Handbook of congenital malformations / edited by Alan Rubin.

Date:
1967
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Handbook of congenital malformations / edited by Alan Rubin. Source: Wellcome Collection.

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    RUBELLA (continued) gestation, when a woman is least apt to be aware that she is pregnant. The efficacy of gamma globulin after exposure must be regarded as unproven at this time, although there is suggestive evidence that it may prevent embryopathy if given soon after exposure. There is some evidence that it may prevent infection if given prior to or approximately at the time of exposure. The great disadvantages are that it often ameliorates the illness sufficiently so that the diag¬ nosis cannot be reached on the basis of clinical signs alone and that it confuses the interpretation of serological studies. It is best used immediately after exposure in those cases in which there is no possi¬ bility of therapeutic abortion. The question of therapeutic abortion can only be resolved through an individual approach to each case. The decision must be based on an evaluation of fetal risk (which depends on the time of infection and the certainty of the diagnosis), consideration of the possible effects of the birth of a malformed baby on the mother and the rest of her family, the legality of the procedure, and the religious and moral convictions of the patient and the physician. The chance of significant damage to the fetus depends primarily on the timing of infection. With infection very early in gestation, more than 50 per cent of pregnancies end in abortion, stillbirth, or malformation. With infection at the end of the first trimester, the probability of malformation is only slightly higher than for an uncom¬ plicated pregnancy. It is reassuring that congenital rubella apparently occurs only after primary infection, that actively acquired immunity is apparently complete and life-long, and that 70 to 85 per cent of American women are immune by the time they reach child-bearing age. Reference: Brody, J, A., Sever, J. L., and Schiff, G. M.: Pre¬ vention of rubella by gamma globulin during an epidemic in Barrow, Alaska, in 1964. New Engl. J. Med. 272:121, 1965. Cooper, L. Z., and Krugman, S.: Diagnosis and man¬ agement: congenital rubella. Pediatrics 57:335, 1966. Korones, S. В., et al.: Congenital rubella syndrome: new clinical aspects with recovery of virus from affected infants. J. Pediat. 67:166, 1965. Sever, J. L., et al.: Rubella epidemic on St. Paul Island in the Pribilofs, 1963. J.A.M.A. 191:624, 1965. Sever, J. L., et al.: Antibody responses in acute and chronic rubella. Proc. Soc. Exp. Biol. Med. 122:513, 1966. Sever, J. L., Nelson, K. В., and Gilkeson, M. R.: Rubella epidemic, 1964: effect on 6000 pregnancies. Am. J. Dis. Child. 110:395, 1965. TOXOPLASMOSIS. Toxoplasma gondii is a protozoan and an obli¬ gate intracellular parasite. A single, very ubiquitous strain infects many birds and mammals, in addition to man. It is a pale, comma- shaped organism with an eccentric nucleus and is just large enough 359