PRACA ORYGINALNA

ORIGINAL ARTICLE

Influence of the transferred syphilitic infection on the course of pregnancy, childbirth and the state of newborns

WPŁYW PRZENOSZONEJ DROGĄ PŁCIOWĄ INFEKCJI KIŁĄ NA PRZEBIEG CIĄŻY, PORODU ORAZ STAN OGÓLNY NOWORODKÓW

Viacheslav M. Husiev, Daria S. Khapchenkova

Donetsk National Medical University, Liman, Ukraine

Abstract

Introduction: The article presents information about the peculiarities of the course of pregnancy and childbirth in women with a syphilitic infection in the anamnesis. The peculiarities of the state of newborn babies born from mothers who have suffered syphilis are described. To date, the incidence of syphilis in Ukraine has a clear tendency to decline, but still remains quite high. The maximum incidence of syphilis is observed in women aged 15-20 years. The combination of pregnancy and syphilitic infection in an anamnesis is an unfavorable factor in regard to high risk of perinatal complications, the frequency of which does not tend to decrease.

The aim – study the features of the course of pregnancy and childbirth in women with a syphilitic infection in the anamnesis, the evaluation of the state of newborns.

Materials and methods: A prospective examination of 57 healthy women and their newborns (control group) and 60 pregnant women with a history of syphilitic infection (the main group) had been conducted. All pregnant women had undergone ultrasound examination, including feto- and placentometry, an estimate of the amount of amniotic fluid. The effect of the transferred syphilis on the state of the newborn had been assessed in accordance with the results of the clinical examination of an anthropometric data, including an Apgar score.

Results: It is stated that the incidence of latent (41,66%) and forms with a prolonged course (20,00%) of syphilitic infection. The threat of premature childbirth was almost 3,5 times higher than in women with syphilis, cases of an anemia in pregnant women – 2 times, hypertensive disorders of pregnant women were 2,4 times more common in women of the main group, fetal development retardation syndrome 6,4 times, while a greater percentage of this disorder was recorded among women in the main group who were ill with latent forms and suffered secondary recurrent syphilis (35%). In 20% of the cases, pregnancy in women with syphilis has been completed by the cesarean section, an abnormality of the contractile capacity of the uterus was significantly higher – 23,33%. The adaptive capacity of the newborns in the main group has been significantly lower, compared to the control group.

Conclusions: Syphilitic infection in the anamnesis complicates the course of pregnancy with numerous pathological conditions. Syphilitic infection, borne before pregnancy, affects not only the course of pregnancy, but also the course of childbirth and the postpartum period. The pathological conditions in infants are due to a decrease in resistance to birth stress, early depletion of adaptive resources of newborns under the influence of a syphilitic infection of the mother. In children who have experienced chronic intrauterine hypoxia, the risk of hemorrhagic syndrome is significantly higher due to increased permeability of the vascular wall. Such children have a tendency to develop neurological disorders and respiratory system lesions.

Key words: syphilis, pregnancy, children

Wiad Lek 2019, 72, 2, 175-180

INTRODUCTION

To date, the incidence of syphilis in Ukraine has a clear tendency to decline, but still remains quite high [1, 2, 3]. It is worth noting that the problem of syphilis is far from the optimal solution not only in our country. In 2000 91,5 new cases were registered per 100 thousand of population, whereas in 2007 this indicator decreased to 29,9, in 2009, it amounted to – 20,0, in 2011. – 17,4, in 2012. – 13,6 cases. The incidence of syphilis in Ukraine is characterized by a gradual decline (in 2014 – 3,674 cases (8,6 per 100 000 population), in 2015 – 3228 cases (7,6 per 100 000 population).

The maximum incidence of syphilis is observed in women aged 15-20 years. [1-3]. The established frequency of syphilis in the population among pregnant women ranges from 0,2% in developed and up to 13% in developing countries [1-8].

According to available data, hidden and late forms predominate in the structure of the incidence of syphilis in Ukraine, as well as in the countries of the near and far abroad: from 20 to 40%. According to the literature, in the group of patients with latent syphilis, persons with early forms predominate – from 57 to 95,7%, late syphilis is recorded in 9,8-13,6%, and in unspecified patients – in 6,4-13,1% of patients [1-9].

