Intrauterine fetal death in adolescent pregnancy complicated by maternal syphilis: A case study in nursing

Abstract

Maternal syphilis during pregnancy remains a major risk factor for intrauterine fetal death (IUFD), particularly among adolescents. However, detailed case studies on this presentation remain limited in the current literature, underscoring the need to enhance nursing knowledge and clinical management in this case. A 15-year-old primigravida (G1P0A0) presented with an absence of fetal heart tones during a routine antenatal evaluation. Ultrasound examination confirmed IUFD with no detectable cardiac activity. Although a prior ultrasound had established a gestational age of 22 weeks and 2 days, current biometric measurements revealed an average ultrasound age (AUA) of 18 weeks and 3 days, with an estimated fetal weight of 287 g—suggesting severe early-onset intrauterine growth restriction prior to fetal demise. Serological testing confirmed active maternal syphilis, with a reactive Treponema pallidum hemagglutination assay (TPHA 1:2560) and Venereal Disease Research Laboratory test (VDRL 1:16), with no documented record of prior penicillin treatment. The patient subsequently underwent uncomplicated vaginal delivery of a stillborn fetus. Nursing assessments identified critical risks, including postpartum infection secondary to untreated maternal syphilis, postpartum haemorrhage following IUFD delivery, and psychosocial distress associated with perinatal loss. Accordingly, nursing care focused on monitoring for physiological complications, promoting adherence to penicillin, delivering comprehensive reproductive health and sexually transmitted infection (STI) education, and providing grief support. As learned in this case that integrating nursing care plans into antenatal and postpartum management is essential to improve quality of care, maternal coping mechanisms, and mitigate the risk of adverse outcomes in future pregnancies.

Keywords: Adolescent pregnancy, intrauterine fetal death, maternal syphilis, maternity nursing, nursing care