<s>[INST] context: Women that acquire rubella during pregnancy are at risk of developing fetal infection and congenital rubella syndrome. If the mother is infected during the first trimester the malformation rate in the fetus is approximately 50%. These malformations include microcephaly, mental retardation, cataracts, deafness, and congenital hea diseasealthough all organs may be affecteD. Therefore, all women need to be vaccinated with the rubella vaccine-most often given as pa of the MMR series of vaccines. However, because the MMR vaccine is a live-virus vaccine, there is a concern that administration Of the vaccine within 3 months of conception, or during the pregnancy, could result in bih defects or illness. Yet, this concern is more theoretical than real as studies performed on women given the rubella vaccine sholy before becoming pregnant or during pregnancy have failed to show any increase in the risk of malformations compared to the general background risk in the population. To state that there is no vaccine risk and termination is completely inappropriate (choice A) is incorrect. Although the risk of the MMR vaccine appears more theoretical than real, one cannot state that there is no risk. To state that the vaccine risk is moderate and termination should be considered (choice C) or that the vaccine risk is high and termination should be strongly considered (choice D) is incorrect. As stated above, the risk of the MMR vaccine-associated defects is so small as to be considered negligible. [/INST] question: A 23-year-old woman comes to the physician because she thinks that she may be pregnant. She missed her last two periods and feels "different." A urine pregnancy test is positive and an ltrasound reveals a 12-week fetus. The patient is very concerned because she received the measles-mumps-rubella (MMR) vaccine four months ago and was told to wait 3 months before attempting conception. The pregnancy is desired. The patient asks if she should have a termination of pregnancy because she was vaccinated sholy before becoming pregnant. Which of the following is the most appropriate response? | options: A: There is no vaccine risk and termination is completely inappropriate B: The vaccine risk is low and is not in itself a reason to terminate C: The vaccine risk is moderate and termination should be considered D: The vaccine risk is high and termination should be strongly considered | answer: B </s>