The combination of pregnancy and syphilitic infection is an extremely unfavorable factor in view of high perinatal complications, the frequency of which does not tend to decrease. The urgency of studying this problem is also due to the lack of dynamic observation of the physical and mental development of children born to women who had syphilis [10-12].

According to numerous authors [11, 13-16], pregnancy after syphilis is complicated with preeclampsia, polyhydramnios, premature births, anemia [14, 16, 17-19]. Postponed syphilitic infection is likely to cause a decrease in the energy resources of the uterus, which is one of the reasons for the secondary weakness of labor and inferiority of the period of expulsion in some pregnant women. There is also a premature discharge of the amniotic fluid, atonic bleeding, premature detachment of the normally located placenta [14, 15, 16-19].

A frequent complication in children born to mothers who have had syphilis in an anamnesis is the pathology of the central nervous system. Due to the cerebral dysfunction, children aged 6-13 years are diagnosed with psychopathic, cerebroasthenic and convulsive conditions, schizophrenia, oligophrenia, mental retardation syndrome, accompanied by symptoms of peripheral nervous system lesions in the form of asymmetry of nervous regulation [12, 17, 20-21]. In this case, the revealed disorders are associated with the lesion of the chromosome apparatus of the reproductive cells (gameto-, blasto- and embryopathies). Such conditions are called parasyphilitic and are manifested by various defects of physical, neurological, mental and intellectual development in the catamnesis [12, 15, 22, 23].

THE AIM

In view of the foregoing, it is important to study the features of the course of pregnancy and childbirth in women with a syphilitic infection in the anamnesis, the evaluation of the state of newborns, which served the purpose of our study.

MATERIALS AND METHODS

Design studies, distribution groups. A prospective examination of 57 healthy women and their newborns (control group) and 60 pregnant women with a history of syphilitic infection (the main group) was conducted. All pregnant women underwent ultrasound examination, including feto-and placentometry, an estimate of the amount of amniotic fluid. The state of the newborns was assessed by the results of a clinical examination, including an Apgar score, anthropometric data. Also, the features of the early neonatal period (weight loss and recovery, the complications of the adaptation period and pathological symptoms in newborns) were also determined.

Statistical analysis

Statistical processing of materials was carried out using variational statistical methods using the standard package of MS Office 365 Excel Windows’10’Home application programs. For quantitative characteristics, after calculating the descriptive statistical parameters within each sample, a check was made on the nature of the distribution. In the case of a normal distribution of similar characteristics in the samples, the Student’s test was used to compare them. In the absence of a normal Gaussian distribution in bound sets of quantitative traits (and also with rank characteristics), the comparison was made using non-parametric Fisher criteria. Mismatches between comparable values were considered statistically significant at a significance level of p <0,05.

RESULTS AND DISCUSSION

According to the data, there is a tendency to increase the frequency of latent (41,66%) and long-term (20,00%) forms of syphilitic infection among the pregnant women of the study group (Table I).

It should be noted that the overwhelming majority of women who had a syphilitic infection before pregnancy were housewives – 56,67% of cases compared to the control group – 21,05% (p <0,05). It is pertinent to note that this indicator also includes unemployed women. A relatively high percentage of women with syphilis in the anamnesis accounted for workers in industrial enterprises – 23,33%, employees accounted for 16,67%, compared with the control group 7,02% and 61,40%, respectively (p <0,05).

Complications of pregnancy in the study groups

The most common complications of pregnancy were anemia – 49 (81,67%) in pregnant women of the main group and 23 (40,60%) in the control group, with anemia of mild degree detected in 41 (68,33%) and 21 (36, 84%) women, the average degree – in 8 (13,33%) and 2 (3,51%) cases respectively (p <0,05). The threat of termination of pregnancy occurred in 33 (55,00%) women who had syphilis, and 10 women in the control group (17,55%, p <0,05). A significant part was the threat of termination of pregnancy up to 12 weeks – 17 (28,33%) in women in the main group and 8 (14,04%) in the control group (p> 0.05), the risk of premature birth was diagnosed in 16 (26,67%) and 2 (3,51%), respectively (p <0,05). Preeclampsia, as a complication of pregnancy, was more common among women in the main group and amounted to 18 (30,00%), whereas in the control group these indicators were 7 (12,28%) (p <0,05). The early gestosis accounted for 5 (8,33%) and 3 (5,26%) cases (p> 0,05), mild preeclampsia was diagnosed in the pregnant group in 13 cases (21,67%), in the control group – 4 (7,02%) (p <0,05). Preeclampsia of moderate degree was diagnosed in one patient of the main group (1,67%), due to the deterioration of the condition of a woman with severe preeclampsia, she was delivered in an urgent order.

