Download het volledig rapport (302 p.) - KCE

More documents

Recommendations

Info

<strong>KCE</strong> reports vol. 6A Prenatale zorg 152 Study Ref Populatio n PHLS CDSC and PHLS Syphilis Working Group, 1998 4 [453] N/A Treponemal tests: TPHA, FTA-Abs, EIAs Intervention Outcome Results Comments Study s type testing present. If TPHA is used for screening, then EIA can be used as the confirmatory test Non-treponemal tests: RPR, VDRL Further evaluation of immunoblotting as confirmatory test is needed EIAs: over 98% sensitive, over 99% specific All treponemal tests sensitive at all stages of syphilis (except early primary syphilis) 98% and 98% to 99% specific May result in false negatives, particularly in very early or late syphilis, in patients with reinfection or who are HIV positive Predictive value of these tests is poor when used alone in low-prevalence populations This information is from a report to the UK National Screening Committee (unpublished) Wat are the available interventions for managing women who are infected with syphilis? Study Ref Population Intervention Outcomes Results Comments Study Walker, 2001 Hashisaki et al., 1983 4 [462] Pregnant women with a confirmed diagnosis of syphilis, with and without concomitant HIV infection Cochrane review, most recent update 2001 4 [465] Pregnant woman with history of allergy to penicillin diagnosed with primary syphilis To determine the most effective antibiotic treatment regimen of syphilis Two successive course of erythromycin therapy Maternal resolution of clinical symptoms, miscarriage, stillbirth, neonatal deaths, and congenital syphilis Efficacy of erythromycin treatment No RCTs identified Available evidence is insufficient to determine the optimal penicillin regimen Failure to cure infection. Subsequent successful treatment with penicillin after desensitisation EL SR 4 EL type SR 1a CR 3
<strong>KCE</strong> reports vol. 6A Prenatale zorg 153 Do these interventions improve maternal and perinatal outcomes? Study Ref Population Intervention Outcomes Results Comments Study Alexander et al., 1999 Watson- Jones et al., 2002 4 [463] 4 [464] 448 were diagnosed with syphilis from 28,552 women who delivered at a hospital in Texas, USA, from September 1997 to August 1989 1688 pregnant women at an antenatal clinic in Tanzania from Treatment with 2.4 million units of intramuscular benzylpenicillin (penicillin G) for primary, secondary or early latent syphilis and 7.2 million units of intramuscular benzylpenicillin for women with late latent syphilis (over 3 weeks) Treatment with single dose benzylpenicillin in women with a positive RPR. Screen for syphilis. Syphilis status of child 340 diagnosed antenatally Pregnancy outcomes (stillbirth, IUGR or preterm birth and Treatment prevented congenital syphilis in all 27 maternal primary and 136 maternal late infections Congenital syphilis prevented in 100/102 in maternal early latent infection group 4/75 treatment failures in maternal secondary syphilis group 2 congenital syphilis cases stillborn Overall, a 98.2% success rate for preventing congenital syphilis No significant differences in adverse pregnancy 108 were diagnosed postpartum and therefore not included in the study group Women screened (RPR and VDRL) for syphilis at first prenatal visit, 28 to 32 weeks prenatal visit and at delivery (confirmed with microhaemagluttinin assay) Clinical stage assigned by clinical examination of dark field microscopy EL type CH 2b CH 2b
Page 1 and 2:
NATIONALE RICHTLIJN PRENATALE ZORG:
Page 3 and 4:
Nationale richtlijn prenatale zorg:
Page 5 and 6:
KCE reports vol. 6A Prenatale zorg
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132: KCE reports vol. 6A Prenatale zorg
Page 181: KCE reports vol. 6A Prenatale zorg
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
This page is left intentionally bla
Page 301:
KCE reports 1. Effectiviteit en kos
show all

Download het volledig rapport (302 p.) - KCE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?