Rac Martha W F, Bryant Stefanie N, McIntire Donald D, Cantey Joseph B, Twickler Diane M, Wendel George D, Sheffield Jeanne S
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Am J Obstet Gynecol. 2014 Oct;211(4):426.e1-6. doi: 10.1016/j.ajog.2014.05.049. Epub 2014 Jun 4.
The purpose of this study was to evaluate ultrasound findings of fetal syphilis and to describe their progression after maternal treatment.
This was a retrospective cohort study from September 1981 to June 2011 of seropositive women after 18 weeks of gestation who had an ultrasound before treatment to evaluate for fetal syphilis. Only those women who received treatment after the initial ultrasound scan, but before delivery, were included. If the initial ultrasound scan was abnormal, serial sonography was performed until resolution of the abnormality or delivery. Patient demographics, ultrasound findings, stage of syphilis, delivery, and infant outcomes were recorded. Standard statistical analyses were performed. Kaplan-Meier estimates were constructed to estimate time to resolution.
Two hundred thirty-five women met the inclusion criteria; 73 of them (30%) had evidence of fetal syphilis on initial ultrasound scan. Abnormalities included hepatomegaly (79%), placentomegaly (27%), polyhydramnios (12%), ascites (10%) and abnormal middle cerebral arterial Doppler assessment (33%). After treatment, middle cerebral arterial Doppler assessment abnormalities, ascites, and polyhydramnios resolved first, followed by placentomegaly and finally hepatomegaly. Infant outcomes were available for 173 deliveries; of these, 32 infants (18%) were diagnosed with congenital syphilis. Congenital syphilis was more common when antenatal ultrasound abnormalities were present (39% vs 12%; P < .001). Infant examination findings at delivery were similar between women with and without an abnormal pretreatment ultrasound scan. However, in those infants with congenital syphilis, hepatomegaly was the most frequent abnormality found, regardless of antenatal ultrasound findings.
Sonographic signs of fetal syphilis confer a higher risk of congenital syphilis at delivery for all maternal stages. Hepatomegaly develops early and resolves last after antepartum treatment.
本研究旨在评估胎儿梅毒的超声表现，并描述母体治疗后其进展情况。
这是一项回顾性队列研究，研究对象为1981年9月至2011年6月期间妊娠18周后血清学阳性的孕妇，这些孕妇在治疗前接受了超声检查以评估胎儿梅毒。仅纳入那些在初次超声扫描后、分娩前接受治疗的女性。如果初次超声扫描异常，则进行系列超声检查，直至异常情况消失或分娩。记录患者的人口统计学信息、超声检查结果、梅毒分期、分娩情况及婴儿结局。进行标准的统计学分析。构建Kaplan-Meier估计值以估计异常情况消失的时间。
235名女性符合纳入标准；其中73名（30%）在初次超声扫描时有胎儿梅毒的证据。异常表现包括肝肿大（79%）、胎盘肿大（27%）、羊水过多（12%）、腹水（10%）以及大脑中动脉多普勒评估异常（33%）。治疗后，大脑中动脉多普勒评估异常、腹水和羊水过多最先消失，其次是胎盘肿大，最后是肝肿大。173例分娩有婴儿结局数据；其中32例婴儿（18%）被诊断为先天性梅毒。产前超声检查有异常时，先天性梅毒更常见（39%对12%；P<.001）。有无异常治疗前超声扫描的女性分娩时婴儿检查结果相似。然而，在那些患有先天性梅毒的婴儿中，无论产前超声检查结果如何，肝肿大是最常见的异常表现。
胎儿梅毒的超声征象在所有母体梅毒分期中均使分娩时先天性梅毒风险更高。肝肿大出现早，产前治疗后最后消失。
