Discharge in pregnancy

Vaginal discharge occurs more frequently during pregnancy due to:

• higher estrogen production,
• the increased blood flow to the vagina.

This discharge consists of:

• white blood cells, which serve to protect the vagina from viruses and bacteria. To penetrate into the uterus from the outside, it is necessary to pass through the vagina,
• normal bacterial flora,
• Secretions from the cervix.

When should a doctor be informed?

It is important to know that a woman can have different types of discharge. It should have a certain color and texture and a certain smell:

1. Milky color
2. Fluid
3. Odourless or with only a slight odour.

When is it not okay:

• Abundant thin and clear discharge can be amniotic fluid.
• Before the 37th week of pregnancy, if the discharge is watery or mucous and bloody discharge develops, even if it is only slightly pink or brownish tinged. This may be a sign of premature birth.
• If the color is pink, brownish, yellowish, greenish or gray, there may also be an infection (for example, by yeast fungi).
• When whitish discharge is accompanied by itching or burning.
• If it has a fish-like foul smell

If in doubt, a doctor or midwife should be contacted.

Yellowish or greenish discharge

Generally, yellowish or greenish discharge is triggered by an infection or sexually transmitted disease.

In the sexually transmitted disease called trichomoniasis, the discharge is:

• Yellow or green
• Frothy
• Malodorous

Other possible symptoms of trichomoniasis are found on the vagina and consist of:

1. Reddening
2. Irritation
3. Itch

There may be pain during urination or during sexual intercourse.

Gonorrhea is a sexually transmitted disease that causes:

• Yellowish secretion
• Bloody discharge
• Burning sensation during urination
• Abdominal pain

A chlamydial infection is a bacterial infection that is often asymptomatic, but it can cause:

• Vaginal discharge
• Burning sensation during urination
• Abdominal pain

Chlamydia can cause pelvic inflammatory disease if the infection spreads to the genitals or rectum.

In this case, the symptoms are:

1. Backache
2. Nausea
3. Fever
4. Bloody discharge

Red discharge in pregnancy

At the beginning of pregnancy, there is often some bloody discharge because the uterus is not yet fully occupied by the fetus.

However, this can also indicate an internal abortion (the embryo dies in the uterus but is not expelled because the cervix does not open), which can only be diagnosed with an ultrasound examination.

In the first trimester (and sometimes after), red discharge may occur at the normal time of menstruation.

As a rule, this discharge includes smaller amounts than during the menstrual cycle.

These secretions (incorrect menstruations) are due to:

1. Hormonal imbalance in the body.
2. The uterus is not completely occupied by the embryo or fetus.

Cardioaspirin or baby aspirin (anticoagulant drugs that prevent platelet coagulation) may favor the occurrence of vaginal bleeding.

A woman may need this medication to prevent:

• Placental detachment
• Preeclampsia
• Miscarriage
• Growth retardation in the child

If the patient regularly suffers from bloody discharge, the gynecologist usually recommends interrupting the intake.

In the second and third trimesters, bright red discharge may be a sign of:

• Opening of the cervix (risk of premature birth).
• Placental abruption.
• Uterine polyps (usually benign structures).
• ectropion (a non-serious health problem consisting in the displacement of a special type of epithelium of the cervix from the inside to the outside of the cervix).

However, bloody discharge should never be underestimated, especially if it occurs massively and the abdomen or abdomen feels hard.

Red discharge can also occur for these reasons if the woman uses progesterone suppositories to favor the implantation of the embryo in the uterus.

Bloody vaginal discharge, when to worry?

One should go to the emergency room immediately if:

• The blood flow becomes stronger or remains constant.
• The uterus is hard and hurts.

In these cases, there is a risk of miscarriage.

In some cases, normal bloody discharge may occur due to the bursting of a capillary vessel (without risk to the child):

1. During sexual intercourse.
2. After a difficult bowel evacuation (in case of constipation) due to the pressure that the intestine exerts on the uterus.
3. During an examination by the gynecologist. Many women think that a transvaginal ultrasound could be dangerous for the child. In truth, there are no risks and they can have the examination carried out with peace of mind.

