Syphilis of the placenta: The histologic examination of 1,085 placentas of mothers with strongly positive blood wassermann reactions

Abstract The histologic examination of syphilis was attempted on 1,085 placentas of women with strongly positive blood Wassermann reactions. The histologic examination of 679 placentas of live term babies, regardless of the treatment that the mother received during pregnancy, showed a positive or a negative diagnosis in 654. In only 25 was the diagnosis equivocal. The placentas of 63 dead term babies were studied. The diagnoses were positive or negative in 45 and doubtful in 18. There were almost as many doubtful diagnoses in 63 placentas of dead term babies as there were in 679 placentas of live term babies. The organisms of syphilis were found in 13 dead term babies in whom long-bone changes indicative of syphilis were present. One placenta was syphilitic, and one was not syphilitic. Eleven of the placentas were given doubtful diagnoses. In 2 dead term babies the organisms of syphilis were found: the roentgen ray examinations were negative. Both placentas were diagnosed negative. In 18 dead-term babies neither organisms nor long-bone changes were found (no roentgen ray examination was made of one baby). All the placentas were negative except one which was diagnosed premature and negative. Roentgen ray examinations of the long bones of 101 live term babies were made. Long-bone changes indicative of syphilis were present in 6 of the babies. The 6 placentas were negative. There were 3 doubtful diagnoses in these 101 placentas; all the others were negative. Roentgen ray examinations of the long bones were made of 54 dead term babies. The placentas of 22 babies with positive long-bone changes were examined. Six of the placentas were negative, 3 were positive; and 13 were doubtful. The placentas of the 32 babies in whom no long-bone changes were present were negative in 29; and doubtful in 3. The attempt to diagnose syphilis of the placenta of 78 premature live babies resulted in a doubtful opinion in 20 of them, again, nearly as large a failure as was obtained in the 679 placentas of live term babies. The diagnostic attempt on the placentas of 142 premature dead babies resulted in doubtful diagnoses in 82. There were 32 premature dead babies in whom the organisms of syphilis were found and the long-bone changes of syphilis present. The 32 placentas were examined. Eight were negative; 5 were positive; and doubtful diagnoses were made in 19. There were 6 premature dead babies in whom the organisms of syphilis were found, but no long-bone changes were present. Only one of these placentas was diagnosed positive; the other 5 were diagnosed doubtful. Roentgen ray examinations of the long bones were made of 25 premature live babies. Five of these showed positive long-bone changes. Two of the placentas were positive for syphilis, and 3 were diagnosed doubtful. There were no long-bone changes present in the other 20 babies. The placentas were negative in 17, positive in 1 and doubtful in 2. Roentgen ray examinations of the long bones were made of 126 premature dead babies. Eighty-one babies showed positive long-bone changes. The placentas were negative in 22, positive in 14 and doubtful in 45. There were no long-bone changes seen in the other 45 babies. The placentas were negative in 16, positive in 1, and doubtful in 28. A positive or a negative diagnosis of syphilis of the placenta was made in only 35 of the placentas of the 123 abortions studied. The placentas of 86 stillborn abortions, the mothers receiving no prenatal antisyphilitic treatment, were studied. Doubtful diagnoses were made on 58 of them. The placentas of 34 stillborn abortions, the mothers receiving either more or less treatment, were examined. Doubtful diagnoses were made on 28. There were only 6 mothers in the series of 123 abortions who received 7 or more prental antisyphilitic treatments. Both long-bone changes and the organisms of syphilis were found in 35 abortions. The placentas were examined and doubtful diagnoses of various kinds were made of 30. Organisms were found but no long-bone changes were seen in 2 aborted fetuses. Both placentas were diagnosed doubtful for syphilis. Roentgen ray studies were made of the long bones of 99 stillborn abortions. Sixty-six showed positive long-bone changes. A diagnosis of syphilis was made on only 3 of the 66 placentas. Seven of the placentas were negative: the other 56 were doubtful. There were 33 abortions in this group in which no long-bone changes were present. Fifteen of the placentas were negative; the rest were doubtful. Plass told me ten years ago that he believed that the antisyphilitic treatment of pregnant women had some definite influence on the histologic appearance of the placenta. This work seems to confirm that statement. The placentas of 272 mothers who received 7 or more treatments were examined. One placenta was positive. There were but 13 equivocal diagnoses in the group. The more distant from term, the greater is the difficulty in making a histologic diagnosis of syphilis of the placenta. Dead babies seem to increase this difficulty, regardless of the duration of the pregnancy.