• Marjorie Garlow Hebmuller - Hebmuller, Marjorie Garlow - Pontifícia Universidade Católica do Rio Grande do Sul, Pediatria - <jogarlow@terra.com.br> +
Coautor(es):
• Eleonor Gastal Lago - Lago, Eleonor Gastal - Pontifícia Universidade Católica do Rio Grande do Sul, Pediatria - <eglago@pucrs.br>
• Humberto Holmer Fiori - Fiori, Humberto Holmer - Pontifícia Universidade Católica do Rio Grande do Sul, Pediatria - <hfiori@pucrs.br>
Área Temática:
Políticas em Saúde
Resumo:
Este estudo incluiu gestantes positivas para sífilis atendidas por parto ou aborto, entre 1997 e 2004, no Hospital São Lucas, Porto Alegre, RS. Foram levantados desfechos obstétricos subsequentes das mesmas, até dezembro 2011, para investigar a recorrência da doença. De 450 gestantes com sorologia positiva atendidas de 1997 a 2004, 166 tiveram pelo menos mais um atendimento obstétrico até dezembro de 2011, sendo incluídos 266 novos desfechos obstétricos. A sífilis congênita (SC) foi evidenciada em 81,9% das gestações iniciais e em 68,4% das subsequentes. As principais causas da SC nas gestações subsequentes foram positivação do VDRL no parto e tratamento não documentado. Os títulos de VDRL foram superiores a 1:4 em 50,4% nas gestações iniciais e em 13,3% nas subsequentes (p<0,001). A taxa de natimortalidade foi de 119/1000 nas gestações iniciais e de 41/1000 nas subsequentes (p<0,01). A recorrência da SC foi frequente em gestações sucessivas da mesma paciente. A ausência ou inadequação de pré-natal foi o principal fator de risco para SC, tanto nas gestações iniciais quanto nas subsequentes. Os dados obtidos sugerem que, nas gestações subsequentes, mais neonatos não infectados possam ter sido definidos como casos de SC pela insuficiência de informação sobre os antecedentes pré-natais da gestante.
Palavras-chave:
Sífilis Congênita
Cuidado Pré-Natal
Gravidez
Abstract:
This study included pregnant women with positive serum tests for syphilis, attended between 1997 and 2004 at the Hospital São Lucas, Porto Alegre, Brazil. Subsequent obstetric outcomes among these patients were investigated by December 2011, searching for recurrent cases of the disease. Among 450 pregnant women attended between 1997 and 2004, 166 had at least one obstetric outcome until December 2011, totaling 266 new obstetrical outcomes included in the study. Congenital syphilis (SC) was observed in 81.9% of initial and in 68.4% of subsequent pregnancies. The main causes of SC in subsequent pregnancies were positivation of VDRL at delivery and undocumented treatment. VDRL titers were greater than 1:4 in 50.4% of patients in the first obstetrical outcomes and in 13.3% in the subsequent (p <0.001). The rate of stillbirth was 119/1000 in the initial pregnancies and 41/1000 in subsequent (p <0.01). Recurrence of SC was common in successive pregnancies of the same patient. The absence of prenatal care was the main risk factor for SC, both in the early as in subsequent pregnancies. The data suggest that in subsequent pregnancies more uninfected newborns were defined as cases of SC, due to insufficient information on prenatal antecedents of the pregnant woman.
Subsequent pregnancies in women that had a pregnancy with syphilis
Resumo (abstract):
This study included pregnant women with positive serum tests for syphilis, attended between 1997 and 2004 at the Hospital São Lucas, Porto Alegre, Brazil. Subsequent obstetric outcomes among these patients were investigated by December 2011, searching for recurrent cases of the disease. Among 450 pregnant women attended between 1997 and 2004, 166 had at least one obstetric outcome until December 2011, totaling 266 new obstetrical outcomes included in the study. Congenital syphilis (SC) was observed in 81.9% of initial and in 68.4% of subsequent pregnancies. The main causes of SC in subsequent pregnancies were positivation of VDRL at delivery and undocumented treatment. VDRL titers were greater than 1:4 in 50.4% of patients in the first obstetrical outcomes and in 13.3% in the subsequent (p <0.001). The rate of stillbirth was 119/1000 in the initial pregnancies and 41/1000 in subsequent (p <0.01). Recurrence of SC was common in successive pregnancies of the same patient. The absence of prenatal care was the main risk factor for SC, both in the early as in subsequent pregnancies. The data suggest that in subsequent pregnancies more uninfected newborns were defined as cases of SC, due to insufficient information on prenatal antecedents of the pregnant woman.
