Pregnancy:
- Fatima's pregnancy proceeds to term.
- Her baby is small for gestational age.
- Arrangements are made to deliver the baby in an isolation suite to avoid infection of other babies and health care workers.
Neonate:
- Physical examination of the baby at birth reveals a heart murmur.
- Head circumference at the lower limit of the normal range.
- Toxoplasmosis/Rubella/Cytomegolovirus/Herpes serology on cord blood - only Rubella IgM is positive.
- Cardiac investigations instituted.
- Parents counselled on need for careful monitoring of the baby's development to assess if other effects of rubella become manifest.
- Babies born with rubella are contagious until one year of age.
Development:
- Cardiac surgery to correct abnormality (patent ductus arteriosus) is successful.
- 18 months: child is still not talking.
- As deafness is a likely outcome, serial audiograms are performed which show a progressive increase in severity of hearing loss.
- Child enrolled in a special education program.
- Fatima receives good emotional support and practical assistance from extended family but finds increasing difficulty in coping with demands of other children and the new baby.