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Question 27
Feto-maternal medicine → Perinatology
Classification
Question
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Maternal HIV status
Question Stem
A pregnant woman requires invasive prenatal diagnosis, but her HIV status is not yet known. What is the most appropriate management before proceeding?
Options
A
Proceed immediately because HIV status does not affect invasive testing
B
Delay invasive testing until her HIV status is known
C
Perform CVS rather than amniocentesis regardless of gestation
D
Administer antibiotics and proceed
E
Avoid all prenatal diagnostic testing for the remainder of pregnancy
Explanation
When maternal HIV status is unknown, RCOG advises delaying invasive prenatal testing until the result is available. In women living with HIV, transmission risk should be assessed in the context of antiretroviral therapy and viral load. When a woman is receiving effective combination antiretroviral treatment and has an undetectable viral load, mother-to-child transmission risk is very low, but management should still be individualised.
Option Validity
A) Maternal HIV status is relevant when assessing the transmission risk associated with invasive testing.
C) CVS is not automatically safer and its use depends on gestation and clinical indication.
D) Antibiotic administration does not substitute for determining maternal HIV status and assessing viral transmission risk.
E) Invasive diagnosis is not universally contraindicated in women living with HIV; management is individualised according to treatment and viral load.
Further Reading
Navaratnam K, Alfirevic Z; Royal College of Obstetricians and Gynaecologists. Amniocentesis and chorionic villus sampling: Green-top Guideline No. 8. BJOG. 2022;129:e1-e15.