Session 2 Management of Syphilis in Pregnancy.pptx

Care and management of syphilis in pregnancy

1. Care & Management of Syphilis in Pregnant Women Classroom Training of Medical Officer for STI/RTI services

2. Session Objectives By the end of the session, the participants will understand: Care of Syphilis In Pregnant Women

3. Newer Four Prongs: EVTHS under NACP-V Prongs Prong 1 Prong 2 Prong 3 Prong 4 HIV Primary prevention of HIV, especially among women of reproductive age-group Prevention of unintended pregnancies among WLHIV Prevention of vertical transmission of HIV & Syphilis during pregnancy and childbirth Provision of care and management services for infected women & their exposed/ infected children during post-natal and breastfeeding period Syphilis Primary prevention of syphilis, especially among women of reproductive age-group Partner Management There are 4 prongs, but our concern here is Prong 4

4. Syphilis in Pregnancy Syphilis can be transmitted from an infected pregnant woman to her child during pregnancy and labour. Congenital Syphilis infection is associated with various adverse birth outcomes including: early foetal loss stillbirths neonatal deaths low birth weight prematurity and transmission of infection to the infant Image source: https://images.app.goo.gl/AVpGGNozsZyt3BY17 Congenital syphilis is a se r 4 i 6 o 6 us but preventable disease Generated from eOffice by SUMAN SEHRAWAT, BSD-CONSULTANT(SS)- NACO MOHFW, CONSULTANT, DOHFW DEPARTMENT on 20/10/2023 03:23 PM 3363728/2023/BSD

5. Care of Pregnant women with Syphilis infection Classroom Training of Medical Officer for STI/RTI services

6. Syphilis Testing in pregnancy Syphilis testing in pregnancy by: Dual RDT test kits at screening sites RPR/ VDRL test kits at confirmatory sites Direct-in labour cases should be screened by RPR/ VDRL or Dual RDT test kits Criteria for repeating Syphilis test at 32nd-36th weeks of pregnancy and during labour in pregnancy: Syphilis Seronegative W omen who: Live in areas with Syphilis sero-positivity more than 1% among pregnant women Are “A t-risk” for Syphilis Whose partners were not tested/treated, need repeat testing in labour room Have history of repeated abortions / stillbirths/ premature delivery/neonatal deaths

7. Treatment Monitoring of Syphilis in Pregnancy Complete Treatment of Syphilis: Three doses of with Inj. BPG, with 2.4 million IU, one dose once a week R epeat testing for Syphilis: after 12 weeks of treatment or at 32 weeks of pregnancy or during labour (whichever is earlier) Successful Treatment defined as fourfold reduction in titers, equivalent to a change of two dilutions [e.g., from 1:16 falls to 1:4] Treatment Failure: titer values persist at the same level or increase after 12 weeks and repeat three doses of Inj. BPG over 3 weeks need to given 7

8. Follow up on all Syphilis Reactive cases All the pregnant women screened reactive for Syphilis need tracking to ensure completion of Syphilis treatment and further follow-up for response to treatment The treatment response should be monitored at 12 weeks after treatment, or at 32 weeks of pregnancy or during labor (whichever is earlier) at DSRC/treatment facility If RPR/VDRL titer values persist at same level or increase after 12 weeks, treatment failure/ reinfection can be suspected. In this care complete treatment to repeated 8

9. Women Presenting Directly in Labour Pregnant women presenting directly in labor should be screened for HIV and Syphilis Screening for Syphilis done using the available RPR/VDRL or Dual RDT kits in labour room Woman screening reactive for Syphilis, should receive complete treatment for syphilis First dose of injection BPG should be given while in hospital (if available) The woman should be referred to DSRC for further management Responsibility: Labour room nurses 9

10. Messages for Syphilis infected mother Counselling messages for her would be: Linkage to EVTHS programme Protected sex practices to avoid HIV or STI infection, throughout pregnancy and breastfeeding Nutritional counselling aimed at taking ‘a balanced diet’ during pregnancy and breast feeding Iron, folic acid and calcium supplementation throughout pregnancy and breast-feeding Institutional delivery for interventions during labour and delivery Repeat testing at 3 months after treatment, or in 3rd trimester or during labor (whichever is earlier) at DSRC/treatment facility Her baby to be referred to SNCU/ NICU/ paediatric treatment facility soon after birth, for evaluation and management by paediatrician RPR/VDRL tests of baby and mother at birth Her baby to be kept under follow up till 6 months of age (visits at 14 th week & 6 month) under a paediatrician

11. Thank You Classroom Training of Medical Officer for STI/RTI services