Background:
Congenital syphilis has long been considered a “sentinel event” marker indicative of a community's public health capacity to control and monitor STIs during pregnancy. Much effort in the past has focused on identification of issues, barriers and contributory factors to the case of an allowed congenital syphilis. While prenatal care access has improved and syphilis in reproductive age women is at an all time low nationally, many states continue to note stagnant adverse birth and pregnancy outcomes, low birth weight rates that have not significantly improved and persistent prevalence of other STIs in reproductive age women.

Objective:
Examine the relevance of the classic sentinel event and explore the application of other data as a viable marker for the health of a community's pregnant and newborn populations.


Method:
Descriptive and bivariate analysis of morbidity data and birth record data for all reported STIs among pregnant and newborn populations of Florida for years 2000-2005, linked to vital statistics birth data. The findings were then examined as predictors of components of the classic sentinel event process evaluation.

Result:
2.5% of all births were associated with an STI during gestation or at delivery; very few women had less that 10 prenatal care visits; the primary factor was a failure to screen during pregnancy for STIs; pooled STI data were more indicative of health care delivery system gaps than congenital syphilis data alone.

Conclusion:
This analysis suggested a much wider involvement of STIs in pregnancy outcomes than can be attributed to the rare event of syphilis during pregnancy. The use of pooled STIs in pregnancy is a more relevant and acceptable marker of problems to community health care providers.

Implications:
Nationally STD programs should explore an “expanded sentinel event” definition and revised outcome measure for the pregnancy associated with an STI and implication for local regulation or laws.