Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit

ABSTRACT Objective To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. Methods This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. Results The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). Conclusion Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

Streptococcus spp. en el embarazo, patología y avances en su detección temprana / Streptococcus spp. in pregnancy, pathology and advances in early detection

El Streptococcus spp ha adquirido mucha importancia a nivel mundial debido a la gran patogenicidad de sus diferentes especies. Una de ellas es el Streptococcus del Grupo B que comúnmente se encuentra a nivel vaginal en mujeres embarazadas, lo que puede ocasionar una contaminación al recién nacido en el momento del parto. Solo un pequeño porcentaje de estos neonatos desarrollan la infección y pueden llegar a presentar sepsis, meningitis, neumonía neonatal, entre otras complicaciones, así como secuelas neurológicas permanentes, retraso en el crecimiento y muerte. Debido a esto, se han implementado estrategias preventivas, en las que se incluyen pruebas de tamizaje para su detección temprana y evitar el riesgo de infección. En las últimas décadas se ha incrementado el uso de técnicas moleculares para su diagnóstico precoz y tratamiento temprano, de manera de disminuir la morbimortalidad atribuida al Streptococcus del Grupo B.

Streptococcus spp has acquired great importance due to the high pathogenicity of its different species around the world. The Group B Streptococcus is commonly found in the vaginal area of pregnant women, which at delivery may lead to contamination of the newborn. Only some of these infants develop the infection and may present sepsis, meningitis, neonatal pneumonia, among other complications, including permanent neurological sequelae, delayed growth and death. Preventive strategies include screening and early detection to avoid the risk of infection. In recent decades the use of molecular techniques for early diagnosis and treatment has increased that would decrease morbidity and mortality attributed to Group B Streptococcus.

Gestações complicadas por sífilis materna e óbito fetal / Pregnancies complicated by maternal syphilis and fetal death

OBJETIVO: Descrever as características de gestações complicadas por sífilis materna e óbito fetal. MÉTODOS: Foi feito um estudo retrospectivo descritivo conduzido por revisão de prontuários de 48 gestantes com sífilis materna e desfecho de óbito fetal, admitidas no período 2005-2008, no Hospital Geral de Nova Iguaçu, Baixada Fluminense, Estado do Rio de Janeiro. O peso ao nascer >500 g e o óbito fetal documentado por declaração de óbito foram os critérios de inclusão. Os seguintes aspectos foram analisados: sociodemográficos, antecedentes reprodutivos, aspectos da gestação atual, cuidados de pré-natal, realização e resultados do teste Venereal Disease Research Laboratory (VDRL), presença de intercorrências na gestação, além da sífilis, sendo as mortes fetais classificadas como materna, placentária ou fetal. Os resultados foram apresentados por porcentagem, média, desvio padrão (DP) e valor máximo e mínimo. RESULTADOS: A média de idade materna foi de 22,7 anos (DP=0,9 anos) e pelo menos metade das pacientes tinham baixo grau de escolaridade. Na admissão hospitalar, 68,8 por cento do grupo se encontrava no terceiro trimestre e com média de idade gestacional de 29,2 semanas (DP=0,5); mais de 50 por cento estava em trabalho de parto. A grande maioria dos casos de óbito fetal (93 por cento) ocorreu antes da hospitalização materna. Entre as pacientes que frequentaram o pré-natal (54,2 por cento), 30,8 por cento não realizaram o VDRL, 30,8 e 15,4 por cento tiveram resultado reativo e não-reativo, respectivamente e nenhuma teve mais de um VDRL no pré-natal. No momento do parto, a maioria das pacientes (95,8 por cento) realizou o VDRL. No geral, a titulação do VDRL variou de 1:1 a 1:512, predominando titulações >1:4 (91,7 por cento). Em 23 por cento dos casos foram encontradas outras condições relacionadas ao óbito fetal, além da sífilis. CONCLUSÕES: A infecção foi a principal causa clinicamente identificada do decesso fetal nesta série de casos. O desfecho de feto morto ocorreu no pré-termo e na presença de títulos altos de infecção materna, sugestivos de sífilis recente.

PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50 percent of the patients had low educational level. At hospital admission, 68.8 percent of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50 percent were in labor. The vast majority of fetal deaths (93 percent) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2 percent), 30.8 percent had no VDRL test, 30.8 and 15.4 percent had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8 percent) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7 percent). In 23 percent of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.