Model Answers Microbiology Written examinations 2007 - RCPA

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Microbiology PART 2, 2007 Model answers Question 1, Marker 1 What is the role of antenatal serology in modern medical practice and why? Roles of serology Routine screening At risk screening Diagnosis where risk of consequences When the infection is likely to have consequence for the foetus – eg contact with rash or rash-like illness in pregnancy. This is incorporated into the discussion of each of the specific infections. Diagnosis of acute disease Where interventions are available or where reassurance can be given that no foetal harm is likely e.g. EBV BFV RRV etc
General principles Routine vs selective The following factors should be taken into account when selecting a screening strategy: 1. Detect infection Does the test detect potential foetal infection and damage? 2. Assay Is there a sensitive and specific reliable assay available? 3. Intervention Is there a safe and effective intervention strategy available if detected? 4. Frequency Problems Does the infection occur at a frequency that has a cost benefit for the screening? Asymptomatic infections Poor positive predictive value Requiring further investigative actions Repeat serology/avidity etc Amniotic fluid examination Foetal blood examination Cord blood examination Often the true state of affairs remains unresolved Can generate angst for mother and family Termination as a result of not tolerating even minimal risk Psychological, Medicolegal, Ethical, Medical dilemmas Practical points Never base management decisions on a single test result Repeat tests preferably using a different method and on a second collection False positive IgM‟s are not that uncommon Serial sample testing important Avidity testing also may help – proportional to the maturation response of antibodies High avidity excludes infection in the previous 3- 4 months Low avidity usually BUT, not always, implies recent infection Stored serum samples at least for one year are important Examples Syphilis 1. Detect potential foetal infection and damage
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Model Answers Microbiology Written examinations 2007 - RCPA

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