Gestantes notificadas com sífilis e ocorrência de sífilis congênita: estudo de coorte retrospectiva
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Data
2018-08-20
Autores
Almeida, Anelisa Soares de
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Universidade Estadual Paulista (Unesp)
Resumo
A sífilis é doença causada pelo Treponema pallidium e transmitida por via sexual, hematogênica ou vertical. Sua forma congênita ocorre quando a gestante com sífilis não tratada ou tratada inadequadamente transmite a doença para o recém-nascido. Tem-se por objetivo investigar a ocorrência e a influência de fatores maternos e relativos ao pré-natal sobre a sífilis congênita. Trata-se de estudo de coorte retrospectiva, formada por 158 casos de sífilis em gestantes notificados no período de 2013 a 2015, com seguimento realizado pelo Programa de DST/Aids de município de médio porte do interior paulista. A análise estatística foi realizada descritivamente e por regressão logística múltipla, sendo considerado p crítico <0,05. A maior parte das gestantes notificadas em decorrência da sífilis era branca, tinha nove ou mais anos de escolaridade e trabalho não remunerado; quase a totalidade havia feito pré-natal (96,8%). Do total de gestantes incluídas na coorte, 74 (46,8%) tiveram recém-nascido classificado com sífilis. A análise univariada evidenciou que a chance de sífilis congênita foi menor entre as mulheres com maior escolaridade, maior número de consultas e realização de acompanhamento pré-natal em Unidade de Saúde da Família e foi maior quanto maior a idade gestacional no início do tratamento e quanto maior a titulação do exame não treponêmico materno (p<0,20). Essas variáveis foram incluídas em modelo de regressão logística final, que evidenciou ser o número de consultas pré-natais o único fator independentemente associado à ocorrência de sífilis congênita, sendo menor a chance com o aumento no número de consultas: p=0,013, OR=0,87, IC95%=0,79-0,97. No conjunto de gestantes com sífilis ocorreram 12 (7,6%) desfechos negativos, considerando-se abortamento, natimorto e óbito neonatal. Na definição dos casos de sífilis congênita, falhas no tratamento do parceiro e da mãe foram as justificativas mais frequentes. Dos 74 recém-nascidos com sífilis congênita, 33 (44,6%) apresentaram intercorrência ao nascer. Conclui-se que para redução da sífilis congênita no município deste estudo, ações deverão ser implementadas para qualificação da assistência pré-natal, tanto no que diz respeito à garantia de consulta para seguimento pré-natal e desenvolvimento de ações de educação em saúde voltadas à adesão a esse seguimento quanto em relação ao adequado tratamento das gestantes com sífilis e suas parcerias. Em consonância com essas ações, como produto desta dissertação, mediante aprovação da coordenação do Programa Municipal de DST/aids, foram realizadas adequações no Instrumento de Acompanhamento da Sífilis: Gestantes, Puérperas, Parcerias e Bebês Expostos e sua divulgação para utilização no Departamento Regional de Saúde VI, com a finalidade de contribuir com as ações de vigilância em saúde e redução dos casos de sífilis congênita.
