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The relationship of congenital syphilis to abortion and miscarriage, and the mechanism of intrauterine protection


, : The relationship of congenital syphilis to abortion and miscarriage, and the mechanism of intrauterine protection. Amer Jour Obstet And Gynecol 47(3): 369-379

Systematic search for spirochetes was made in Levaditi stains of liver, lung, adrenal, pancreas and kidney from autop-sied nonviable.fetuses of 68 nonsyphilitic and 67 luetic [female] [female] Fetal syphilis" was diagnosed only when spirochetes were found in fetal organs, usually in largest numbers in peri-vascular tissues of liver and lungs. None were found in 68 fetuses from nonsyphilitic [female] [female]- In 3 macerated fetuses from missed abortions, variable forms of spirochetes were found and interpreted as dead or dying organisms. In 16 of 67 (23.9%) fetuses of luetic [female] [female] , Spirochaeta pallida were identified, indicating the role syphilis played in abortion and miscarriage; they were found in 14 of 42 (33.3%) fetuses of Wassermann 4- mothers, and in 2 of 9 (22.2%) fetuses of Wass.[long dash]mothers, reaffirming that negative serology following antiluetic therapy is no assurance against congenital syphilis. Spirochetes were not found in fetal tissues before the 18th wk. of gestation, i.e., in the abortion period; the incidence rose from 10% in the first 1/2 of the miscarriage period to 50% in the latter 1/2, with the highest incidence (66.7%) in the 26th wk. It is concluded that the Langhans layer of chorionic epithelium affords some protection to the fetus against maternal luetic infection and that it is only when these cells normally disappear after the 16th wk. that the spirochetes pass the placental barrier. Although there is apparently some natural protection of the fetus against syphilis during the 1st 17 wks. of pregnancy, Wass. + mothers must receive therapy before the 18th wk. if their fetuses are to be. guarded against syphilis, and both Wass. + and[long dash]gravida must have therapy before the 23rd wk. or 50% of their fetuses may be infected before viable.

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