Many Rubella-related abortions could have been avoided with better diagnosis: doctors

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A woman in northern Vietnam spent three years undergoing treatment for infertility, and then had to have an abortion in the 12th week of her pregnancy after she caught the Rubella virus.


The woman is one of more than 1,000 mothers-to-be at the Central Obstetrics and Gynecology Hospital in Hanoi who, since February this year, have been advised to abort their babies after they tested positive for the virus which could result in congenital deformities.


Yet many of them were victims of poor rubella diagnosis techniques, a recent study at the hospital found.


According to the study, many of the aborted fetuses could have been born with no rubella syndrome.


Le Anh Tuan, deputy director of the hospital, said more than 2,000 pregnant women at the hospital had caught Rubella virus during the period and half of them decided to have abortions.


It is said that  70 to 100 percent of women infected with rubella virus during their first three months of pregnancy will have babies with congenital rubella syndrome.


Phan Van Quy, a doctor at the hospital, said that the hospital in May and June was overloaded with mothers-to-be who wanted to end the Rubella risk and there were not enough beds for them.


That is not to mention the number of Rubella abortions at Hanoi Ob-Gyn Hospital and ob-gyn departments at other hospitals in the region, Tuan said.


At Tu Du Hospital, a leading ob-gyn hospital in Ho Chi Minh City, 103 pregnant women had abortions last year after they caught Rubella. The number rose to 159 since February this year, said the hospital deputy doctor Le Quang Thanh.


However, a study at the Central Ob-Gyn Hospital last month showed that among 103 aborted fetuses, only 17 of them would have been infected with Rubella if they were born.


The conclusion was based on immunity tests of umbilical cord blood.


"According to the figures, though not yet official, only 16.5 percent of the abortion advice was correct," Tuan said.



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The doctor said he was sad about the results but poor diagnostic techniques left doctors with little choice.


According to Tuan, diagnosing Rubella infection in fetuses has been difficult as the tests cannot determine the time of infection at the women, the time the rash starts to appear or if the women catch the virus for the first time.


Tuan also said there's no way to know for sure if a Rubella-infected mother would give birth to an abnormal child or not.


But doctors have no other choice than to advise the mothers to end their pregnancy, he said.


Most women contracting the Rubella virus from the 18th week of their pregnancy onwards would be closely supervised by doctors as the chance of infection of the fetus is low, doctors said.


Women infected between their 13th and 18th week will be advised to abort, although the chances for having a congenitally affected baby is fifty-fifty, they said.


If only


Vietnam has recently received a Japanese medical equipment that uses biomolecule technology to diagnose rubella infection in fetuses with more than 95 percent accuracy.


The test, which costs VND1.5 million (US$73), will examine the amniotic fluid after the mothers developed the Rubella rash for five to seven weeks, said doctors at the Central Ob-Gyn Hospital.


With this technology, many of the recent infection cases do not have to go for an abortion, the doctors said.


"If only the technology was applied earlier," Tuan said.


He said many developed countries do not even care about the test because their countries have been cleared of Rubella.


Nguyen Tran Hien, chief of the National Institute of Epidemiology Hygiene, said that serum tests or the polymerase chain reaction (PCR) technique can detect fetus deformations in Rubella-infected mothers.


But the doctors will decide what is necessary on a specific case basis, Hien said.


Truong Viet Dung, head of the Institute of Science and Training at the Health Ministry, also said that all city/provincial preventive health centers have been equipped for PCR tests.


But Dung said Rubella vaccination should be part of a good pregnancy preparation regime.


The National Institute of Epidemiology Hygiene in June this year submitted a plan to the ministry to have all Vietnamese women aged 15 to 35 years vaccinated against Rubella.


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