Nonimmune hydrops fetalis due to congenital syphilis associated with negative intrapartum maternal serology screening

Zalman Levine, David M. Sherer, Adam Jacobs, Ohad Rotenberg

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


We present an unusual case, in which a woman presenting with markedly decreased fetal movements at 29 weeks gestation following a recent increase in fundal height was noted sonographically to have fetal hydrops consisting of scalp edema, marked hepatomegaly, ascites, and polyhydramnios. No lethal structural congenital anomaly was noted. Admission laboratory examinations revealed a negative antibody screen and a negative RPR. Emergent cesarean section was performed due to prolonged fetal bradycardia during biophysical profile testing. The acidotic hydropic neonate weighing 1825 g was resuscitated yet succumbed at 3 hr of life following intravenous administration of antibiotics. Neonatal blood was RPR positive at 1:16. Postmortem pathology examination demonstrated severe multiorgan system failure secondary to over-whelming congenital syphilis. Extensive extramedullary hematopoiesis was noted and histopathology with Dieterle stains revealed numerous hepatic spirochetes. Postpartum reexamination of the maternal blood with serial dilutions revealed a positive RPR at 1:1024. This case emphasizes that initial negative screening for syphilis may be seen despite overwhelming infection, a condition that has been termed the 'prozone effect'.

Original languageEnglish (US)
Pages (from-to)233-236
Number of pages4
JournalAmerican Journal of Perinatology
Issue number4
StatePublished - Apr 1998


  • False- negative syphilis screening
  • Fetal distress
  • Nonimmune hydrops fetalis
  • Prozone phenomenon
  • Syphilis
  • Ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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