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:
- congenital sensorineural deafness
- congenital cataract formation
- congenital cardiac anomalies: particularly
- intellectual/learning disabilities
- intra-uterine growth restriction (IUGR)
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
- 1. Carey BM, Arthur RJ, Houlsby WT. Ventriculitis in congenital rubella: ultrasound demonstration. Pediatr Radiol. 1987;17 (5): 415-6. - Pubmed citation
- 2. Beltinger C, Saule H. Sonography of subependymal cysts in congenital rubella syndrome. Eur. J. Pediatr. 1988;148 (3): 206-7. - Pubmed citation
- 3. Tang JW, Aarons E, Hesketh LM et-al. Prenatal diagnosis of congenital rubella infection in the second trimester of pregnancy. Prenat. Diagn. 2003;23 (6): 509-12. doi:10.1002/pd.631 - Pubmed citation
- 4. Hwa HL, Shyu MK, Lee CN et-al. Prenatal diagnosis of congenital rubella infection from maternal rubella in Taiwan. Obstet Gynecol. 1994;84 (3): 415-9. - Pubmed citation
- 5. Yamashita Y, Outani Y, Kawano Y et-al. Clinical analyses and short-term prognoses of neonates with subependymal cysts. Pediatr. Neurol. 6 (6): 375-8. Pediatr. Neurol. (link) - Pubmed citation
- 6. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon
- 7. Agbede OO, Adeyemi OO, Olatinwo AW. Significance of IgG-Avidity in Antenatal Rubella Diagnosis. Journal of family & reproductive health. 7 (3): 131-7. Pubmed
- 8. Sawlani V, Shankar JJ, White C. Magnetic resonance imaging findings in a case of congenital rubella encephalitis. (2013) The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale. 24 (4): e122-3. Pubmed