Medical Rubella vaccination in pregnant women

[Monique]

I was reading the news and there is a report of many women in Turkey have opted for abortion after having received the rubella virus vaccine during their pregnancy.

In light of the recent discussion of the flu-vaccine I thought it might be of interest. These women were not properly counseled, which is a terrible thing. Vaccination with live virus during the first 28 days of pregnancy can cause congenital rubella syndrome, but apparently vaccination after that period is not contra-indicated (especially in high-risk exposure groups) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5049a5.htm

Edit: http://www.translate.google.com/translate?hl=en&sl=nl&tl=en&u=http%3A%2F%2Fwww.volkskrant.nl%2Fbuitenland%2Farticle1302281.ece%2FVeel_abortussen_na_vaccinatie_Turkije"

 

[Moonbear]

A lack of proper counseling is certainly the case. However, one difficulty is that the risk period is before most women know they are pregnant. I've discussed this issue with my nursing students, since there are other risks in that early part of pregnancy and they need to know how to talk to patients in a way that will determine if they need to give them a pregnancy test or not, or if they should make the patient wait before administering the vaccine until pregnancy can be determined.

Often when giving vaccinations, the routine question asked of women is when was their last menstrual period. While a long lapse since the last period might be a useful indicator that SOMETHING is going on, it really doesn't help determine if someone is pregnant in that first month...especially during the first two weeks. They may have had their normal period the previous month and have not waited long enough to miss one yet, or could have had some bleeding in that first month of pregnancy to not realize they are pregnant yet (it is quite common to still have bleeding at least in the first month, and some women continue to have light bleeding throughout pregnancy, though distinctly different from a normal period...usually).

On the other hand, you're also not always going to get a straight answer if you ask someone if there is any chance they could be pregnant, which is really what you're trying to find out when giving a vaccination. Or, they may not realize that they really could be pregnant because of a misapplication of a particular form of contraceptive.

They really need to ask a series of questions...are you sexually active, do you use contraception, what form of contraception, and in the past two months, have you ever forgotten to use that contraception or had a mishap with it (i.e., did you miss a pill, did a condom break, etc.), were you taking any medications that might have interfered with the efficacy of a contraceptive (i.e., have you been on antibiotics during that time frame while taking the pill), etc.

There are a number of vaccines that are contraindicated in early pregnancy. However, there are also times when one should get the vaccine regardless of that contraindication. For example, if they cannot avoid being in an area where the disease the vaccine protects against is prevalent, and the disease itself would pose a higher risk to the fetus and mother than the vaccine. But, the woman should understand these risks before receiving the vaccine and allowed to consider delaying vaccination, or being carefully monitored for pregnancy and potential fetal abnormalities.