Congenital syphilis

Real-time audits

Abstract

Introduction: a progressive increase in VDRL positive pregnant women and newborns was registered at the Pereira Rossell Hospital Center. For this reason the Programa Nacional de Salud de la Niñez (Children’s Health National Programme) conducted research to identify the factors that contribute to congenital syphilis by auditing medical histories.
Method: we conducted a descriptive study based on the information arising from the mother-child binomial medical record and on interviews to mothers and treating doctors. For four months (October 2007-January 2008) we identified all VDRL positive newborns and their mothers. Data were analyzed with EpiInfo 6.4. software.
Results: we found 58 newborns that corresponded to 56 mothers. Maternal precedents led us to consider serologic activity in 12 newborns as an immune memory. Ten pregnant women had no prenatal controls and infection was proved in other 12 women, although they were not treated. 24 (52.2%) were infected or re-infected in the last trimester. 41.9% informed about previous episodes of syphilis and problems such as abortions, fetal death or low weight. Five newborns presented clinical or para-clinical manifestations of congenital syphilis. The latter and the newborns with probable congenital syphilis were treated with penicillin for ten days. Responsible services failed to reach sexual partners and only reported 44% of congenital syphilis.
Conclusions: audits provided more information, evidencing weaknesses in records, failures in prenatal controls, re-infection frequency and the fact that CS is under-reported.