Complete Resolution of Nonimmune Hydrops Fetalis Secondary to Maternal Syphilis Infection

Abstract

Maternal syphilis infection is a common infectious cause of nonimmune hydrops fetalis. Generally, hydrops fetalis is equated with poor prognoses in affected pregnancies. A 38-year-old G5P2114 presented at 28 ^5/7 weeks' gestation with newly diagnosed primary syphilis infection, sonographic findings of hydrops fetalis, and elevated middle cerebral artery Dopplers concerning for fetal anemia. Following treatment with intramuscular penicillin, the symptoms of hydrops fetalis were resolved and our patient delivered a healthy male neonate with no signs of congenital syphilis at the time of delivery. Routine and early testing for syphilis is an important component of prenatal care. Though not previously documented, the secondary findings of suspected fetal syphilis may be able to completely resolve in utero with penicillin treatment.

Keywords: early testing; fetal syphilis; hydrops fetalis; maternal syphilis; penicillin.

Fig. 1

Initial presentation on hospital day (HD)1 with pleural effusion ( A , arrow ), ventriculomegaly ( B , arrow ), enlarging fetal ascites ( C ), and elevated middle cerebral artery (MCA) Dopplers ( D ), compared with resolution of pleural effusion ( A ), ventriculomegaly ( B ), fetal ascites ( C ), and normalized MCA ( D ) Dopplers on HD8.