Provider Adherence to Syphilis Testing Recommendations for Women with Stillbirth

Background: Syphilis infection during pregnancy can result in stillbirth; however, it is unclear what proportion of stillbirths are evaluated for syphilis. We aimed to assess overall adherence to CDC and ACOG recommended guidelines for syphilis testing among women who delivered a stillbirth and compared it to other tests recommended for stillbirth evaluation.

Methods: We used 2012-2013 MarketScan claims data with annual 40 million commercially-insured and 8 million Medicaid enrollees to estimate prenatal care and follow-up testing among women who had stillbirths in 2013. Stillbirth was identified if women had any ICD-9 codes related to stillbirth outcome (V27.1, V27.3, V27.4, V27.6, V27.7, 779.9, and 656.4). Among women with stillbirth delivery, we estimated the proportions of women who received prenatal care within 280 days prior to stillbirth, prenatal syphilis testing, and testing at the time of delivery (syphilis testing, complete blood count (CBC), placental examination and autopsy). These services were identified using CPT codes.   

Results:  We identified 3,731 Medicaid women and 6,096 commercially-insured women with stillbirths.  Approximately 73.2% and 65.5% of Medicaid women and 76.5% and 56.6% of commercially-insured women received prenatal care and prenatal syphilis testing, respectively. At the time of delivery, 6.5%, 61.5%, and 31.2% of Medicaid women and 9.3%, 58.0%, and 35.8% of commercially-insured women, received syphilis testing, placental examination, and CBC, respectively.  Autopsies were too low to be reported.

Conclusions:  Syphilis testing among women after stillbirth delivery is < 10%, illustrating limited adherence to the CDC and ACOG recommendations. Such a low syphilis testing rate may impact the number of congenital syphilis cases reported to the national surveillance system.  Our results re-emphasize the need to improve syphilis testing at the time of stillbirth delivery to improve diagnosis of syphilitic stillbirths, identify women with syphilis infection, and provide treatment to these women to avoid recurrence of syphilis-related adverse outcomes.