Written by Dr.M.D.Mazumdar, MD

Once you are pregnant, you may notice that your vaginal discharge has increased. The discharge may be thick or thin, scanty or profuse.

Sometimes, you may find a little thick mucus sticking to your panties. Or the discharge may be so much as to make your panties wet and you you may need to use vaginal pads for protection.

Increase in the amount of vaginal discharge in pregnancy is perfectly normal especially in early pregnancy .

The high level of estrogen necessary to maintain pregnancy stimulates the glands in the cervix. These respond by producing more mucous.

The glands in the walls of the vagina also responds to the circulating hormones to secrete fluids to keep the vagina wet and lubricated. These can leak out to some extent as vaginal discharge.

Vaginal secretions may be safely ignored unless there are certain signs of abnormalities. Look at your secretions carefully - What colour are they? White or creamy? Or are they brown, red, greenish or blackish? The color of the vaginal discharge is an important indicator of infection.

Is there any smell - a foul or a fishy odour? Is there any associated itching? Is your vagina or other parts of the external genital organs red and swollen?

If you notice any of these conditions, visit your gynecologist for a checkup. You may be suffering from infections that can affect your baby. Or if your discharge is dark brown, red or blackish, there may even be blood mixed with your discharge.

Dark Brown / Red vaginal Discharge in Pregnancy

A reddish or brownish colour usually mean the presence of blood in the discharge and indicates bleeding somewhere in the reproductive tract. A red colour points to fresh blood while a brown colour means old denatured blood.

The causes of bleeding in pregnancy is different in early pregnancy and in late pregnancy

A. Bleeding in Early Pregnancy

• Abortion: In early pregnancy, the commonest cause is impending abortion. Most abortions start with the leaking of blood from the uterus. An ultrasonography will tell your doctor if your baby is all right. Immediate treatment may even keep your pregnancy safe and sound.

• Cervical Erosion: Cervical Erosion or Entropion occurs at the mouth of the cervix due to changes in the cervical cells in response to the high estrogen level in the blood. It is a harmless condition and generally clears up spontaneously within 3 months after childbirth. The pregnancy is not affected.

• Cervical Polyp: A cervical polyp is a small benign growth at the mouth of the cervix. It is harmless but can sometimes bleed in pregnancy.

• Cervical Varicosity: The cervix can develop varicose veins due to engorgement of the veins at its mouth. Engorgement occurs due to enlargement of the veins during pregnancy.

B, Bleeding in Late Pregnancy

In late pregnancy, there are three main causes of bleeding.

• Placenta praevia : In placenta previa, the placenta is positioned abnormally near the opening of your uterus. As the uterus enlarges in size, bleeding can occur from the placental base.

• Placental Abruption : Placental Abruption is a condition in which there may be sudden bleeding at the base of the placenta where it is fixed to the uterine wall. It is more common if you have high blood pressure.

• Labour : Most labour pains start with mild bleeding from the cervix (mouth of the uterus). Initially there may be only a brownish discharge, but as labour proceeds the color becomes reddish and fresh bleeding mixed with mucus can occur.

• Cervical polyp, Cervical Erosion : Bleeding can also occur from cervical erosion or polyps but are somewhat uncommon in later pregnancy.

White or Creamy discharge

A white or creamy discharge is normal throughout pregnancy if there is no additional symptoms like itching or swelling or a foul odor. If it is excessive, you can use pads for protection. If addiitonal symptoms are present , it may be due to vaginal infections which need to be treated.

Infections Causing Increased Vaginal Discharge in Pregnancy

• Trichomonas vaginalis: The trichomonas vaginalis organism can be identified in as many as 20 % of all pregnant women. But it is usually dormant in most cases. Infections causing the typical symptoms of itching, irritation and foamy discharge is comparatively less during pregnancy. It is diagnosed by examining fresh vaginal secretions under a microscope. The organism shows up as a tiny pear-shaped body with a tail and active movements.

  It is believed that acute trichomonas infections can cause premature labour or premature rupture of membranes, but this belief has not been confirmed.

  Treatment: Treatment of this infection is by metronidazole tablets. But metronidazole given orally in the first trimester of pregnancy can cause fetal congenital abnormalities.

  So, it is better to take vaginal tablets of metronidazole as they are not much absorbed through this route and acts directly on the organisms.

• Candida Albicans: Candida also called vaginal yeast can be cultured in about 25% of all pregnant women. It has a typical fishy odour. Serious fetal infections by candida can occur but are very rare.

  Treatment: If asymptomatic, no treatment is necessary. If it causes profuse, irritating discharge however, miconazole vaginal cream 2% should be used thrice daily.

Dirty Discharge

Occasionally if the genitals are not kept clean, the discharge may be stained with a light brown colour. This can be differentiated from bleeding in that this discharge smells dirty and goes away after the genitals are washed thoroughly.

Also Read-

• Breastfeeding after Childbirth.
• Second trimester of Pregnancy - Symptoms and management .
• HIV and AIDS - Symptoms and Diagnosis .
• Constipation in Pregnancy.