Provider Adherence to Syphilis Testing Recommendations for Women Delivering a Stillbirth

Patel, Chirag G.; Huppert, Jill S.; Tao, Guoyu

doi:10.1097/olq.0000000000000656

Cited by 13 publications

(12 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our analysis, only 15% of infected mothers with care underwent a detailed ultrasound to interrogate the fetus for findings consistent with congenital syphilis. Similar to our findings concerning provider practices, a large study evaluating intrauterine fetal demise found only 34% of providers tested for syphilis as an etiology, demonstrating a lack of consistent testing and management for this significant cause of fetal death [22]. Of note, testing for prenatal syphilis is not a requirement in six states, despite the current CDC, American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG) recommended screening guidelines stating that all pregnant women should undergo testing at the first prenatal visit, at third trimester, and at delivery if at high risk, a guideline implemented in Louisiana based delivery centers (Warren HP 2018, CSC.gov/std/tg2015/screening-recommendations [23, 24]).…”

Section: Discussionsupporting

confidence: 82%

Challenges in the Contemporary Management of Syphilis among Pregnant Women in New Orleans, LA

Stafford

Berra

Minard

et al. 2019

Infectious Diseases in Obstetrics and Gynecology

View full text Add to dashboard Cite

Objective. The aim of this retrospective review is to evaluate trends in the management of maternal and congenital syphilis (CS) in a tertiary care center in New Orleans, LA. Study Design. All cases of maternal and neonatal syphilis over a five year period at Touro Infirmary, New Orleans, LA, were identified using ICD-9/10 codes. Charts were reviewed for demographic and obstetrical variables, stage of syphilis at diagnosis, lab values, and treatment regimen. Newborn treatment and other outcomes were recorded. Results. During the study period 106 infected mother-baby pairs were identified. Of these, 73 charts are available for review. 41% (n = 30) of women received inadequate therapy according to their stage of disease. 9% of newborns (n = 6) were found to be symptomatic for CS; however, only 83.3% of these were admitted to the neonatal intensive care unit. Only 20% (n = 6) of infants were adequately treated with an extended penicillin regimen if the mother was not adequately treated. Furthermore, only 63.0% of newborns had a nontreponemal titer performed. Conclusion. With rising rates of CS, strict adherence to the 2015 CDC guidelines for treatment of syphilis must be maintained.

show abstract

Section: Discussionsupporting

confidence: 82%

Challenges in the Contemporary Management of Syphilis among Pregnant Women in New Orleans, LA

Stafford

Berra

Minard

et al. 2019

Infectious Diseases in Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…Furthermore, we observed increasing rates of stillbirth within Indiana in recent years. Integrated data further enabled measurement of syphilis testing rates for stillbirth cases, which were similar to those reported by Patel et al 3 using a large, national administrative data set. Testing rates in Indiana are well below the targets set by national and international public health organizations.…”

Section: Discussionsupporting

confidence: 67%

Surveillance of Stillbirth and Syphilis Screening Using Electronic Health Records

