Inadequate syphilis screening among women with prenatal care in a community with a high syphilis incidence.
ABSTRACT OBJECTIVES AND GOAL: This study was designed to evaluate the extent to which pregnant women in a community with a high syphilis incidence were screened for syphilis according to standard recommendations of twice during prenatal care and at labor and delivery.
Labor and delivery records from 4 hospitals in Miami-Dade County, Florida, were abstracted to obtain maternal and prenatal care characteristics and syphilis screening practices.
Of the 1991 women, records indicated that 1655 (83%) were screened at least once during prenatal care, 220 (11%) were screened twice during prenatal care before delivery, and 184 (9%) were screened twice during prenatal care and at delivery. Attending a private clinic, having more than adequate prenatal care and having private insurance were associated with not being screened at least twice before delivery.
Few women were screened according to standard recommendations, and provider or institutional-related factors affected adequacy of screening.
- New England Journal of Medicine 02/1990; 322(4):270-1. · 51.66 Impact Factor
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ABSTRACT: Descriptive characteristics and clinical information from 322 cases of congenital syphilis were reviewed. The births (318 mothers) included 31 (10%) stillborn and 59 (18%) with clinical evidence of congenital syphilis. Only 60 (19%) had a complete laboratory workup, including radiographs of long bones and spinal fluid analysis. For a subset of 244 women with available information, 218 (89%) had > or = 1 risk factors for syphilis; however, residence in an area with high morbidity from syphilis was the only identified risk factor for 83 (34%). Eighty women (25%) were treated for syphilis during pregnancy; only 24 were treated appropriately for their stage of syphilis > 30 days before delivery. Five of these pregnancies resulted in infants with clinical signs of syphilis. These findings emphasize the need for expanded prenatal screening of high-risk women, the necessity of screening at delivery, and the need for complete evaluation of infants at risk for congenital syphilis. Further, the data suggest that in some cases therapy in the last trimester of pregnancy may be insufficient to adequately treat the fetus.The Journal of Infectious Diseases 03/1995; 171(3):732-5. · 5.85 Impact Factor
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ABSTRACT: The incidence of congenital syphilis in Florida increased sixfold from 1985 through 1989, and more than 80% of the cases occurred in metropolitan areas of southern Florida. To characterize the population of pregnant women in Florida at high risk of delivering an infant with congenital syphilis, the authors conducted a case-control study using birth certificates. Birth certificates were obtained for 256 of the 344 live infants reported as having congenital syphilis from 1987 through 1989 (74%); the 246 of these infants born in hospitals were matched for hospital and week of birth with an equal number of controls. In conditional multiple logistic regression, the following maternal characteristics were independent risk factors for congenital syphilis: young age, black race, single marital status, absence of a father's name on the birth certificate, previous pregnancy, substance abuse, and lack of prenatal care. Although the national origin of the mother was not a significant risk factor, the infants of black mothers born in the United States were at greater risk than the infants of black mothers born outside the United States. Mothers who had < or = 3 prenatal visits had an increased risk of delivering an infant with congenital syphilis as compared with mothers who had > 3 visits. This study suggests that targeted outreach efforts are necessary to control congenital syphilis and provides guidance for public health intervention activities.American Journal of Epidemiology 09/1992; 136(6):657-61. · 4.78 Impact Factor