Estudo de coorte retrospetivo desenvolvido num hospital terciário de referência, cujo principal critério de inclusão foi a presença de serologia positiva para sífilis. O estudo incluiu todas as grávidas admitidas no nosso Hospital entre janeiro de 2004 e dezembro de 2013. Os recém-nascidos foram classificados de acordo com a probabilidade de infeção, com base nas recomendações do Centers for Disease Control and Prevention.

Resultados

Entre as 27 gravidezes em risco de SC, 48,2% (n = 13) tiveram diagnóstico durante o 1° trimestre; a idade gestacional média no final do tratamento foi de 28 semanas. Em 44,4% (n = 12) das mulheres, o tratamento foi considerado inadequado. Em 30,8% dos casos (n = 8) houve algum evento adverso da gravidez, dos quais 5 foram adequadamente tratados. Em dois dos casos (7,7%) a SC foi provada ou considerada como altamente provável, 10 (38,5%) com SC provável, 12 (46,1%) com SC pouco provável, e 2 (7,7%) com SC improvável. Nos lactentes, o tratamento foi bem sucedido, com exceção de um caso de neurossífilis.

Conclusão

Este estudo visa realçar muitas das dificuldades/preocupações encontradas na vigilância materno-neonatal dos casos com diagnóstico de sífilis. ublinhamos, não só, a importância de se assegurar a deteção precoce de infeção como forma de se garantir o tratamento atempado, mas também, uma adequada adesão à vigilância/ tratamento, através de uma rede mais eficiente entre as diferentes instituições envolvidas no acompanhamento das grávidas.

Palavras-chave:
sífilis; infecção; sífilis congênita; diagnóstico pré-natal

Cases	Pregnancy follow-up
	Maternal age/Gravida/Para	Stage of disease/ Time of diagnosis	Neonatal outcomes	Maternal treatment
1 (SGA + PTD)	27 yearsPrimigravida	Early latent2nd trimester	Adequate	Incorrectly treated(Incomplete 2nd treatment at 31 WG - inadequate serologic response)
2 (SGA)	36 yearsGravida 2/Para 1	Early latent2nd trimester	Adequate	Properly treated^c Two doses of intramuscular benzathine penicillin G - 4.8 million IU
3 (PTD)	32 yearsPrimigravida	Early latent2nd trimester	Adequate	Properly treated^c Two doses of intramuscular benzathine penicillin G - 4.8 million IU
4 (SGA)	19 yearsPrimigravida	Latent of unknown duration/1st trimester	Adequate	Properly treated^a Notes: a Three doses of intramuscular benzathine penicillin G - 7.2 million IU. (2nd treatment at 28 WG - inadequate serologic response)
5 (CS)	29 yearsGravida 3 /Para 2	Latent of unknown duration/2° trimester	IrregularSurveillance	Properly treated^a Notes: a Three doses of intramuscular benzathine penicillin G - 7.2 million IU.
6 (CS)	19 yearsPrimigravida	Latent of unknown duration/ At delivery	Without surveillance	Not treated
7 (PTD)	29 yearsGravida 4/Para 2	Late latent(Previously treated)	IrregularSurveillance	Properly treated^a Notes: a Three doses of intramuscular benzathine penicillin G - 7.2 million IU.
8 (SGA + PTD)	38 yearsGravida 8/ Para 6	Late latent(Not treated)	IrregularSurveillance	Incorrectly treated
Cases	Pregnancy follow-up
	Otherobstetric complications	Time at delivery/Birth weight	RPR Titers(Newborn/ mother)	Probability ofDeveloped CS^b Probability of developed CS based on the four scenarios proposed by the CDC guidelines.	CS
1 (SGA + PTD)	None	36 WG2,030 g (p1)	1:16/ 1:16	Possible	NoAqueous penicillin G10 days (100,000–150,000 units/Kg/day)
2 (SGA)	None	39 WG2,660 g (p4)	1:16/ 1:16	Less likely	No
3 (PTD)	Thrombophilia	33 WG2,130 g (p48)	1:32/ 1:32	Less likely	NoAqueous penicillin G10 days (100,000-150,000 units/Kg/day)^d Treatment at 5 months after an elevation in the CLIA titers
4 (SGA)	None	38 WG2,260 g (p1)	1:4/ 1:4	Less likely	No
5 (CS)	None	40 WG3,950 g (p85)	1:0/ 1:0	Proven or highly probable	YesAqueous penicillin G10 days (100,000-150,000 units/Kg/day)
6 (CS)	None	36 WG2,215 g (p4)	1:16/ 1:16	Proven or highly probable	YesAqueous penicillin G14 days (100,000-150,000 units/Kg/day)
7 (PTD)	None	34 WG2,220 g (p32)	1:4/ 1:8	Less likely	No
8 (SGA + PTD)	None	35 WG1830 g (p1)	1:4/ 1:4	Possible	NoAqueous penicillin G 10 days (100,000–150,000 units/Kg/day)

