is not advised not to get pregnant for 3 months. By this time, the rubella virus is not longer active and may not cause teratogenic effects to the fetus if pregnancy would occur.
Nursing Management for Rubella
- Prevention. The best management for rubella is to prevent its occurrence. All pregnant women should avoid contact with children with rashes.
- Infants who are born to mothers who had rubella during pregnancy should be isolated fro other newborns as the neonate may be capable of transmitting the disease after birth.
- Live attenuated vaccine should be given to all children.
- Women of childbearing age should be tested for immunity and vaccinated if susceptible if established that they are not pregnant.
- Nurses who care for pregnant women or newborns should receive immunization against rubella to ensure that they neither spread nor contract the disease.