In a pregnant client, a serum sample is collected at the first prenatal visit to determine immunity to the rubella virus. A positive immune response indicates immunity to the rubella virus, attributed to either past infection or vaccination. A negative, or nonimmune, response indicates that the client is susceptible to rubella disease and requires vaccination. An equivocal response indicates partial immunity to rubella and is treated clinically the same as nonimmune status. Measles-mumps-rubella (MMR) is a live attenuated vaccine. Live vaccines are contraindicated in pregnancy due to the theoretical risk of contracting the disease from the vaccine. Maternal rubella infection can be teratogenic for the fetus. The fetal effects of congenital rubella syndrome include congenital cataracts, deafness, heart defects (patent ductus arteriosus), and cerebral palsy. The best time to administer an MMR vaccine to a nonimmune client is in the postpartum period just prior to discharge (Option 2).

The MMR vaccine can safely be administered to breastfeeding clients.

(Options 1 and 3) MMR vaccine is contraindicated in pregnancy. Also, pregnancy should be avoided for at least 1-3 months after the immunization is given.

(Option 4) This client is rubella nonimmune and is susceptible to rubella if exposed. The vaccine should be offered in the postpartum period.