Silva-Chávarro AM, Bois-Melli F

Language: Spanish
References: 14
Page: 54-60
PDF size: 326.68 Kb.

ABSTRACT

Introduction: Inadequately treated maternal syphilis is a public health problem since it can produce fetal and neonatal morbidity and mortality. Objective: To describe factors related to failure in diagnosis and treatment of maternal syphilis. Patients and methods: A case control study was perfomed at the Maternal and Child Hospital of Malvinas Argentina, 2014-2015. Cases: puerperal women with syphilis untreated or inadequate and newborns with congenital syphilis. Controls: postpartum women and healthy newborns. Medical records were reviewed to gather the data. Statistics: Fisher test and Student t-test. Crude and adjusted OR and 95% confidence intervals (95% CI) were estimated for “fault diagnosis” and “treatment failure”. Results: There were 106 cases of congenital syphilis and 100 controls. Infants born to mothers with ≤ 5 prenatal consultations (PC) and with low education had increased risk of failure in the diagnosis of maternal syphilis in comparison with control group (OR: 4.83; 95% CI: 1.79 to 12.98). Mothers ≤ 18 years and those with ≤ 5 PC constituted a significant risk factors for treatment syphilis failure OR: 4.07; 95% CI: 1.43 to 11.57 and OR: 2.85; 95%: 1.29 to 6.28, respectively. Conclusions: Implementing strategies aimed to increase the number of prenatal controls, particularly in low-level education and adolescents pregnant women, could contribute to improve both the diagnosis and treatment of maternal syphilis and diminish incidence of congenital syphilis.

REFERENCES

1. Parker LA, Deschutter EJ, Bornay-Llinares FJ, Hernandez-Aguado I, Silva G, Piragine Rdel C et al. Clinical and socioeconomic determinants of congenital syphilis in Posadas, Argentina. Int J Infect Dis. 2012; 16(4): e256-e261.

2. Walker GJ, Walker DG. Congenital syphilis: a continuing but neglected problem. Semin Fetal Neonatal Med. 2007; 12(3): 198-206.

3. Reyes J, Chorbadjian G, Parada A, Turrys J, Bravo N, Araya G. Sífilis congénita: optimizando el diagnóstico en 191 neonatos de madres seropositivas. Rev Chil Infectol. 2004; 21(4): 307-311.

4. Newman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A et al. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med. 2013; 10(2): e1001396.

5. Goldenberg RL, McClure EM, Saleem S, Reddy UM. Infectionrelated stillbirths. Lancet. 2010; 375(9724): 1482-1490.

6. World Health Organization. The global elimination of congenital syphilis: rationale and strategy for action. Geneva, Switzerland; 2007: 1-46.

7. Fondo de las Naciones Unidas para la Infancia (UNICEF). Sífilis. En Guía de Prevención y Tratamiento de las Infecciones Congénitas y Perinatales. Argentina: Dirección Nacional de Maternidad e Infancia. Ministerio de Salud Presidencia de la Nación; 2010: 10-23.

8. Fondo de las Naciones Unidas para la Infancia (UNICEF). Resultados. En VIH y sífilis. Seroprevalencia en puérperas de Argentina. Argentina; 2012: 1-64.

9. Serafim AS, Moretti GP, Serafim GS, Niero CV, da Rosa MI, Pires MM et al. Incidence of congenital syphilis in the South Region of Brazil. Rev Soc Bras Med Trop. 2014; 47(2): 170-178.

10. Rodrigues CS, Guimarães MD, César CC. Missed opportunities for congenital syphilis and HIV perinatal transmission prevention. Rev Saude Publica. 2008; 42(5): 851-858.

11. Peeling RW, Ye H. Diagnostic tools for preventing and managing maternal and congenital syphilis: an overview. Bull World Health Organ. 2004; 82(6): 439-446.

12. Piaggio G, Ba’aqeel H, Bergsjø P, Carroli G, Farnot U, Lumbiganon P et al. The practice of antenatal care: comparing four study sites in different parts of the world participating in the WHO Antenatal Care Randomised Controlled Trial. Paediatr Perinat Epidemiol. 1998; 12 Suppl 2: 116-141.

13. World Health Organization. Antenatal care in developing countries: promises, achievements and missed opportunities: an analysis of trends, levels and differentials, 1990-2001. Geneva, Switzerland; 2003: 1-36.

14. Patel SJ, Klinger EJ, OʼToole D, Schillinger JA. Missed opportunities for preventing congenital syphilis infection in New York City. Obstet Gynecol. 2012; 120(4): 882-888.