Dixon

wang

O’Connor

et al. 2018

OJPHI

View full text Add to dashboard Cite

Objective: To measure stillbirth delivery rates and syphilis screening rates among women with a stillbirth delivery using electronic health record data available in a health information exchange.Introduction: Reports of infants born with congenital syphilis have increased in the United States every year since 2012. Prevention depends on high performing surveillance systems and compliance with the U.S. Centers for Disease Control and Prevention (CDC) recommendations to perform syphilis testing early in pregnancy, in the third trimester and at delivery if a woman is at high risk, and following a stillbirth delivery. These guidelines exist, because untreated syphilis is associated with adverse fetal outcomes including central nervous system infection and death.Surveillance of congenital syphilis and stillbirth is challenging because available data sources are limited. Assessment of compliance with testing guidelines is particularly challenging, since public health agencies often lack access to comprehensive cohorts of tested individuals as most public health laws only require reporting of positive disease case information.Methods: Using integrated electronic health records available in a community-based health information exchange, we examined syphilis testing patterns for women with a stillbirth delivery in Indiana between 2010-2016. The cohort was examined to determine whether the women received syphilis testing in accordance with the CDC recommendations. During this time period, Indiana recorded around 84,000 live births per year.Data were extracted from electronic health records, including encounter data, laboratory test results and procedure data, captured by the Indiana Network for Patient Care (INPC), one of the largest community-based HIE networks in the United States. The INPC connects over 90 health care facilities, including hospitals, physicians’ practices, pharmacy networks, long-term post-acute care facilities, laboratories, and radiology centers. In addition to clinical care, the INPC supports surveillance of STIs1.Women with a stillbirth delivery were identified using International Classification of Disease (ICD) Clinical Modification (CM) codes from the 9thand 10th editions (ICD-CM-9 and ICD-CM-10). Inclusion codes: ICD-CM-9 codes 656.4, 779.9, V27.1, V27.3, V27.4, V27.6, V27.7, V32.01, V32.1, V32.2, V36.1; and ICD-CM-10 codes P95, P96.9, O36.4, Z37.1, Z37.3, Z37.4, Z37.9.Using the master person index for the INPC, we linked stillbirth deliveries with pregnancy encounters and laboratory testing data. We analyzed documentation of syphilis testing during the pregnancy (up to 270 days prior to the stillbirth delivery) as well as after the stillbirth delivery (up to 30 days). Broad time ranges were utilized to account for potential delays in reporting of either the stillbirth delivery or the syphilis test results. Documentation could include either presence of a result from a laboratory test for syphilis or a CPT code (80055, 86780, 86781, 86592, 86593) indicating performance of a syphilis test.Results: A total of 4,361 stillbirth deliveries attributable to 4,265 unique women were identified in the INPC between 2010-2016; representing a rate of 7.44 stillbirths per 1,000 live births during the same time period. Of the stillbirth deliveries, syphilis testing occurred within 270 days prior to or 30 days after delivery for 2,763 (63.4%) cases. Figure 1 displays the number of stillbirth cases observed each year and the number of cases in which syphilis testing occurred during the pregnancy or after delivery.Conclusions: Using integrated electronic health records data, we discovered that fetal deaths occurred more frequently (7.44 versus 4.09 per 1,000) than previously estimated2 through fetal death reporting mechanisms in Indiana. Furthermore, we observed increasing rates of stillbirth within Indiana in recent years. Integrated data further enabled measurement of syphilis testing rates for stillbirth cases, which were similar to those reported by Patel et al.3using a large, national administrative data set. Testing rates in Indiana are well below the targets set by national and international public health organizations. Accessing more complete data on populations using a health information exchange is valuable, although doing so may uncover a more negative picture of health in one’s community. Deeper analysis of these trends is warranted to explore factors related to increasing rates as well as limited testing in this population.

show abstract

“…However, it is also likely that some cases of congenital syphilis, particularly syphilitic stillbirths, are never diagnosed or reported. 18,19 Underascertainment or under-reporting of syphilis cases among pregnant women would lead to an underestimate of the proportion of potential congenital syphilis cases averted. Conversely, underascertainment or underreporting of congenital syphilis cases or syphilitic stillbirths would lead to an overestimate of the proportion of potential congenital syphilis cases averted.…”

Section: Discussionmentioning

confidence: 99%

Use of National Syphilis Surveillance Data to Develop a Congenital Syphilis Prevention Cascade and Estimate the Number of Potential Congenital Syphilis Cases Averted

et al. 2018

View full text Add to dashboard Cite

Although the majority of potential congenital syphilis cases in the United States were averted in 2016, there was substantial geographic variation, and significant gaps in delivering timely prenatal care, syphilis testing, and adequate treatment to pregnant women with syphilis were identified. The congenital syphilis prevention cascade is a useful tool to quantify programmatic successes and identify where improvements are needed.

show abstract

Provider Adherence to Syphilis Testing Recommendations for Women Delivering a Stillbirth

Cited by 13 publications

References 25 publications

Challenges in the Contemporary Management of Syphilis among Pregnant Women in New Orleans, LA

Challenges in the Contemporary Management of Syphilis among Pregnant Women in New Orleans, LA

Surveillance of Stillbirth and Syphilis Screening Using Electronic Health Records

Use of National Syphilis Surveillance Data to Develop a Congenital Syphilis Prevention Cascade and Estimate the Number of Potential Congenital Syphilis Cases Averted

Contact Info

Product

Resources

About