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Cited by 67Syphilis Diagnosis and TreatmentNeonatal and Maternal InfectionsFetal and Pediatric Neurological Disorders

Progression of ultrasound findings of fetal syphilis after maternal treatment

Rac, Martha W.F., Bryant, Stefanie N., McIntire, Donald D., Cantey, Joseph B., Twickler, Diane M., Wendel, George D., Sheffield, Jeanne S.·2014·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2014.05.049
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Abstract

Objective The purpose of this study was to evaluate ultrasound findings of fetal syphilis and to describe their progression after maternal treatment.Study design This was a retrospective cohort study from September 1981 to June 2011 of seropositive women after 18 weeks of gestation who had an ultrasound before treatment to evaluate for fetal syphilis. Only those women who received treatment after the initial ultrasound scan, but before delivery, were included. If the initial ultrasound scan was abnormal, serial sonography was performed until resolution of the abnormality or delivery. Patient demographics, ultrasound findings, stage of syphilis, delivery, and infant outcomes were recorded. Standard statistical analyses were performed. Kaplan-Meier estimates were constructed to estimate time to resolution.Results Two hundred thirty-five women met the inclusion criteria; 73 of them (30%) had evidence of fetal syphilis on initial ultrasound scan. Abnormalities included hepatomegaly (79%), placentomegaly (27%), polyhydramnios (12%), ascites (10%) and abnormal middle cerebral arterial Doppler assessment (33%). After treatment, middle cerebral arterial Doppler assessment abnormalities, ascites, and polyhydramnios resolved first, followed by placentomegaly and finally hepatomegaly. Infant outcomes were available for 173 deliveries; of these, 32 infants (18%) were diagnosed with congenital syphilis. Congenital syphilis was more common when antenatal ultrasound abnormalities were present (39% vs 12%; P < .001). Infant examination findings at delivery were similar between women with and without an abnormal pretreatment ultrasound scan. However, in those infants with congenital syphilis, hepatomegaly was the most frequent abnormality found, regardless of antenatal ultrasound findings.Conclusion Sonographic signs of fetal syphilis confer a higher risk of congenital syphilis at delivery for all maternal stages. Hepatomegaly develops early and resolves last after antepartum treatment.

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  • Absence of ultrasound abnormalities does not exclude congenital infection as up to 70% of the cases are asymptomatic.

    “Absence of ultrasound abnormalities does not exclude congenital infection as up to 70% of the cases are asymptomatic. 23”

    From Syphilis in pregnancy: A practical guide for prenatal care providers (2025) · cites this paper as [23]

  • Treatment of syphilis during pregnancy aims to resolve fetal symptoms, notably hydrops.

    “Note that the treatment of syphilis during pregnancy aims to resolve fetal symptoms, notably hydrops. 23”

    From Syphilis in pregnancy: A practical guide for prenatal care providers (2025) · cites this paper as [23]

  • A majority of women will not achieve a fourfold decrease in titers before delivery, although this does not indicate treatment failure.

    “A majority of women will not achieve a fourfold decrease in titers before delivery, although this does not indicate treatment failure (645).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [645]

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Authors
Rac, M. W. F., Bryant, S. N., McIntire, D. D., Cantey, J. B., Twickler, D. M., Wendel, G. D., & Sheffield, J. S.
Affiliations
The University of Texas Southwestern Medical Center (US)
Corresponding author
Rac, Martha W.F.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2014-10
Volume
211
Issue
4
Pages
426.e1-426.e6
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2014.05.049
OpenAlex
W2030460870
Cited by
67
References
32
Citations by year
2026: 1 · 2025: 9 · 2024: 8 · 2023: 5 · 2022: 10 · 2021: 9 · 2020: 7 · 2019: 4 · 2018: 5 · 2017: 5 · 2016: 4
FWCI
2.00
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
Keywords
congenital syphilis, hepatomegaly, placentomegaly, polyhydramnios, fetal ascites, middle cerebral artery Doppler, infant outcomes
MeSH terms
Adult, Anti-Bacterial Agents, Drug Administration Schedule, Female, Hepatomegaly, Humans, Infant, Infant, Newborn, Injections, Intramuscular, Penicillin G Benzathine, Pregnancy, Pregnancy Complications, Infectious, Prenatal Care, Retrospective Studies, Syphilis, Syphilis, Congenital, Cohort Studies, Ultrasonography, Prenatal, Treatment Outcome, Ultrasonography, Doppler

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