An intervention study to reduce adverse pregnancy outcomes as a result of syphilis in Mozambique.

OBJECTIVES: To create and evaluate an alternative screening approach among pregnant women in order to reduce adverse pregnancy outcome as a result of syphilis in Mozambique. METHODS: Four suburban antenatal clinics, two "control" and two "intervention" clinics, were compared regarding syphilis screening and treatment. Pregnant women with positive rapid plasma reagin (RPR) test (n = 929) were enrolled, 453 in the intervention and 476 in the control clinics. In control clinics the normal routine regarding syphilis screening was followed for 383 women remaining for follow up. In intervention clinics nurse midwives were trained to perform the RPR test. RPR seropositive cases were immediately treated on site by the nurse midwives and the partners were invited to come any afternoon for treatment. In the third trimester (around 30 weeks) a new RPR test was performed and all women with positive RPR test results were again treated and the partners were invited to come for treatment. RESULTS: At delivery, the drop out rate was 15.7% in the intervention and 20.1% in the control group. The perinatal mortality was significantly higher in the control group than in the intervention group, 3.4% v 1.3% (p = 0.030). At delivery the intervention group had significantly more negative RPR results--40.9% v 24.2% (p = 0.000). CONCLUSION: More active training of nurse midwives in antenatal care to perform on site RPR tests, to give syphilis treatment, and to notify partners results in improved perinatal outcome and more seronegative parturient women.

Low birth weight and genital infections. An incident case-referent study.

In an attempt to elucidate the potential association between genital infections and low birth weight (LBW) births, 51 women with LBW neonates were identified and compared to 51 women with normal birthweight (NBW) neonates. Both groups were matched according to age and parity. All women were subjected to interviews regarding socioeconomic background and obstetric history. The were examined clinical and tested regarding serum haemoglobin, malaria parasitaemia, syphilis and HIV serology. Cultures were taken from the vagina, endocervix, amniotic fluid and from various sites of newborn, including the conjunctivae and the stomach and from the interior of the placenta. Whilst socioeconomic background factors did not differ among cases and referents, previous neonatal death did. Significant differences were also found in mid-upper-arm circumference (OR 3.08) and body mass index (OR 6.00). The prevalence of alleged risk factors according to the antenatal card was similar among cases and referents. Birthweight < 2,000 g was significantly more often associated with chorioamnionitis than birthweight between 2,000 and 2,499 g (OR 5.46). Bacteriological findings did not show significant differences in cases and referents. Haemoglobin values and prevalence of malaria parasitaemia were similar as was the neonatal mortality. It is concluded that LBW births is difficult to predict by use of alleged risk factors in existing antenatal cards.