Vaginal Discharge in Pregnancy - Causes, Symptoms and Treatment

Vaginal discharge is the name given to any fluid secretion through the vaginal canal. The discharge is a very common situation and in most cases does not indicate any gynecological problem. Any woman from puberty may have some degree of vaginal discharge.

Normal discharge, which is unrelated to diseases or gynecological inflammation, is called a physiological vaginal discharge. When the woman has a gynecological disease and the discharge arises because of this problem, we call it pathological vaginal discharge.

Mucus plug
Mucus plug

Vaginal discharge in pregnancy

The physiological vaginal discharge is formed by the combination of dead cells of the vagina, natural bacteria of the vaginal flora and secretion of mucus. The normal discharge usually has between 1 and 4 ml of daily volume and its function is to moisten, lubricate and keep the vagina clean, preventing inflammation and making it difficult to develop infections.

The physiological vaginal discharge is stimulated by the estrogen hormone and therefore may have its volume increased in periods where there is increased hormonal stimulation, as in cases of pregnancy. Another factor that increases the volume of discharge in pregnancy is the greatest contribution and blood to the vaginal region.

Normal vaginal discharge usually is white, milky or transparent, thick and with a weak odor. One of the most important tips for identifying a physiological discharge is the absence of signs or symptoms of irritation, such as pain, burning, redness or itching of the vagina and/or vulva.

It is important to note that mild vulval irritation may occur in some women with physiological discharge. In these cases, it is up to the obstetrician, through exams, to rule out the presence of infections.

The discharge in pregnancy usually intensifies as the pregnancy progresses, being greater in the 2 nd and 3rd trimesters of gestation. In some women, discharge can be very bulky, causing some discomfort and embarrassment. Even if the discharge is very large, do not try to stop it and do not use internal tampons as this increases the risk of gynecological infection.

Tips to prevent contamination of discharge:
  • Use neutral soaps. Avoid scented or bactericidal soaps.
  • During hygiene, there is no need to wash inside the vagina.
  • Never take a vaginal shower, even after intercourse.
  • Wear wide pants or skirt.
  • Do not use tampons.

Pregnant women may present other vaginal secretions during pregnancy beyond physiological discharge. These include loss of mucus plug, bleeding, rupture of the pouch, and pathological defects. It is important to know the characteristics of each one to know how to distinguish them.

Loss of mucus plug

Throughout pregnancy, the natural secretions produced by the vagina are deposited in the cervix, sealing it in relation to the outside. This accumulated substance is called mucosal tampon and its function is to prevent bacteria from the vagina from having access to the inside of the uterus.

In the final moments of pregnancy, the baby's weight associated with a thinning and enlargement of the cervix causes the tampon to be expelled. The outlet of the mucus plug is a sign that the uterus is preparing for childbirth.

There are women who lose mucus plug just hours before giving birth, but there are cases in which labor goes on for several days, sometimes up to 2 weeks, to start. Exit from the mucus plug indicates that the baby will be born soon, but it is by no means a sign of labor onset. If there are no other signs, it is not necessary to contact the obstetrician urgently.

The mucus plug may have several appearances. In some women it is a very clear sticky secretion, clear egg type, and may go unnoticed, mingling with the physiological discharge. The mucus plug may also have a gelatinous appearance, similar to a cold. Having some mixed blood is also common, making the tampon look similar to the one above.

Brown or bloody discharge

Any brown, reddish or coffee-grounds-like discharge should always be valued, as it usually indicates the presence of blood. The brown discharge is usually a sign of coagulated blood that has been in contact with the air inside the vagina before it is expelled. Straining with live blood, on the other hand, is usually a sign of bleeding that has just occurred.

In the first days of pregnancy there may be a discrete brownish discharge, which usually occurs as a consequence of the implantation of the embryo in the wall of the uterus. In general, when this occurs, women still do not know they are pregnant, and some even confuse it with the onset of a new menstrual period. This type of discharge is perfectly normal.

During the first trimester, with increased vascularization of the uterus and vagina, there may be some brownish or bloody discharge from small vessels, especially after sexual intercourse or any other effort. This type of bleeding is usually discreet and self-limiting, posing no risk to pregnancy.

However, bleeding in the first trimester may be a sign of miscarriage or ectopic pregnancy. The warning signs are a bloody discharge in large amount associated with abdominal pains or cramps. In doubt, any discharge with suspected blood should be evaluated by the obstetrician.

By the third trimester, bloody discharge may indicate some complication, such as premature placental abruption or preterm labor. Another condition that can cause vaginal bleeding in pregnant women in late pregnancy is the placenta previa, a problem that occurs when the placenta is implanted in front of the uterus, obstructing the passage and preventing the exit of the fetus during childbirth.

Any bloody discharge in the second half of pregnancy should be evaluated rapidly by an obstetrician.

Yellowish and/or foul-smelling discharge

Lengths that do not have characteristics of physiological discharge should be evaluated by the obstetrician, since a gynecological infection may be in progress. Among the signs of a pathological discharge, we can highlight:
  • Yellowish or greenish discharge
  • Strong smell (smell of raw fish)
  • Vaginal pain
  • Vaginal itching
  • Flow associated with burning to urinate
  • Sudden change in the characteristics or volume of the discharge

Gynecological infections during pregnancy are important because they are associated with numerous complications, such as preterm birth, abortion, fetal death, fetal infection, etc.

Infections that cause vaginitis (inflammation of the vaginal canal) are the main causes for pathological discharge. Are they:

Breaking the bag

The fetus inside the uterus is wrapped by a membrane, which is filled with amniotic fluid. This membrane is popularly called a water bag.

The rupture of the pouch occurs early in labor and causes a large drainage of fluid through the vagina. In most cases, there is not much like confusing this with a vaginal discharge. However, fluid outflow may be small and intermittent if the fetal head touches the cervix and functions as a kind of valve, allowing the passage of amynotic fluid only partially when the mother lies down or coughs.

The amniotic fluid is very clear and liquid, but can be a bit yellowish and sometimes with a few streaks of blood.

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