How should I manage a pregnant patient who has been exposed to rubella?

Management of a pregnant patient exposed to rubella:

• Immediately contact the local Health Protection Team (HPT) to report the exposure and seek advice on investigations and management. Rubella is a notifiable disease and must be reported without waiting for laboratory confirmation ¹.
• Arrange laboratory testing for rubella infection regardless of the patient’s previous immunisation status or stage of pregnancy. Testing may include rubella-specific IgM and IgG antibodies and possibly other infections with similar presentations (e.g., parvovirus B19, measles) ¹.
• Clearly indicate on laboratory requests that the patient is pregnant to ensure appropriate handling and interpretation of results ¹.
• If rubella infection is confirmed and the pregnancy is less than 20 weeks gestation, urgently refer the patient to obstetrics (fetal medicine) for risk assessment, counselling, and management due to the risk of congenital rubella syndrome (CRS) ¹.
• Understand the risk of CRS varies by gestational age: approximately 90% risk before 8–10 weeks, 10–20% risk between 11–16 weeks, low risk of deafness between 16–20 weeks, and no reported CRS cases beyond 20 weeks ¹.
• There is no effective treatment to prevent CRS; routine use of human normal immunoglobulin for post-exposure prophylaxis is not recommended but may be considered in secondary care if termination of pregnancy is unacceptable ¹.
• Further diagnostic tests such as amniocentesis or fetal blood sampling may be indicated to assess fetal infection ¹.
• If infection is confirmed after 20 weeks gestation, reassure the woman that CRS has not been reported beyond this gestation. Rubella immunisation should not be given during pregnancy but can be offered postpartum if non-immune ¹.
• Advise the patient on self-care measures including rest, adequate hydration, and paracetamol for symptom relief if needed ¹.
• Advise the patient to avoid contact with other pregnant women and to inform healthcare staff of the exposure or infection before attending medical facilities until non-infectious ¹.
• Ensure the patient understands the importance of hygiene measures to reduce transmission, such as covering mouth and nose when coughing or sneezing and handwashing ¹.