(122) Reexamining a Paradigm of Maternal Syphilis Management when Fetal Ultrasound Findings are Present

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Allison Kurzeja, MD (she/her/hers)

MFM Fellow
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Coauthor(s)

HY

Heath Yancey, BA

Medical Student
University of Texas Southwestern Medical Center
Dallas, Texas, United States
JP

Jessica E. Pruszynski, PhD

University of Texas Southwestern
Dallas, Texas, United States
Emily H. Adhikari, MD

Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Objective: To characterize pregnancies with abnormal ultrasound findings of congenital syphilis and compare management and outcomes among pregnancies with and without ultrasound findings following current management protocols.

Study Design: Retrospective chart review of maternal syphilis cases diagnosed after 20 weeks from 2021 through 2023 at a large public hospital with uniform management of maternal syphilis, including 24 hours of fetal monitoring following initial benzathine penicillin dose if abnormal ultrasound was documented. A detailed fetal evaluation for congenital syphilis included assessment of placentomegaly, polyhydramnios, hepatomegaly, ascites, and elevated MCA systolic velocity. We compared demographics, syphilis stage, RPR titers, delivery outcomes, and neonatal outcomes among individuals with and without an abnormal detailed ultrasound prior to initiation of treatment.

Results: 97 individuals diagnosed after 20 weeks had a detailed ultrasound for congenital syphilis prior to treatment. Of those, 43 (44%) had abnormal findings, most commonly placentomegaly (63%) or hepatomegaly (53%). Syphilis stage and RPR titer were not associated with abnormal findings. Substance use disorder was prevalent in both groups. Consistent with our practice, individuals with abnormal findings were more likely to have received treatment with fetal monitoring on L&D. Despite being more likely to have monitoring, gestational age at delivery and cesarean rates were similar in both groups. There were no cases of stillbirth. Neonatal outcomes, including NICU admission and syphilis treatment, were not significantly different.

Conclusion: Delivery for fetal indication during maternal syphilis treatment remains a rare event, even in the setting of abnormal sonographic findings. Even in high resource settings, the added value of detailed ultrasound or prolonged fetal monitoring may not outweigh the benefit of immediate treatment initiation in pregnancy.