Patel Chirag G, Huppert Jill S, Tao Guoyu
From the *Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, and †Oak Ridge Institute of Science and Education, Oak Ridge, TN.
Sex Transm Dis. 2017 Nov;44(11):685-690. doi: 10.1097/OLQ.0000000000000656.
To assess overall adherence to Centers for Disease Control and Prevention and American College of Obstetrics and Gynecology recommended guidelines for syphilis testing among women who delivered a stillbirth and compare it with other tests recommended for stillbirth evaluation.
We used MarketScan claims data with 40 million commercially insured and 8 million Medicaid enrollees annually to estimate prenatal care and follow-up testing among women who had stillbirths between January 1, 2013, and December 24, 2013. Stillbirth was identified if women had any International Classification of Disease, Ninth Revision codes related to a stillbirth outcome. Among women with stillbirths, we estimated the proportions of women who received prenatal care and prenatal syphilis testing within 280 days before stillbirth, and testing at the time of stillbirth (syphilis testing, complete blood count, placental examination and autopsy) using Physician's Current Procedural Terminology codes.
We identified 3672 Medicaid-insured women and 6023 commercially insured women with stillbirths in 2013. Approximately, 61.7% of Medicaid-insured women and 66.0% of commercially insured women had claims data indicating prenatal syphilis testing. At the time of stillbirth, Medicaid-insured and commercially insured women had similar rates of syphilis testing (6.5% vs 9.3%), placental examination (61.6% vs 57.8%), and complete blood count (31.9% vs 37.6%). Autopsies were too infrequent to be reported. Approximately, 34.6% of Medicaid-insured women and 29.7% of commercially insured women had no syphilis testing either prenatally or at the time of stillbirth.
Syphilis testing among women after stillbirth was less than 10%, illustrating limited adherence to Centers for Disease Control and Prevention and American College of Obstetrics and Gynecology recommendations. Such low prenatal and delivery syphilis testing rates may impact the number of stillbirth cases identified as congenital syphilis cases and reported to the national surveillance system. Our results emphasize the need to improve syphilis testing to improve diagnosis of syphilitic stillbirths, identify women with syphilis infection, and provide treatment to these women to avoid syphilis-related adverse outcomes.
评估死产妇女对美国疾病控制与预防中心及美国妇产科医师学会推荐的梅毒检测指南的总体依从性，并将其与推荐用于死产评估的其他检测进行比较。
我们使用了MarketScan理赔数据，该数据每年涵盖4000万商业保险参保者和800万医疗补助参保者，以估算2013年1月1日至2013年12月24日期间死产妇女的产前护理和后续检测情况。如果妇女有任何与死产结局相关的国际疾病分类第九版编码，则判定为死产。在死产妇女中，我们使用医师当前操作术语编码估算了在死产前280天内接受产前护理和产前梅毒检测的妇女比例，以及在死产时进行检测（梅毒检测、全血细胞计数、胎盘检查和尸检）的妇女比例。
我们在2013年识别出3672名医疗补助参保死产妇女和6023名商业保险参保死产妇女。大约61.7%的医疗补助参保妇女和66.0%的商业保险参保妇女有理赔数据表明进行了产前梅毒检测。在死产时，医疗补助参保妇女和商业保险参保妇女的梅毒检测率（6.5%对9.3%）、胎盘检查率（61.6%对57.8%）和全血细胞计数率（31.9%对37.6%）相似。尸检太少，无法报告。大约34.6%的医疗补助参保妇女和29.7%的商业保险参保妇女在产前或死产时均未进行梅毒检测。
死产妇女中的梅毒检测率低于10%，这表明对美国疾病控制与预防中心及美国妇产科医师学会建议的依从性有限。如此低的产前和分娩梅毒检测率可能会影响被确定为先天性梅毒病例并报告给国家监测系统的死产病例数量。我们的结果强调需要改进梅毒检测，以改善梅毒死产的诊断，识别梅毒感染妇女，并为这些妇女提供治疗，以避免梅毒相关不良后果。
