Carga global de aborto espontáneo y muerte fetal por sífilis gestacional no tratada: revisión sistemática de estudios de prevalencia

Abstract

Untreated gestational syphilis continues to be a preventable infectious cause of fetal loss, despite the availability of inexpensive diagnostic tests and effective benzathine penicillin. The objective was to systematically analyze the scientific evidence published between 2019 and 2026 on the prevalence of miscarriage and fetal death attributed to untreated maternal syphilis. A systematic review with narrative synthesis, reported according to PRISMA 2020, was conducted with PECO question and search in PubMed/MEDLINE, Embase, Scopus, Web of Science, LILACS, SciELO and Cochrane, in Spanish, English and Portuguese. Two independent review authors selected studies and risk of bias was assessed with JBI and Newcastle-Ottawa. 25 studies were included. The combined prevalence of stillbirth in pregnant women with syphilis was 5.02%, with high heterogeneity (I² = 90.67%); it rose to 11.69% with low treatment coverage and decreased to 2.81% with moderate-high coverage. In untreated women, fetal loss ranged from 21.4% to 26.4% and miscarriage to about 15%, while treatment before 28 weeks reduced fetal death to 0–2.4%. A large part of the adverse outcomes occurred in unscreened women. It is concluded that fetal loss due to syphilis reflects failures in the coverage and performance of health systems, not in therapeutic efficacy; universal screening in the first trimester, dual rapid tests, partner treatment, and continuous penicillin administration would prevent it.