Introduction
Vaginal discharge is a common gynaecological condition among women of childbearing age that requires care. Pathological vaginal discharge can cause complications in pregnant women and the new born. Complications in the pregnant women such as Threatened preterm, premature rupture of membranes (PROM), Preterm labour, chorio-amnionitis and post-partum endometritis.
Complications in new born are prematurity, low birth weight, respiratory distress. normally there is increased cervical secretions and vaginal transudate during pregnancy due to increased vascularity and hyper estrogenic state. Vaginitis due to candida albicans is relatively more common than other organisms most commonly patient presents with vaginal discharge, foul smell, itching, lower pain abdomen and rarely fever. Asymptomatic colonization of organisms requires no treatment. Hence screening is not recommended routinely. However symptomatic patients require prompt treatment.
Aim and Objective
To determine the prevalence, pattern and risk factors associated with clinico-pathological discharge and its complications.
Materials and Methods
A prospective study was done from January 2019 to August 2019 in department of OBG at Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka. The study included all pregnant women with vaginal discharge.
Patients with vaginal discharge evaluated with the following
Result
Total of 100 women attending antenatal clinic with white discharge were studied.
Total no of cases-100. Total no of asymptomatic patients - 70 and symptomaticpatients- 30.
Age distribution
Out of 100 pregnant women 22 were </= 20 years of age, 40 were between 21 to 25 years of age, 26 were between 26 to 30 years of age and 12 were between 31 to 35 years of age.
Out of 100 pregnant women who developed Vaginal discharge , 58 (58%) were primigravida and 42 (42%) were multigravida.
Risk factors
Out of 100 patients there were 76 from low socioeconomic status risk group, 14 were from urinary tract infection risk group, 47 were from anaemia risk group, 9 were from diabetes risk group and 10 were from vaginal discharge in previous pregnancy.
Table 1
| Risk Factors | Number of Pregnant Women |
| Low socioeconomic | 76 |
| Urinary tract infection | 14 |
| Anemia | 47 |
| Diabetes | 9 |
| Vaginal discharge in previous pregnancy | 10 |
Incidence of vaginitis in symptomatic patients: Out of 30 (30%) symptomatic patients there were 23 (76.6%) Vaginal Candidiasis, 6 (20%) Bacterial Vaginosis and 1 (3.3%) Trichomoniasis.
Out of 30 (30%) symptomatic patients there were 8 (26.6%) developed threatened Preterm, 6 (20%) PROM, 2 (6.6%) Preterm delivery.
Discussion
In our study Vaginal discharge affected 30% of the women. A higher prevalence of vaginal discharge during pregnancy was seen in women younger than 24.
Risk factors associated were young age, low socioeconomic condition, vaginal discharge in a previous pregnancy, anemia and urinary infection.
Hence timely detection and prompt treatment helps to avoid maternal and perinatal morbidity and improves the pregnancy outcome.
In other study
In a cross sectional study conducted by Tania Maria and et al1 in the city of Rio Grande, 2,395 pregnant women were included in the study.
The prevalence of vaginal discharge during pregnancy was 43% among all women studied. About 20% were adolescents (younger than 20), 44% were primiparous and 11% reported pathological vaginal discharge in a previous pregnancy.
Pathological vaginal discharge during pregnancy was significantly associated with the following variables: maternal age; vaginal discharge in a previous pregnancy (84%); diabetes (45.3%) and urinary infection (54.2%).
In a study conducted by Sanusi Mohammed Ibrahim and et al2 in the University of Maiduguri Teaching Hospital, Nigeria. 800 pregnant women were studied.
Vaginal discharge in pregnancy is common, but distinguishing abnormal vaginal discharge from normal leucorrhoea of pregnancy is challenging. Since findings have showed that the trio of vaginal candidiasis, trichomoniasis and bacterial vaginosis are common causes of abnormal vaginal discharge in pregnancy; efforts must be made to exclude these conditions in pregnant patients presenting with vaginal discharge so that appropriate treatment can be instituted timely.
Of the 400 patients with abnormal vaginal discharge, the commonest microorganism found was C. albicans, 160 (40%), whereas N. gonorrhoea infection was the least, 1(0.2%). E. coli was isolated in 20 (5%), T. vaginalis in 7 (1.8%), Staphylococcus aureus in 36 (9%), Klebsiella species in 8 (2%), G. vaginalis in 68 (17%) and Streptococcus species in 8 (2%) of the pregnant women. Samples from 92 (23%) patients had negative culture.
The high prevalence observed in this study of infections such as candidiasis, trichomoniasis, and bacterial vaginosis in pregnant women emphasizes the need to adopt effective strategies for their early detection associated with a reinforcement in the measures for prevention and treatment of both women and their partners.
In this study only the discharge among pregnant women and the organisms responsible for vaginal discharge has been studied.
Conclusion
Pathological vaginal discharge in pregnant women is found to be most common in younger age group and in primigravida.
Strong association has been found between pathological vaginal discharge and threatened preterm, PROM and prematurity.
Our study concludes the need for timely detection and advise on good hygiene habits and intervention in the form of medical management and prevention of complications.
