WBR0082

Author	[[PageAuthor::Aditya Govindavarjhulla (reviewed by Jad Al Danaf, Rim Halaby, M.D. [1])]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Microbiology
Sub Category	SubCategory::Reproductive
Prompt	[[Prompt::A 26 year old G1P0 woman in her 16th week of pregnancy presents for her second trimester checkup. She is very anxious because she had a contact one week ago with her 3-year-old niece who had fever. The patient was informed today that her niece developed a mild maculopapular rash that "looks like measles". The patient requests further information regarding whether her fetus is in danger. At what time during pregnancy is the fetus of a mother infected with rubella virus at highest risk of congenital defects?]]
Answer A	AnswerA::Preconception
Answer A Explanation	AnswerAExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation.
Answer B	AnswerB::0-12 weeks
Answer B Explanation	AnswerBExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation.
Answer C	AnswerC::12-24 weeks
Answer C Explanation	AnswerCExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation and decreases after the 12th week of gestation with defects rare after the 20th week of gestation.
Answer D	AnswerD::24-36 weeks
Answer D Explanation	AnswerDExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation with defects rare after the 20th week of gestation.
Answer E	AnswerE::After 36 weeks
Answer E Explanation	AnswerEExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation with defects rare after the 20th week of gestation.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Rubella is a viral illness caused by a togavirus of the genus Rubivirus and is characterized by a mild, maculopapular rash. Children usually develop few or no constitutional symptoms, but adults may experience a 1–5-day prodrome of low grade fever, headache, malaise, mild coryza, and conjunctivitis. Postauricular, occipital and posterior cervical lymphadenopathy is characteristic and precedes the rash by 5–10 days. Arthralgia or arthritis may occur in up to 70% of adult women with rubella. Congenital rubella syndrome (CRS) is an illness resulting from rubella virus infection during pregnancy. When rubella infection occurs during early pregnancy, serious consequences—such as miscarriages, stillbirths, and a constellation of severe birth defects in infants can result. The risk of congenital infection and defects is highest during the first 12 weeks of gestation and decreases after the 12th week of gestation with defects rare after the 20th week of gestation. Common congenital defects of CRS include cataracts, congenital heart disease, hearing impairment, and developmental delay. Infants with CRS usually present with more than one sign or symptom consistent with congenital rubella infection. However, infants may present with a single defect. Hearing impairment is the most common single defect. Educational Objective: When rubella infection occurs during pregnancy, especially during the first 12 weeks, serious consequences can result. These include miscarriages, fetal deaths/stillbirths, and a constellation of severe birth defects known as congenital rubella syndrome (CRS). The most common congenital defects are cataracts, heart defects and hearing impairment. References: CDC.gov [2] Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 1982;2(8302):781–84.]]
Approved	Approved::Yes
Keyword	WBRKeyword::rubella, WBRKeyword::congenital rubella syndrome, WBRKeyword::pregnancy, WBRKeyword::fetal transmission
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::