Lousia KH Poon, KS Lun, WH Lee

Congenital rubella syndrome is uncommon in the past few years. We report a case of congenital rubella syndrome born recently by a 35-year old healthy Chinese woman, who has given birth to 2 healthy boys aged 8 and 1 year in Hong Kong. During the two previous pregnancies, rubella status was not checked during the antenatal visits in a government subvented hospital. Rubella antibody was found to be positive at 18th gestational week during this pregnancy. Intrauterine growth retardation was detected since second trimester. Mother reported no history of rash and fever. Amniocentesis at 20 weeks showed normal karyotype. A 2.25 kg male baby was born at 37 weeks gestation by normal vaginal delivery. Features compatible with congenital rubella infection including hepatosplenomegaly, thrombocytopenia, bilateral cataracts, persistent ductus arteriosus, sensorineural hearing deficit (suggested by BAEP) were noted. Serum rubella IgM antibody was positive.

We postulated that the mother was infected during the recent epidemic of rubella before her first antenatal visit. Therefore a positive IgG rubella antibody and an apparently normal obstetric history does not exclude the risk of congenital rubella infection in a growth retarded fetus. We propose universal checking of rubella status in all women during the first pregnancy.