Syphilis in pregnancy: a medical audit in a rural district.

A medical audit was performed in Umzingwane District, Zimbabwe, to assess the quality of antenatal care in 1991 regarding detection and management of syphilis. Two thousand one hundred and sixty one women booked for antenatal care, 1433 (66 pc) received a RPR test result, 197 (14 pc) tests were positive. In 32 (16 pc) of the 197 RPR positive women the outcome of the pregnancy could not be established. Of 165 women 111 (67 pc) received adequate treatment for syphilis. A perinatal mortality rate (PNMR) of 173/1,000 was associated with inadequately or not treated RPR positive mothers and a PNMR of 21/1,000 with RPR negative and untested mothers (odd's ratio = 9.9; 95 pc confidence interval 3.8-24.9, p < 0.001). It is estimated that only 42 pc of all pregnant women and 24 pc of the couples with syphilis in 1991 were treated adequately. Recommendations are made to improve the quality of surveillance of syphilis in pregnancy in a rural district.