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Studies about the management of syphilis during pregnancy were reviewed. They lacked uniformity in diagnostic criteria and study design. Currently recommended doses of benzathine penicillin G are effective in preventing congenital syphilis in most settings, although studies are needed regarding increased dosing regimens. Azithromycin and ceftriaxone offer potential alternatives for penicillin-allergic women, but insufficient data on efficacy limit their use in pregnancy. Ultrasonography provides a noninvasive means to examine pregnant women for signs of fetal syphilis, and abnormal findings indicate a risk for obstetric complications and fetal treatment failure. Ultrasonography should precede antepartum treatment during the latter half of pregnancy to gauge severity of fetal infection. However, optimal management of the affected fetus has not been established; collaborative management with a specialist is recommended. Antepartum screening remains a critical component of congenital syphilis prevention, even in the era of syphilis elimination.

Objective: To examine the effect of maternal age on incidence of nonchromosomal fetal malformations.Methods: Malformations detected at birth or in the newborn nursery were catalogued prospectively for 102,728 pregnancies, including abortions, stillbirths, and live births, from January 1, 1988 to December 31, 1994. Maternal age was divided into seven epochs. Relative risks (RRs) were used to compare demographic variables and specific malformations. The Mantel-Haenszel 2 statistic was used to compare agespecific anomalies. Multiple logistic regression analysis was used to adjust for parity.Results: Abnormal karyotypes were significantly more frequent in older women. After excluding infants with chromosomal abnormalities, the incidence of structurally malformed infants also was increased significantly and progressively in women 25 years of age or older. The additional age-related risk of nonchromosomal malformations was approximately 1% in women 35 years of age or older. The odds ratio for cardiac defects was 3.95 in infants of women 40 years of age or older (95% CI 1.70, 9.17) compared with women aged 20 -24 years. The risks of clubfoot and diaphragmatic hernia also increased as maternal age increased. During the past decade, the proportion of women in the United States who gave birth after age 35 increased significantly. In 1996, there were approximately 399,510 births to women aged 35-39 years, 71,804 to women aged 40 -44, and over 3000 to women aged 45-49 years. Conclusion1 Successful pregnancies are now being achieved with oocyte donations in women over age 50 and beyond natural menopause.2 Recently, one such birth to a 63-year-old woman was publicized widely. 3Some of the most devastating adverse outcomes in older pregnant women are anomalies associated with chromosomal aberrations, especially aneuploidies, which occur in about one in 50 births to women at age 40. 4 Increased aneuploidy rates are unequivocally related to advanced maternal age, but the effect of increased age on other congenital malformations is less clear. Each year the National Center for Health Statistics and the Centers for Disease Control and Prevention publish natality statistics of the entire United States, which include information on congenital malformations from birth certificates. Those agencies have cited significantly increased rates of fetal cardiac malformations and chromosomal anomalies with advanced maternal age.5 However, such reports have numerous shortcomings. For example, because individual congenital malformations have such low incidences, epidemiologic studies necessarily include large numbers of pregnancies. To accomplish that, information is gathered from indirect sources such as birth certificates, which often are incomplete and subject to ascertainment biases. Those reports and most similar investigations do not include information on malformations in stillborn fetuses or late abortions.The demographic make-up of Parkland Hospital provides a unique opportunity to study congenital malformations. The large obstetric po...

Findings with fetal syphilis are similar to those of neonatal syphilis. We hypothesize that fetal transaminase elevation occurs early in the course of infection; hematologic abnormalities and hydrops occur later. Severity of disease may be associated with risk of treatment failure.

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The United States has the highest maternal mortality rates among developed countries, and cardiovascular disease is the leading cause. Therefore, the American Heart Association has a unique role in advocating for efforts to improve maternal health and to enhance access to and delivery of care before, during, and after pregnancy. Several initiatives have shaped the time course of major milestones in advancing maternal and reproductive health equity in the United States. There have been significant strides in improving the timeliness of data reporting in maternal mortality surveillance and epidemiological programs in maternal and child health, yet more policy reforms are necessary. To make a sustainable and systemic impact on maternal health, further efforts are necessary at the societal, institutional, stakeholder, and regulatory levels to address the racial and ethnic disparities in maternal health, to effectively reduce inequities in care, and to mitigate maternal morbidity and mortality. In alignment with American Heart Association’s mission “to be a relentless force for longer, healthier lives,” this policy statement outlines the inequities that influence disparities in maternal outcomes and current policy approaches to improving maternal health and suggests additional potentially impactful actions to improve maternal outcomes and ultimately save mothers’ lives.