Fetal death from syphilis: an epidemiologic evaluation in Ribeirão Preto, Brazil.

An epidemiologic study was done of five Ribeirão Preto women whose pregnancies ended in fetal death from syphilis at the University Hospital of the Ribeirão Preto Medical School, São Paulo, in 1991. The study sought to establish the epidemiologic profiles of these women, determine the prenatal care they had received, assess the risk factors involved, and propose strategies for controlling syphilis during pregnancy within the region. Data were collected through home interviews with the study subjects. Obstetric (maternal and fetal) information obtained from these interviews was subsequently verified by consulting the women's medical records. In all, some 25 problems with a bearing on the fetal deaths were found, these being ascribable in roughly equal measure to health system shortcomings and the study subjects' knowledge and behavior. Notable among the health system problems were delayed receipt of serologic findings, failure to comply with recommended routines, late medical diagnosis, and ineffective monitoring of cure. Principal patient-related problems included ignorance of syphilis and unawareness of the importance of prenatal care. In view of the fact that fetal death from syphilis continues to occur in the affected region, it is recommended that maternal and child health authorities seek to establish or reestablish prenatal care of the requisite quality by instituting clear-cut guidelines for serologic screening, implementation of epidemiologic surveillance, and effective action by medical and paramedical teams.