Stillbirth and Congenital Syphilis: Autopsy and Placental Findings of 11 Cases and Review of the Literature.

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Syphilis is a preventable and treatable disease, which continues to strike low-income countries and vulnerable populations in high-income countries. It is caused by T pallidum, a spirochete capable of traversing the placental barrier, with a high rate of fetal and placental infection. Congenital syphilis (CoS) has poor prognosis if left untreated. Autopsy and placental evaluation are important tools to diagnose this disease in the obstetric scenario, to reveal the correct cause of demise and prevent complications in future pregnancies. We describe the histologic findings of eleven feto-placental examinations of non-treated CoS with fetal hydrops and stillbirth. Fetal findings are variable, with hydrops, X-ray long bone metaphyseal bands and hepatic lesions as the most consistent autopsy findings. The combination of chronic and acute villitis/intervillitis is a common placental feature in CoS, and the presence of mixed inflammatory populations is a key to suspect treponemal infection. Mothers from vulnerable populations and with poor obstetric care also deserve increased efforts to rule out CoS as cause of death. This constellation of findings must lead to further testing with direct methods (PCR or tissue immunohistochemistry for T pallidum).