Introduction
Vaginal discharge is a common gynaecological complaint among women
during their reproductive life and especially during pregnancy. Women
are usually unable to differentiate between normal and abnormal vaginal
discharge.1 Normal vaginal discharge or leucorrhoea is
thin, clear, or milky white fluid with mild odour. One of the earliest
signs of pregnancy is vaginal discharge that increases in amount
progressively and continues throughout the pregnancy. Changes in vaginal
discharge can begin as early as one to two weeks after the conception
and the discharge usually becomes more noticeable as pregnancy
progresses and becomes heaviest near the end of pregnancy. In the last
weeks of pregnancy, vaginal discharge contains thick mucus mixed with
streaks of blood, called “show.” This is an early sign of labour and
should not be the cause for alarm. Proper diagnosis and appropriate
management of vaginal discharge is based on the clinical examination and
laboratory investigations.2
Pathological vaginal discharge commonly occurs due to organismal
infections of vagina such as Bacterial vaginosis (BV), Trichomonas
vaginalis (TV) and Vulvovaginal candidiasis (VVC), which is also known
as “vaginal candidiasis” or “candidal vaginitis.”
These infections may lead to vaginal dysbiosis (abnormal vaginal
microbiota) during early stages of pregnancy which is commonly
associated with adverse pregnancy outcomes3 such as
pre-term birth.4 About a half of pregnant women withv aginal discharge experience pruritus (itching), malodour (very
unpleasant smell), dysuria (painful or difficult urination), and
dyspareunia (difficult or painful sexual
intercourse).5
Bacterial vaginosis (BV) is a common vaginal infection that is prevalent
in 15-30% pregnancies and its adverse pregnancy outcomes include
preterm labour and delivery, premature rupture of membranes (PROM),
amniotic fluid infections and postpartum
endometritis.6,7 Vaginal Candidiasis (VC) is a common
type of vaginal infection caused by overgrowth of Candida
species,8 which are part of the lower genital tract
flora present in healthy asymptomatic women.9 VC is a
gynaecologic disorder with a white vaginal discharge, vaginal pain,
difficult or painful sexual intercourse, irritation and itching. The
rate of VC is higher in women treated with broad spectrum antibiotics
and women who are pregnant and/or diabetic and have HIV/AIDS. Candida
albicans is the most common of vaginal Candida species followed by
Candida glabrata that cause vaginal Candidiasis among pregnant
women.10 Vaginal candidiasis may lead to pregnancy
complications such as abortion, premature birth, low birth weight and
other morbidities.6,8 BV, VVC and TV affect about 6%
women.11 These infections are associated with vaginal
discharge and particularly affect women of low socio-economic background
and low literacy level.6,7 Abnormal vaginal discharge
due to vaginal infections is also common during child bearing age.
Because of socio-psychological impacts and adverse maternal and foetal
outcomes vaginal discharge is an important public health issue, which
needs further research especially in women of lower socio-income
communities and those living in lower and middle income countries such
as Pakistan where pregnant women have a higher prevalence of candidiasis12,13 and other bacterial
infections.14
The objectives of this study were to differentiate between normal and
pathological vaginal discharge in pregnant women and to identify common
causes of and adverse pregnancy outcomes associated with pathological
vaginal discharge.