Congenital rubella syndrome

Last revised by Assoc Prof Frank Gaillard on 04 Apr 2019

Congenital rubella syndrome is a spectrum of congenital abnormalities that result from primary maternal infection with the rubella virus. It falls under the TORCH group of infections.

It is important to note that reinfection/reactivation of maternal infection has a significantly lower risk of fetal anomalies than compared to primary infection.

Rarely congenital rubella syndrome can result in progressive diseases known as progressive rubella panencephalitis 8

Features can include:

The first three were classically termed the Gregg syndrome.

The rate of congenital infection is worst during the 1st trimester (particularly during the first 6 weeks). 

  • maternal rubella specific IgG
  • maternal rubella specific IgM

False positive results of IgM antibodies are common. It must be followed with IgG avidity testing to ensure if the infection is recent or not 7.

Sonographic findings are often not specific and a normal scan cannot absolutely exclude an infection. Features that may be seen include

  • evidence of hydrops fetalis if severe
  • evidence of a congenital cardiac anomaly (e.g. ASD and VSD) 8
  • evidence of intra-uterine growth restriction
  • sub-ependymal cysts: on cranial ultrasound 2

Brain manifestations 8:  

  • small head circumference/microcephaly
  • periventricular calcifications
  • white matter hypodensity
  • ventriculomegaly 

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