Nonimmune Hydrops Fetalis Due to Congenital Syphilis Associated with Negative Intrapartum Maternal Serology Screening

Levine, Zalman; Sherer, David M.; Jacobs, Alice K.; Rotenberg, O.

doi:10.1055/s-2007-993933

Cited by 31 publications

(18 citation statements)

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“…35 Ultrasonography was used to detect some of the manifestations of syphilis in the fetus such as hydrops fetalis characterised by scalp oedema, placental thickening, serous cavity eVusion, and polyhydramnios. 58 Other ultrasonographic findings related to fetal syphilis include hepatosplenomegaly, placentomegaly, non-continuous gastrointestinal obstruction, and dilatation of the small bowel. 59 60 Ultrasonographic signs of fetal syphilis indicate a greater risk for fetal treatment failure.…”

Section: Diagnosismentioning

confidence: 99%

Syphilis in pregnancy

Genç¹

2000

Sexually Transmitted Infections

172

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Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, nonimmune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost eVective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitised before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich-Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to eVective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900s. (Sex Transm Inf 2000;76:73-79)

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Section: Diagnosismentioning

confidence: 99%

Syphilis in pregnancy

Genç¹

2000

Sexually Transmitted Infections

172

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“…Only few case reports (n = 12) document fetal hydrops secondary to congenital syphilis [16,17,18,19,20,21,22], and fewer used intrauterine transfusion as a treatment [18,20,22]. The median age of those women was 21 years and 40% were nulliparous.…”

Section: Discussionmentioning

confidence: 99%

Syphilis Infection: An Uncommon Etiology of Infectious Nonimmune Fetal Hydrops with Anemia

Fuchs

Michaux²,

Rousseau

et al. 2014

Fetal Diagn Ther

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An increased prevalence of syphilis has been observed in many developed countries over the last decade. During pregnancy, syphilis can affect the fetus through development of nonspecific symptoms such as microcephaly, ascites, hepatosplenomegaly, dilated and echogenic bowel, placentomegaly, and, uncommonly, fetal hydrops. Congenital syphilis also leads to hematologic abnormalities such as anemia, thrombocytopenia, leukopenia, and leukocytosis. We present a case of nonimmune fetal hydrops with anemia related to syphilis infection. Diagnosis was confirmed by a maternal serological test and microbiological testing on amniotic fluid, umbilical cord, and placental tissues. The patient was treated with penicillin and the fetus received an intrauterine red blood cell transfusion, but fetal death occurred shortly after. Such a presentation is mostly related to parvovirus B19, and syphilis etiology is poorly mentioned because physicians have rarely seen early congenital syphilis in the past. However, given the increasing prevalence of this disease in the adult population, clinicians should remain alert to the various presentations of congenital syphilis.

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“…Other findings include polychromasia and erythroblastemia. Paroxysmal nocturnal hemoglobinuria is a late manifestation of congenital syphilis [247,248]. Although the leukocyte count usually falls within the normal range [236], leukopenia, leukocytosis, and a leukemoid reaction all can occur [229].…”

Section: Hematologic Manifestationsmentioning

confidence: 99%

“…False-negative results can occur when a high concentration of antibody inhibits agglutination (the prozone phenomenon), which can be avoided with serial dilutions of the serum; this occurs in approximately 1% to 2% of individuals, usually with secondary syphilis [247,315,316]. Failure to recognize a prozone effect in maternal serum tested during pregnancy has resulted in failure to diagnose congenital syphilis [247].…”

Section: Indirect Serologic Identificationmentioning

confidence: 99%