Hi XXXXXXX,
Let me first reassure you that the report values do NOT indicate any evidence of infection of either Rubella or Toxoplasma. The raised IgG value of Rubella, in fact, indicates that your sister is protected against Rubella because IgG are 'protective' antibodies. Since your sister doesn't seem to have these infections, the risk of transmission of these infections to the baby becomes hypothetical. It is possible that Spiramycin was not required at all in the first place. These tests are often misinterpreted and are NOT recommended for routine testing because they cause more alarm than good.

Now about this rash - it could be a side-effect of Spiramycin. It may be wise to revert back to your doctor who can physically examine this rash, its type and take relevant history - itching, yellow coloured urine etc. and prescribe appropriate testing.

Please understand that ALL women have anxiety about the wellness of the unborn child. This is understandable and until a normal baby is in their arms that anxiety doesn't go away. The risk of malformations in the baby is more if the mother's age is more than 35 years, as in the case of your sister, who is 38 years.

However, there are ways to check the presence of infections and malformations of the unborn baby although these methods cannot be fool proof. Its possible that your sister may have had these tests. Nevertheless, let me guide you -

Between 10 to 14 weeks of pregnancy she can have a blood test called Dual Test and a detailed ultrasound (both together are called the Combined Test).
In case your sister misses this date for initial testing, then at 15-18 weeks she could have the blood test called Triple Test (or the Quadruple Test if it is available to her locally).
These tests are essentially to rule out Down's Syndrome (mental retardation).

Around 18 -20 weeks is a good time to get the Targeted Ultrasound Scan also called the Level 2 Scan (this latter term is now obsolete but still used by many doctors). This scan can check out the skull, brain structures, heart, lungs, eyes, cleft lip and palate, abdomen, kidneys and the urinary system, stomach, limbs and bony defects etc. It requires an expert in ultrasound to perform this test. Its very reassuring to get this done. One can even do a 3 D reconstruction of the baby to look at it from structural point of view.

These tests are currently recommended by most North American and European associations for pregnant women of ALL ages, not just those more than 35 years of age or those with family history or a previous malformed baby. Therefore your sister and even you, once you are pregnant, are well advised to have them done.
I hope this helps.
Take care.
Dr Nirja Chawla

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Well it's good that the issue has been sorted out on review by your doctor after this consultation :)
No, I don't think your Toxoplasma values are of much concern. Equivocal means - neither clearly positive, nor clearly negative. But I always feel that there should be no loose threads. Therefore I suggest that you repeat Toxo IgG and IgM 2 weeks after the initial test. A rise in any of these above the basic value should be reviewed by gynaecologist.

In very early infection, IgM rises first. IgG begins to rise much later. Therefore, if the repeat testing shows a rise, it will indicate an active infection. At that point Spiramycin is indicated, not empirically = without any real scientific proof.
Hope this discussion has improved your understanding about how decisions are taken in medicine. I also hope your queries are answered.
Take care.
Dr Nirja Chawla

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