Case	1	2
Maternal age/Gravida/Para	19 yearsPrimigravida	29 yearsGravida3 /Para2
Pregnancy follow-up
Time at diagnoses/Stage of disease	At delivery/Latent of unknown duration	28 WG/Latent of unknown duration
Follow-up	None	Irregular
Maternal treatment	None	Properly treated: 3 doses of intramuscular penicillin G(7.2million IU)ⁱ Partner was properly treated too.
Time at delivery/ Type of birth/ Birth weight/ sex/ Apgar score	36 WG; Eutocic; 2,115 g (p4); Male; 5/7	40 WG; Vacuum-assisted; 3,950 g (p85); Male; 5/8
Neonatal outcomes and evaluation
Clinical signs	Maculopapular rash;hepatosplenomegaly jaundice; upper gastrointestinal bleeding; seizures	Respiratory distress;hypotonia; seizures
RPR Titers(Newborn/ mother)	1:16/1:16ⁱⁱ Lumbar puncture was not performed because the diagnosis of a grade I intraventricular hemorrhage contra-indicated the procedure.	1:0/1:0Tp PCR + (CSF)ⁱⁱⁱ Blood Tp PCR (mother and newborn) negative; CLF: Cerebrospinal fluid.
Analytic findings	Anemia and thrombocytopenia;hyperglycemia; hyperbilirubinemia	Anemia and thrombocytopenia
Imaging findings	Transfontanellar ultrasound:bilateral intraventricular hemorrhage; hyperechogenic corpus callosumLong-bone X-ray: periostitis	Transfontanellar ultrasound: abnormalities on the ventricular lining and bilateral intraventricular strand, mild ventricular dilatation, and bilateral hypoechogenic area in the choroid plexus.MRI: subdural hemorrhage
Treatment	Aqueous penicillin G 14 days(100,000-150,000 units/Kg/day)	Aqueous penicillin G 10 days(100,000-150,000 units/Kg/day)

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

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[1] Address for correspondence Magda Maria do Vale Pinto Lopes de Magalhães, MD, Rua Luís Castro Rodrigues da Silva, lote 11, 4C. 3030- 254 Pinhal de Marrocos, Coimbra, Portugal (e-mail: magdamariamagalhaes@gmail.com).

Age at delivery (y) (mean ± 2σ)	32.5 ± 5.7(18–43)
Number of previous gestations (median; range)	2 (0–8)
Parity (median; range)	1 (0–6)
Immigrant mothers	3/27 (11.1)
Unemployed	9/27 (33.3)
Inadequate pregnancy follow-up	12/27 (44.4)
Median RPR titers at treatment	1:16
Weeks of gestation at the end of the treatment (mean ± 2σ)ⁱ Excluding 12 women untreated or incorrectly treated, and 2 women with adequate treatment before pregnancy with stable NTT titers.	27.9 ± 6.9
Adequate antenatal treatmentⁱⁱ Including 2 women with adequate treatment before pregnancy with stable NTT titers.	15/27 (55.6)
Median RPR titers at delivery	1:4
Gestational age at delivery (mean ± 2σ)	38.0 ± 1.9 (33–41)
Preterm delivery (< 37 WG)ⁱⁱⁱ Excluding one woman with spontaneous abortion at 1st trimester	5/26 (19.2)
Birth weight (g) (mean ± 2σ)	3087 ± 699(1830–4700)
Small for gestational age (<p10)	5/26 (19.2)
Median RPR titer of neonate	1:4