Results of fetometry

The intrauterine growth retardation syndrome was diagnosed in antenatal fetometry in 27 pregnant women of the main group (45,00%), whereas in the control group this index was 4 cases (7,02%, p <0,05). The first stage of Fetal growth restriction (FGR) was detected in 13 cases (21,67%) in the group of women who were ill with syphilis, whereas in the control group this indicator was diagnosed in 4 cases (7,02%, p <0,05). Second-degree Fetal growth restriction (FGR) occurred in the main group in 12 cases (20,00%), the third degree – 2 (3,33%), respectively.

Statistics of patients with polyhydramnios showed the following distribution: moderate polyhydramnios occurred in women who had syphilis in 7 (11,67%) cases, in women in the control group – 5 (8,77%) cases. The marked polyhydramnios in 12 (20,00%) and 2 (3,51%), respectively (p <0,05).

The malignancy, which was considered as a marker of intrauterine hypoxia and placental dysfunction, was detected in patients of the main group in 18 cases (30,00%), in 13 cases (21,67%) – moderate malnutrition, expressed malic acid was recorded in 5 cases (8,33%) in the main group. In patients of the control group, moderate malnutrition was detected in 4 cases (7,02%, p <0,05).

Features of the course of labor and the postpartum period

Syphilitic infection, borne before pregnancy, affects not only the course of pregnancy, but also the course of childbirth and the postpartum period. The most common was premature discharge of amniotic fluid, which was observed in 25,00% (15 cases) of pregnant women who had syphilis, whereas in women with a physiological pregnancy this percentage was below 10,53% (6 cases, p <0,05). Premature births were found in the 1st case of women in the main group (1,67%). Due to worsening of the condition of the pregnant women against a background of pre-eclampsia, a premature delivery was performed – a caesarean section, in the control group there were no such cases.

In 14 cases (23,33%), the birth was complicated by abnormalities of uterine contractile activity in the pregnant women of the main group, whereas this complication was observed only in 4 cases (7,02%) of the pregnant control group (p <0,05). Bleeding during the III stage of labour was observed in 4 patients (6,67%) of the main group, in the control group this complication was not observed (p <0,05). When the placenta was examined in the postpartum period, 10 cases (16,67%) of the women of the main group were found to have defects, which led to a manual revision of the uterine cavity and the removal of placental defects. In women of the control group, this pathology was observed in 3 cases (5,26%, p <0,05). Birth injuries occurred in 8 women of the main group (13,33%) and in 5 cases of the control group (8,77%, p <0,05). As a result of the analysis it was found that in 6 patients of the main group (10,00%) the postnatal period was complicated by the subinvolution of the uterus, in the 1st (1,67%) – endometritis. In the control group, only the first patient was diagnosed with a lochiometer (1,75%, p <0,05).

Condition of newborns

Children with symptoms of congenital syphilis were not recorded. When assessing the state of newborns and the course of the early postnatal period, the following was noted: the Apgar score of newborns in the main group was significantly lower than in the control group (6,69 ± 0,18 and 8,25 ± 0,12 points in the first minute and 7, 67 ± 0,12 and 9,19 ± 0,11 points in the fifth minute, respectively (p <0,05)). Low Apgar scores were set due to a decrease in muscle tone in 13 newborns – 21,67% and reflex excitability – 16 newborns – 26,67%, due to the pallor of the skin – 15 (25,00%), respectively. The average body mass index of newborns in the main group is significantly lower than in the control group (3062,00 ± 36,8 and 3497,72 ± 51,23 g, p <0,05) (Table II).

