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.