Adverse maternal, pregnancy and neonatal outcomes
associated with vaginal discharge
Our findings revealed statistically significant higher proportion of
women with pathological vaginal discharge with adverse maternal,
pregnancy and neonatal outcomes. The adverse maternal outcomes were
irritation and pain and uterine contractions and post-partum
endometritis and the adverse pregnancy outcomes were premature membrane
rupture, abortion and pre-term delivery.26 The adverse
neonatal outcomes significantly associated with pathological vaginal
discharge were low birth weight, low Apgar score at birth, respiratory
distress syndrome, intensive neonatal care hospitalisation and early
neonatal death. Our findings thus provide empirical evidence that
pathological vaginal discharge in pregnant women is a serious maternal c
health issue, which needs through clinical examination, laboratory
investigation and relevant medical treatment and appropriate advice to
pregnant women.22 These approaches especially
laboratory investigation for confirmation of infection and abnormal
vaginal micro biota should be the main part of routine antenatal care
practices in developing countries like Pakistan, because the management
only on the basis of signs and symptoms will not give proper cure and
there will be increased opportunities for taking unnecessary multi drug
regimes. It is therefore imperative that pathological vaginal discharge
is differentiated from normal vaginal discharge so that appropriate
treatment for the particular type of pathogenic infections is prescribed
to improve women’s health and pregnancy outcomes, while the women with
physiological vaginal discharge could be counselled, assured and advised
for good personal hygiene habits and avoidance of unnecessary
medication.
Strengths and limitations
This study contributes in the body of knowledge by providing empirical
evidence on the prevalence of normal (physiological) and abnormal
(pathological) vaginal discharge in pregnant women and a number of
adverse maternal, pregnancy and neonatal outcomes associated with
pathological vaginal discharge in pregnant women in low and middle
income settings and countries like Pakistan.
However, our study has a few limitations, which include convenience
sampling, and lack of data on participant’s education level and economic
and employment status. It may be pertinent to state that there are no
universal, mandatory and systematic antenatal screening appointment
programme and facilities in Pakistan. It is therefore up to the pregnant
woman and her family to seek an antenatal check-up, which depends on
their choice but mostly on their income level. Women from affording
families and higher income mostly go to the private practitioners and
hospitals for antenatal check-up while women of poor families and low
income commonly visit outpatient antenatal clinics in government
hospitals. We therefore used the convenience sample because it was the
most suitable sampling methods12 in the setting this
study was undertaken i.e. outpatient antenatal
clinics.12,13
We could not get information on the participating women’s education
level and economic and employment status. However, most of patients
including pregnant women who attend outpatient clinics in Pakistan
belong to families who are mostly poor and have low level of education.
In addition, our hospital serves patients from a waste catchment area of
rural area where the majority of people are poor, less educated and
involved in agriculture.23 Low literacy and low income
along with unemployment could be risk factors of poor personnel hygiene
often associated with vaginal infections in pregnant
women.6,7 Because of these limitations, the
generalisability of our findings might be limited.