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AI-Generated response:

What are the specific ultrasound markers indicating fetal infection of syphilis?

Answer generated on June 5, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Specific ultrasound markers indicating fetal infection of syphilis include hepatomegaly, placentomegaly, elevated peak systolic velocity in the middle cerebral artery, ascites, and hydrops fetalis.[1]

  • Hepatomegaly and placentomegaly are common findings in fetal syphilis infection, indicating inflammation and abnormal growth.

  • Elevated peak systolic velocity in the middle cerebral artery suggests fetal anemia, which can be a consequence of syphilitic infection.

  • Ascites and hydrops fetalis represent severe systemic effects of syphilis on the fetus, indicating widespread body inflammation and fluid accumulation.

  • These ultrasound findings warrant immediate and careful management of syphilis in pregnancy with benzathine penicillin G to prevent further complications.

  • Pregnancies with these ultrasound abnormalities are at higher risk of compromise during syphilotherapy and fetal treatment failure, emphasizing the importance of early detection and treatment.

Additional info

The presence of these ultrasound markers in a fetus when a pregnant woman is being treated for secondary syphilis underscores the urgency and critical nature of effective syphilis management. Benzathine penicillin G is the recommended treatment, and it is crucial to administer it according to the maternal stage of infection per CDC guidelines. In cases where the mother is allergic to penicillin, desensitization followed by treatment is necessary to ensure both maternal and fetal safety. The detection of these markers should prompt a thorough evaluation and possibly more aggressive management to mitigate risks to the fetus. Monitoring and follow-up are essential to assess the treatment response and to ensure the resolution of these ultrasound findings, thereby improving the prognosis for both the mother and the fetus.

References

Reference 1

1.

Rac MW, Revell PA, Eppes CS. American Journal of Obstetrics and Gynecology. 2017;216(4):352-363. doi:10.1016/j.ajog.2016.11.1052.

Publish date: April 6, 2017.

Syphilis remains the most common congenital infection worldwide and has tremendous consequences for the mother and her developing fetus if left untreated. Recently, there has been an increase in the number of congenital syphilis cases in the United States. Thus, recognition and appropriate treatment of reproductive-age women must be a priority. Testing should be performed at initiation of prenatal care and twice during the third trimester in high-risk patients. There are 2 diagnostic algorithms available and physicians should be aware of which algorithm is utilized by their testing laboratory. Women testing positive for syphilis should undergo a history and physical exam as well as testing for other sexually transmitted infections, including HIV. Serofast syphilis can occur in patients with previous adequate treatment but persistent low nontreponemal titers (<1:8). Syphilis can infect the fetus in all stages of the disease regardless of trimester and can sometimes be detected with ultrasound >20 weeks. The most common findings include hepatomegaly and placentomegaly, but also elevated peak systolic velocity in the middle cerebral artery (indicative of fetal anemia), ascites, and hydrops fetalis. Pregnancies with ultrasound abnormalities are at higher risk of compromise during syphilotherapy as well as fetal treatment failure. Thus, we recommend a pretreatment ultrasound in viable pregnancies when feasible. The only recommended treatment during pregnancy is benzathine penicillin G and it should be administered according to maternal stage of infection per Centers for Disease Control and Prevention guidelines. Women with a penicillin allergy should be desensitized and then treated with penicillin appropriate for their stage of syphilis.

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