Syphilis is a recent disease caused by Treponema pallidium and transmitted sexually, hematogenously or vertically. Its congenital form occurs when a pregnant woman with syphilis is not treated or treated improperly to make the newborn. It aims to investigate the occurrence and influence of maternal and prenatal factors on congenital syphilis. This is a retrospective study, formatted for 158 cases of syphilis in pregnant women reported in the period from 2013 to 2015, with follow-up performed by the STD / AIDS Program of a medium-sized municipality in the state of São Paulo. Statistical analysis was performed descriptively and by regression, with the announcement of p <0.05. The majority of the pregnant women noticed the result of syphilis was white, superior or superior to schooling and unpaid work; already had a prenatal care (96.8%). Of the total number of pregnant women included in the cohort, 74 (46.8%) had newborns classified as having syphilis. The univariate analysis showed that the chance of congenital syphilis was lower among women with higher schooling, higher number of visits and prenatal follow-up in the Family Health Unit, and the higher the greater the gestational age at the beginning of treatment and the maternal non-treponemal test (p <0.20). These variables were included in a final logistic regression model, which showed that the number of prenatal consultations was the only factor independently associated with the occurrence of congenital syphilis, with a lower number of visits: p = 0.013, OR = 0.87, 95% CI = 0.79-0.97. In the group of pregnant women with syphilis, there were 12 (7.6%) negative outcomes, considering abortion, stillbirth and neonatal death. In the definition of cases of congenital syphilis, failures in the treatment of the partner and the mother were the most frequent justifications. Of the 74 newborns with congenital syphilis, 33 (44.6%) presented intercurrence at birth. It is concluded that for the reduction of congenital syphilis in the municipality of this study, actions should be implemented to qualify prenatal care, both regarding the guarantee of consultation for prenatal follow-up and development of health education actions aimed at adherence to this follow-up and regarding the adequate treatment of pregnant women with syphilis and their partnerships. In agreement with these actions, as a result of this dissertation, with the approval of the coordination of the Municipal STD / AIDS Program, adjustments were made to the Syphilis Monitoring Instrument: Pregnant Women, Puerperas, Partnerships and Babies Exposed and their disclosure for use in the Regional Department of Health VI, with the purpose of contributing to health surveillance actions and reducing cases of congenital syphilis.
Syphilis is a recent disease caused by Treponema pallidium and transmitted sexually, hematogenously or vertically. Its congenital form occurs when a pregnant woman with syphilis is not treated or treated improperly to make the newborn. It aims to investigate the occurrence and influence of maternal and prenatal factors on congenital syphilis. This is a retrospective study, formatted for 158 cases of syphilis in pregnant women reported in the period from 2013 to 2015, with follow-up performed by the STD / AIDS Program of a medium-sized municipality in the state of São Paulo. Statistical analysis was performed descriptively and by regression, with the announcement of p <0.05. The majority of the pregnant women noticed the result of syphilis was white, superior or superior to schooling and unpaid work; already had a prenatal care (96.8%). Of the total number of pregnant women included in the cohort, 74 (46.8%) had newborns classified as having syphilis. The univariate analysis showed that the chance of congenital syphilis was lower among women with higher schooling, higher number of visits and prenatal follow-up in the Family Health Unit, and the higher the greater the gestational age at the beginning of treatment and the maternal non-treponemal test (p <0.20). These variables were included in a final logistic regression model, which showed that the number of prenatal consultations was the only factor independently associated with the occurrence of congenital syphilis, with a lower number of visits: p = 0.013, OR = 0.87, 95% CI = 0.79-0.97. In the group of pregnant women with syphilis, there were 12 (7.6%) negative outcomes, considering abortion, stillbirth and neonatal death. In the definition of cases of congenital syphilis, failures in the treatment of the partner and the mother were the most frequent justifications. Of the 74 newborns with congenital syphilis, 33 (44.6%) presented intercurrence at birth. It is concluded that for the reduction of congenital syphilis in the municipality of this study, actions should be implemented to qualify prenatal care, both regarding the guarantee of consultation for prenatal follow-up and development of health education actions aimed at adherence to this follow-up and regarding the adequate treatment of pregnant women with syphilis and their partnerships. In agreement with these actions, as a result of this dissertation, with the approval of the coordination of the Municipal STD / AIDS Program, adjustments were made to the Syphilis Monitoring Instrument: Pregnant Women, Puerperas, Partnerships and Babies Exposed and their disclosure for use in the Regional Department of Health VI, with the purpose of contributing to health surveillance actions and reducing cases of congenital syphilis.
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Palavras-chave
Sífilis, Sífilis congênita, Gravidez, Récem-nascido, Syphilis, Congenital Syphilis, Pregnancy, Newborn