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.