A stillborn due to congenital syphilis in the metropolitan region of Rio de Janeiro in 2023: case report

Abstract

Introduction: Syphilis and its outcomes are important public health issues, with emphasis on congenital syphilis (CS), which has a large number of cases in Brazil. The state of Rio de Janeiro has the highest rate of incidence and deaths from CS among all states in the federation. Objective: To report the case of a stillborn due to congenital syphilis in 2023 in the metropolitan region of Rio de Janeiro, as well as to identify instances in prenatal care that may have contributed to this fatal outcome. Case report: First pregnant between 25 and 29 years old, the patient started prenatal care in August 2022 and reported a non-reactive rapid test for syphilis (RT) at the first consultation. However, there was no proof of this RT in the pregnant woman's record. In January 2023, she underwent RT for syphilis with positive results. Treatment occurred only the following day with just one dose of 2.4 million units of benzathine penicillin (BP). The VDRL was only collected in February 2023, days after treatment, resulting in 1:512. In March 2023, she was admitted to a Maternity Hospital in the Metropolitan Region of Rio de Janeiro with a diagnosis of fetal death. While still in the maternity ward, the patient denied recent syphilitic lesions on herself or in sexual partners. Ten days after hospitalization, there was a visit to the health unit where prenatal care took place with a report that “classification as primary syphilis because it was the first time that the patient had tested positive”. Only one dose of PB was administered for treatment in this case. Furthermore, there was no doctor in the unit and laboratory tests were requested, scheduled and collected on different days, resulting in frequent delays in receiving results and handling them. As for treatment, only on the day following the diagnosis was it explained that the clinic will receive the antibiotic after the case has been notified to the health department. Fragments of the placenta were sent for histopathological analysis and Treponema pallidum PCR research, which demonstrated chronic villitis associated with fetal vascular changes, compatible with congenital syphilis, and detected genetic material of Treponema pallidum. Conclusion: The occurrence and deaths due to CS reflect, in most cases, inadequate prenatal care, whether in direct care for pregnant women or in the establishment of care flows in the basic health network.