Most often, strong blood discharge is caused by:

• Placenta previa
• Premature birth
• Miscarriage

White discharge in pregnancy

Loss of mucus plug during pregnancy
This is a dense and gelatinous liquid of milky-white color, secreted by the glands of the cervix.
The mucus plug protects the uterus, fetus and amniotic sac from infection.
You can lose it, but that’s not a reason to go to the hospital. It does not pose a problem because the body creates a new mucus plug.
The discharge is filamentous and abundant.

You can lose the plug:

1. Complete and at once
2. First the outer layer and then the inner layers

If there are slight traces of blood or old blood residues in the mucus plug, there is no need to worry. However, you should visit an emergency room if:

• There is a lot of blood
• The plug is yellow, because this could indicate an infection

Infections
If one notices a thin white or gray discharge with a fishy odor, it may be another type of vaginal infection called bacterial vaginosis.

A cream cheese-like vaginal secretion is a symptom of vaginal candidiasis.
Unfortunately, this is a frequent companion of pregnant women.
The moist and warm environment that arises with abundant vaginal discharge and that forms at
the beginning of pregnancy is an ideal breeding ground for fungal infections.
The future mothers may feel burning or itching in the vulvar and vaginal area, which worsens:

• In the 24/48 hours after sexual intercourse (may also come from the vagina)
• In the shower
• During sporting activities

Watery discharge in pregnancy

It is not easy to distinguish normal discharge during pregnancy and involuntary loss of urine from amniotic fluid.
The amniotic fluid protects the child from being pressed against the pelvic bone and from bacteria and cold.

Theoretically, the amniotic fluid looks like normal water. It’s:

1. Odorless
2. Colourless
3. Liquid, i.e. not viscous or sticky

Some women, on the other hand, claim it smells like bleach.
Obstetricians and gynecologists explain that in this case, the discharge persists continuously for a longer period of time, while normal discharge (white or watery) occurs intermittently.

The recommended procedure is:

• Go to the toilet to urinate.
• Use an absorbent (the panty liner is not suitable) and check after 2 hours.
• If it is wet, change the absorbent.
• Check again after another 2 hours. If it’s still wet, it’s probably amniotic fluid and you should go to the emergency room.

Bursting in the lower part of the amniotic sac causes very strong discharge as when urinating, but if the crack occurs in the upper area, the discharge is small.

There are tests available in the pharmacy, so-called amniocentesis, which are based on the pH value of the discharge.

Amniotic fluid has a pH of over 6.5.

This test contains:

1. A bandage with a test strip
2. A plastic container.

You wear the bandage until it gets wet, then pull out the test strip and put it in the plastic container.
After 10 minutes, check the color of the test strip. If it is blue or green, one should contact a gynecologist or go to the hospital, as it could be amniotic fluid or the woman could be suffering from an infection.
Many pharmacies do not sell this test, but you can also buy it online.

When the amniotic sac bursts, childbirth could be initiated or the doctor could decide what is best to do depending on the week of pregnancy.

Brown discharge in pregnancy

Brown discharge may be caused by:

1. Blood residues that have remained in the uterus and are excreted by the body. The brownish color comes from oxidation, which is a natural process. It does not cause any other signs or symptoms.
2. Implantation bleeding occurs a few days before the usual date when menstruation usually begins. This phenomenon is normal and should not be a concern, provided that the discharge is only mild and stops within 24/48 hours.
3. Extrauterine or ectopic pregnancy, the embryo does not implant in the uterus, but develops in another organ (for example, in the fallopian tube). Symptoms include brownish or bright red discharge, mostly unilateral abdominal pain and nausea.
4. Molar pregnancy, in which the embryo does not develop, but the placenta, uterus and ovaries swell. Symptoms include red or brown discharge, vomiting, and high blood pressure.
5. A genital wart (or papilloma) can cause bloody discharge, white secretion, burning and itching.
6. After sexual intercourse or a visit to the gynecologist with a transvaginal ultrasound examination, there may be brown or red discharge due to a small injury to the cervix.

