Management of STIs/RTIs
Chapter 9. STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period

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Vaginal discharge in pregnancy and the postpartum period

Vaginal discharge as a symptom or sign of RTI presents different challenges during pregnancy, because physiological changes during pregnancy can affect the normal microbiological environment (flora) of the vagina. For example, discharge may be more abundant and yeast infection is more common. Women with vaginal discharge should be carefully questioned and examined to make sure that the discharge is not an early sign of a more serious problem. For example:

• In early pregnancy, discharge may mask spotting or light bleeding that could indicate ectopic pregnancy, threatened abortion, or cervical cancer.
• A watery discharge in late pregnancy could be amniotic fluid from ruptured membranes.

A careful history and examination will usually provide clues that will help distinguish simple vaginitis from more serious conditions. When discharge is accompanied by bleeding, fever, abdominal pain or amniotic fluid leakage, the patient should be managed or referred for possible sepsis.

If pregnancy complications have been ruled out, all women with vaginal discharge should be treated for bacterial vaginosis, trichomoniasis and yeast infection. Yeast infection is very common during pregnancy and is often recurrent, so if a woman comes back with the same symptoms, she should be treated for yeast infection only.

 

Flowchart 9. vaginal discharge in pregnancy and postpartum period