Anthropometric measurements revealed that the average circumference of the head and shoulders of the newborn in the main group was significantly lower than that in the control group, and amounted to 33,28 ± 0,42 and 35,53 ± 0,15 cm and 33,75 ± 0, 4 and 34,82 ± 0,17 cm, respectively (p <0,05). Physiological weight loss in newborns as a percentage of women in the main group was 4,75 ± 0,28 g, in newborns in the control group – 4,26 ± 0,24 g, respectively.

The course of postnatal adaptation

The disturbance of early postnatal adaptation of newborns, manifested by a combination of pathological symptoms, is twice as high in women who have had syphilis. Hemorrhagic syndrome occurred in 7 (11,67%) of newborns, from mothers who had syphilis, in the control group this pathology occurred in 3 (5,26%, p <0,05) cases; neurological disorders – in 6 (10,00%) of the newborns of the main group, 2 (3,51%, p <0,05) – control group; respiratory distress syndrome was observed in newborns of only the main group in 3 cases (5,00%, p <0,05).

Syphilitic infection in the anamnesis complicates the course of pregnancy with numerous pathological conditions. In women with syphilitic infection, pregnancy was accompanied by complications, among which a fairly high percentage accounted for Fetal Growth Retardation, malnutrition and polyhydramnios, anemia of pregnant women, the threat of premature birth, preeclampsia. Reduction of the number of amniotic fluid, according to L.G. Sichinawi et al. [24], is an unfavorable prognostic sign in terms of perinatal losses. Syphilitic infection, borne before pregnancy, affects not only the course of pregnancy, but also the course childbirth and the postpartum period. In the opinion of a number of authors [17, 20], the transferred syphilitic infection may affect the energy capabilities of the neuromuscular apparatus of the uterus, which leads to an increase in the duration of the most energy-intensive phases of the birth act and the frequency of primary and secondary weakness of labor, its discoordination.

The pathological conditions of infants are due to a decrease in resistance to birth stress, early depletion of adaptive resources of newborns under the influence of a syphilitic infection of the mother. According to the literature [25], the risk of haemorrhagic syndrome in children who underwent chronic intrauterine hypoxia is significantly higher due to increased permeability of the vascular wall. Such children have a tendency to develop neurological disorders and respiratory system lesions.

CONCLUSIONS

1. The threat of premature birth was almost 3.5 times higher than in women with syphilis, anemia of pregnant women – 2 times, gestosis of pregnant women was 2,4 times more common in women of the main group, NWFP in 6.4 times, while a greater percentage of this disorder was registered among the women of the main group who were ill with latent forms and suffered secondary recurrent syphilis – 35,00%.

2. In 20,00% of cases, the pregnancy in women with syphilis was completed by cesarean section, the abnormality of the contractile capacity of the uterus in women of the main group was significantly more frequent – 23,33%.

3. The adaptive capabilities of the newborns in the main group had a significantly lower Apgar score than the control group.

References

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Authors’ contributions:

According to the order of the Authorship.

Conflict of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Daria S. Khapchenkova

Department of Human Anatomy № 1,

Donetsk National Medical University

Privokzalnaya Street, 27, Liman, 84404, Ukraine

tel: +38 (050) 9281337

e-mail: xapcha86@gmail.com

Received: 19.09.2018

Accepted: 24.01.2019

Table I. Distribution of women according to the forms of the transferred syphilis

The form of syphilitic infection

Main Group, n = 60

Abs.

%

Primary seropositive

6

10,00

Secondary recent

4

6,66

Secondary recurrent

12

20,00

Latent early

25

41,66

Seroresistance

8

13,33

Discharged

5

8,33

Fig.1. Frequency of complications of pregnancy in patients of the examined groups

Fig. 2. The nature of obstetric complications in the patients of the examined groups.

Table II. Indicators of anthropometry in newborns in both groups (M ± m)

Indicators

Main Group, n = 60

Control Group, n=57

Body weight, g

3062,00 ± 36,80*

3497,72±51,23

Height, cm

51,32±0,35*

53,98±0,26

Head circumference, cm

33,28±0,42*

35,53±0,15

Shoulder сircumference, cm

33,75±0,40*

34,82±0,17

Note. * – probably the difference in the relevant indicators between comparable groups (p <0.05).