Sífilis congênita: evento sentinela da qualidade da assistência pré-natal

Abstract

OBJECTIVE:To evaluate antenatal care in reducing the vertical transmission of syphilis. METHODS:A cross-sectional study was designed to be representative of lowrisk pregnancies in women cared for at the Brazilian Unifi ed Health System (SUS) network in the city of Rio de Janeiro, from November 2007 to July 2008. Pregnant women diagnosed with syphilis were identifi ed through interviews, checking their antenatal care card and searching for reported cases in the public health information systems. Cases of congenital syphilis were sought at the disease reporting system (Sinam), the Mortality Information System (SIM) and the SUS's Hospital Information System (SIH). RESULTS:Syphilis was identifi ed in 46 of the pregnancies, and 16 cases of congenital syphilis were identifi ed, resulting in a prevalence of 1.9% (95%CI 1.3;2.6) of syphilis in pregnancy and an incidence of 6/1,000 (95%CI 3;12/1,000) of congenital syphilis. The vertical transmission rate was 34.8% with three cases resulting in death (1 abortion, 1 stillborn and 1 neonatal death) and high proportions of prematurity and low birth weight. The healthcare pathway of those women revealed fl aws in the care they received, such as late entry to antenatal care, syphilis remaining undiagnosed during pregnancy and lack of treatment for the partner. CONCLUSIONS:Innovative strategies are needed to improve the outcomes of syphilis in pregnancy, including improving the laboratory network, the quality of care delivered to the pregnant women and their sexual partners and, most important of all, investigating every case of congenital syphilis as a sentinel event in the quality of antenatal care.

Gestational and congenital syphilis: maternal, neonatal characteristics and outcome of cases

“…It should be noted that the early initiation of prenatal care and the guarantee of the minimum number of queries are associated with greater suitability of e control actions regarding syphilis, 21 and conversely are factors associated with the occurrence of vertical transmission. 15,17 Cohort study conducted in China pointed out that when the treatment occurs between the 13 to 24 weeks, only 1.6% of infants are infected, and that every week of delay in the treatment increases the risk of congenital syphilis in 12.7%, 1 being that a favorable aspect to women in this study, once 73.5% of them were diagnosed in the first trimester of pregnancy.…”

“…Other studies also point out lack of follow-up on the VDRL test during pregnancy. 15,17,21 According to PAHO, 94% of pregnant women in the Americas had at least one prenatal consultation during pregnancy and 80% received testing for syphilis at some point in pregnancy. 7 In Brazil, a study with 23,894 postpartum women identified that 98.7% held at least one prenatal consultation and 89% had at least one test records of syphilis, but only 41% conducted the second serological test, 14 data that corroborate the present study findings and imply actions aimed at early detection of syphilis Syphilis: maternal, neonatal characteristics and outcome of cases during pregnancy by means of carrying out the examinations in the correct frequency.…”

“…3 The literature points out that syphilis-infected partners increases by five times the risk of congenital syphilis infection, 1 and the grounds for nontreatment are: low adherence to health services; justified by employment issues and lack of knowledge about the importance of treatment for child health and partner; lack of reference site for treatment; and the absence of indication of treatment by the service. [21][22] Strategies such as participation in pre-natal, feature positive actions to establish partnerships with companies that encourage the prevention and treatment of syphilis in its employees. 20 It is known that all pregnant women with syphilis should be stratified as high risk, because they require more frequent queries, 23,24 however, in this study it was possible to notice that 62.5% were properly laminated.…”

Análise dos casos de sífilis gestacional e congênita nos anos de 2008 a 2010 em Fortaleza, Ceará, Brasil

“…Despite the effectiveness of penicillin in its treatment and cure, pregnant women affected are not treated or receive inappropriate treatment 1,2 . When it affects a pregnant woman, syphilis can cause congenital syphilis (CS), which is responsible for approximately 40% of perinatal mortality rates, 25% of stillborn rates, 14% of neonatal deaths 1,3,4 as well as causing serious consequences for the fetus 5 .…”

“…For this reason, it can be seen as a "sentinel event," the control of which is directly linked to the quality of prenatal care, thereby justifying the need to monitor and evaluate this type of treatment within the different services, and at different levels of complexity 2,4,9 . In order to understand the full scale of the problem, some years ago, the Brazilian Ministry of Health (MS) included CS and GS in the national list of diseases that require mandatory notification 12,13 .…”