Sífi lis congênita: evento sentinela da qualidade da assistência pré-natal Congenital syphilis: a sentinel event in antenatal care quality

ABSTRACT OBJECTIVE: To evaluate antenatal care in reducing the vertical transmission of syphilis. METHODS: A cross-sectional study was designed to be representative of low-risk pregnancies in women cared for at the Brazilian Unifi ed Health System (SUS) network in the city of Rio de Janeiro, from November 2007 to July 2008. Pregnant women diagnosed with syphilis were identifi ed through interviews, checking their antenatal care card and searching for reported cases in the public health information systems. Cases of congenital syphilis were sought at the disease reporting system (Sinan), the Mortality Information System (SIM) and the SUS’s Hospital Information System (SIH). RESULTS: Syphilis was identifi ed in 46 of the pregnancies, and 16 cases of congenital syphilis were identifi ed, resulting in a prevalence of 1.9% (95%CI 1.3;2.6) of syphilis in pregnancy and an incidence of 6/1,000 (95%CI 3;12/1,000) of congenital syphilis. The vertical transmission rate was 34.8% with three cases resulting in death (1 abortion, 1 stillborn and 1 neonatal death) and high proportions of prematurity and low birth weight. The healthcare pathway of those women revealed fl aws in the care they received, such as late entry to antenatal care, syphilis remaining undiagnosed during pregnancy and lack of treatment for the partner.