Pregnancy - #9751

Hi kalai, Of course, Kalai. Here's a detailed **doctor-format case summary** including your obstetric history, current condition, lab interpretation, and recommendations: ### **Patient Case Summary** **Name:** Kalai **Age:** 29 **Sex:** Female **Location:** Bangalore **Gravida 2, Para 1 (G2P1)** --- ### **Presenting Concern:** Patient is currently pregnant (second pregnancy) and concerned about the risk of **rubella affecting the fetus**, as in the first pregnancy the child was born with **congenital cataract** and has **developmental delay** attributed to **Congenital Rubella Syndrome (CRS)**. --- ### **Obstetric History:** **G1:** - **Full-term delivery**, 2.5 years ago. - Infant diagnosed with **congenital cataract**, delayed developmental milestones (not walking yet). - Mother was presumed to have **primary rubella infection** during the first trimester based on clinical history. - No documented vaccination history prior to first pregnancy. **G2 (Current Pregnancy):** - Routine antenatal screening shows **Rubella IgG positive**. - No clinical symptoms of recent viral infection (fever, rash, arthralgia, lymphadenopathy) during this pregnancy. - No documentation of **Rubella IgM** in the current pregnancy yet (pending or not performed). - No history of contact with any rubella-infected individuals. - Pregnancy age and trimester: [Insert gestational age or trimester if known]. --- **Lab Investigation Summary:** - **Rubella IgG:** Positive → Indicates **past infection or vaccination-induced immunity** - **Rubella IgM:** [Insert Result if Available] → **If Negative:** Confirms **no recent/active infection** → **If Positive:** May suggest recent infection — requires **IgG avidity testing** to determine timing of infection. **Clinical Assessment:** - Based on the **Rubella IgG positive** status and **absence of symptoms**, it is **most likely that the patient is immune** to rubella due to past exposure (either from first infection or natural immunity). - **Risk of fetal rubella infection in current pregnancy is extremely low**, provided **IgM is negative**. - No additional symptoms to suggest current rubella reinfection. - However, given history of Congenital Rubella Syndrome in the first child, **close fetal monitoring is advised**. --- ### **Recommendations:** 1. **Confirm Rubella IgM status:** - If not yet done, perform **Rubella IgM test**. - If **IgM negative**: Patient is immune; fetus **not at risk**. - If **IgM positive**: Recommend **Rubella IgG avidity test** to assess timing of infection (low avidity = recent, high avidity = old infection). 2. **Fetal Monitoring:** - Serial ultrasounds: Monitor fetal growth and look for signs of congenital anomalies. - Targeted anomaly scan (Level II) at 18–20 weeks. - If any abnormal findings: Consider **fetal echocardiography** and **neurosonography**. - TORCH screening may be done as part of the antenatal panel if not already done. 3. **Genetic Counseling / MFM Referral:** - Referral to **Maternal-Fetal Medicine (MFM) specialist** is recommended due to history of CRS in previous child. - Can provide additional guidance and high-risk pregnancy management. 4. **Psychosocial Support:** - Reassure patient regarding the low likelihood of rubella affecting this pregnancy if immune. - Encourage regular antenatal visits and complete pregnancy monitoring. --- **Summary:** Kalai is a G2P1 woman with a past pregnancy affected by Congenital Rubella Syndrome. She is currently Rubella IgG positive, suggesting immunity. If IgM is negative, there is **no risk of rubella-related congenital defects** in this pregnancy. Continued monitoring is advised due to past obstetric history. --- If you provide your **Rubella IgM result** and **gestational age**, I can complete this summary for you with exact details. You're doing an excellent job being careful with this pregnancy, Kalai—keep following up with your doctor regularly, and don't hesitate to ask for specialized care when needed. Dr Shayeque Reza MD 9800280276