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Related Experiment Video

Updated: Feb 23, 2026

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Provider Adherence to Syphilis Testing Recommendations for Women Delivering a Stillbirth.

Chirag G Patel1, Jill S Huppert, Guoyu Tao

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Syphilis testing rates among women experiencing stillbirth were below 10%, indicating poor adherence to guidelines. Improving prenatal and delivery syphilis testing is crucial for accurate diagnosis and preventing adverse outcomes.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Infectious Disease Epidemiology

Background:

  • Syphilis infection during pregnancy can lead to severe adverse outcomes, including stillbirth.
  • Adherence to recommended syphilis testing guidelines is crucial for early detection and treatment.
  • Stillbirth evaluation guidelines include syphilis testing alongside other diagnostic procedures.

Purpose of the Study:

  • To evaluate adherence to Centers for Disease Control and Prevention (CDC) and American College of Obstetrics and Gynecology (ACOG) syphilis testing recommendations for women with stillbirth.
  • To compare syphilis testing rates with other recommended stillbirth evaluation tests.

Main Methods:

  • Utilized MarketScan claims data (40 million commercially insured, 8 million Medicaid enrollees annually).
  • Identified stillbirth cases between January 1, 2013, and December 24, 2013, using ICD-9 codes.
  • Assessed prenatal care, prenatal syphilis testing (within 280 days pre-stillbirth), and testing at the time of stillbirth (syphilis, CBC, placental exam, autopsy) using CPT codes.

Main Results:

  • Identified 3672 Medicaid and 6023 commercially insured women with stillbirths in 2013.
  • Prenatal syphilis testing was documented in 61.7% (Medicaid) and 66.0% (commercial) of women.
  • Testing at the time of stillbirth: syphilis (6.5% vs 9.3%), placental exam (61.6% vs 57.8%), CBC (31.9% vs 37.6%).
  • 34.6% (Medicaid) and 29.7% (commercial) had no syphilis testing documented prenatally or at delivery.

Conclusions:

  • Syphilis testing rates among women experiencing stillbirth were below 10%, indicating poor adherence to CDC and ACOG guidelines.
  • Low testing rates may lead to underdiagnosis of congenital syphilis and impact national surveillance.
  • Improved syphilis testing is essential for accurate stillbirth diagnosis, identifying maternal infection, and preventing syphilis-related adverse outcomes.