Snapshot An infant is born small for his gestational age and is noted to have hepatosplenomegaly, thrombocytopenia, hepatitis, jaundice, cataracts, and a "blueberry muffin" rash. Introduction Occurs after a German measles infection during pregnancy TORCH infection (Toxoplasmosis, Other [Syphilis], Rubella, CMV, Herpes) Transplacental transmission occurs in first trimester of pregnancy Risk of transplacental transmission: 80% in first trimester 50% second trimester 5% in third trimester Presentation Symptoms usually present at birth including purpuric "blueberry muffin" rash cataracts mental retardation hearing loss patent ductus arteriosis Physical exam IUGR may be evident on prenatal exam hepatosplenomegaly thrombocytopenia hepatitis jaundice cataracts/glaucoma "blueberry muffin" rash hearing loss PDA mental retardation Evaluation IgM Rubella Ab diagnostic golden standard when found in neonate's serum Viral culture may help identify infectious agent Differential Other TORCH infections Treatment Medical management no effective treatment is available against active infection immunization indicated before pregnancy vaccinate mother after pregnancy if serologic titers remain negative indicated in all school-age children in the United States consider abortion if mother is infected or exposed at <20 weeks' gestation Prognosis, Prevention, and Complications Prognosis poor to fatal in infancy Prevention prenatal serologic screening for mothers universal immunization of all children against rubella Complications systemic organ dysfunction or failure, blindness, cardiac arrhythmias, death