Vaginal discharge in the first trimester of pregnancy

In the first trimester, the appearance of low discharge is normal.

Leucorrhea in pregnancy
In the first, second, and third months of pregnancy, the body can produce milk-like discharge called leucorrhea, which is difficult to distinguish from normal mucus that occurs during ovulation.

If this type of discharge occurs and you think you are pregnant, you should avoid the following activities:

1. Too intensive washing, because this can change the bacterial flora of the vagina.
2. Treat a yeast infection independently.
3. The use of tampons or vaginal contraceptives, because these increase the risk of infection.

Implantation bleeding during pregnancy
Another type of discharge can be seen in the first days and weeks of pregnancy, also called spotting.
Implantation bleeding occurs due to detachment of the endometrium
(lining of the uterus).
Dark red or brown spots may appear in the briefs when the fertilized egg (blastocyst) implants in the uterine wall.
This occurs about 10 to 14 days after conception.

Difference between implantation bleeding and menstrual bleeding: Implantation bleeding:

• Occurs a few days before the scheduled time of the cycle (one week after the expected time of ovulation).
• Is less plentiful,
• Lasts a maximum of one or two days.
• Nidation bleeding usually shows up as a small patch or streak, but not like a blood flow.
• If the discharge is pink or red, it means that it has appeared fresh.
• Brown discharge may indicate that it had already formed a few days before or even earlier.

Discharge in the second trimester of pregnancy

In case of bloody discharge in the second trimester, one should consult a gynecologist, because he could indicate a problem.
Nevertheless, red stains in underwear can be normal and harmless if:

1. The discharge is not abundant (for example, some women have a slight discharge at the usual time of the cycle in the first 5 months).
2. The woman does not feel abdominal pain or other symptoms.

Causes of pathological discharge in the second trimester:

Placental abruption: It is a serious health problem and the woman must go to the emergency room immediately.

Placental detachment is characterized by:

• Strong bloody discharge
• Abdominal pain

Depending on the week of pregnancy and the severity of the detachment, the doctor may advise premature induction of childbirth or absolute rest.

Placenta previa: A bloody discharge at the beginning of the second trimester can be caused by placenta previa, i.e. a slipping of the placenta downwards.
Placenta previa may recede on its own in the following months, but can also lead to placental abruption.

Discharge in the third trimester of pregnancy

The likelihood of mild bloody discharge is increased by:

• Increased blood flow towards the end of pregnancy
• Fragility of capillaries

In the third trimester, bloody discharge may occur for the same reasons as in the second trimester:

• Placenta previa
• Placental detachment

However, it could also occur due to premature birth.

Watery discharge can be caused by the bursting of the amniotic sac if it is not very abundant.

What should you do? Therapy for vaginal discharge during pregnancy

With yellowish discharge, the gynecologist makes a vaginal smear. This examination consists in the recording of secretions with a cotton swab for analysis in the laboratory.

Bacterial vaginosis
Sometimes bacterial vaginosis passes on its own. If the woman is in the first trimester, the doctor may wait for the second trimester for treatment.
As a rule, a course of treatment with antibiotics is prescribed, for example, metronidazole or clindamycin.
Before taking any medication during pregnancy, it should be consulted with the doctor.

Vaginal candidiasis
The gynecologist prescribes vaginal suppositories or douching against Candida infection.

Beta-hemolytic streptococci
In general, as a precaution, a smear is taken one month before birth, the examination can be done in the rectal area.

During childbirth, this bacterium can cause:

• A conjunctivitis
• A respiratory infection

Prevention of discharge in pregnancy

One can try to prevent vaginal infections by keeping the genital area dry and not restricting air circulation.

Some behaviors that are useful:

• Wear cotton underwear that allows the genital zone to “breathe”.
• Shower prefers to a bath and use a mild soap for the genital area. Avoid bubble baths or perfumed products.
• Never use intimate sprays or deodorants.
• Do not sit down in a damp swimsuit.
• After showering or swimming, dry the genital area well before putting underwear and clothes back on.
• Avoid sugar, fast food and processed products.

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