Non-infective irritation,
• Cervical ectropion (cervical erosion)
Hormonal Activity
It is quite normal for increased hormonal activity to lead to
an increase in normal vaginal emissions. Clear or whitish mucous based discharge
known as Leukorrhea, which is non irritant and mild smelling, can increase
substantially while pregnant. Panty liners can be used to control these
increased emissions, but tampons and douching are not advised as they can cause
problems.
Infection
Discharges that are smelly, discoloured, irritant or
bloodstained need to be assessed for infection. This will probably involve the
use of swabs in order to find out the type or types of infection suspected. The
two most common infections are:
• Candidiasis (thrush)
• Bacterial vaginosis
Candidiasis
Commonly known as thrush or yeast infection, emissions from
candidiasis are characterised as being whitish or whitish grey in colour, having
a lumpy consistency similar to cottage cheese and a yeasty smell like beer or
baking bread. These infections occur when the yeast organisms, which are always
present, are affected by certain conditions, including pregnancy, and become out
of balance with the other natural micro organisms. For the treatment of thrush,
various home remedies are said to work quite well. Ingestion or direct
application of yoghurt will help to kill the yeast organisms as it contains
lactobacillus which is a probiotic or “friendly bacteria”. The use of garlic and
boric acid are also said to be effective. Various prescription antifungal drugs
exist to treat candidiasis:
• Clotrimazole (e.g. Canesten) whilst no adequate tests have been performed on
pregnant women (as is common with most drugs), no adverse effects on the
foetuses of pregnant animals have been found in tests.
• Nystatin (e.g. Mikostat, Mycostatin oral and Restatin) has a similar safety
status to the above.
• Fluconazole (e.g. Diflucan, Flucand and Flucoheal) also has not been
adequately tested on pregnant women.Tests on animals do indicate adverse effects
and toxicity on foetuses but the drug could be prescribed if the benefits were
thought to outweigh any potential dangers.
• Ketoconazole (e.g. Nizoral creams and shampoos) has a similar safety status to
the above.
Other drugs are used in more severe cases, usually in
hospitals. Sugar intake is a factor that affects yeast infections, and it is
sometimes recommended that cutting back on refined sugars is a good idea.
Bacterial Vaginosis
This condition is also related to the balance of micro
organisms present in the vagina, and is characterised by watery non irritant
discharge with an unpleasant fishy smell. BV is thought to increase the risk of
premature labour threefold, so it is especially important that it is treated.
Antibiotics like metronidazole (e.g. Anazol and Elyzol) are used to treat BV.
This drug although not adequately tested on pregnant women, has not been found
to indicate any risks to animal foetuses in studies
Other Infections
Trichomoniasis is usually transmitted through sexual
intercourse. Symptoms include soreness and a greenish yellow or grey discharge
that is foul smelling. It can affect both sexes, therefore partners must also be
treated to avoid passing it back and forth. Treatment is usually by prescribed
antibiotics.
Chlamydia is also sexually transmitted and sometimes results
in discharge. It is more common to have light bleeding especially after
intercourse and sometimes pain in the pelvic and lower abdominal region.
Always consult a midwife, doctor or health visitor if you
suspect an infection before attempting any course of action.
Non Infective Irritations
Non infective irritation, or non infective vaginitis, is
fairly self explanatory. The symptoms are irritation, itching and sometimes
vaginal discharge without there being any infection. Causes of this condition
can be:
• Reaction to toiletries, vaginal deodorants, fabric softeners etc,
• Wearing tights, exercise pants etc,
• Sweating,
• Wearing a wet bathing suit,
• Sexual activity.
Treatments for this condition should be discussed with a
doctor. Precautionary measures include:
• Wearing cotton underwear
• Cleaning the vaginal area from front to back to avoid contamination
• Not wearing too constrictive clothing around vaginal area
• Not scratching
• Avoiding that which may trigger reaction, vaginal deodorants etc.
Cervical Ectropion (Cervical erosion)
This is a fairly common condition during pregnancy as it is
affected by changes in hormones. It involves a shifting of a delicate membrane
in the cervix area which contains mucus producing glands. This in turn can lead
to vaginal discharge of a mucous like nature and also some light bleeding which
is painless.
The Mucus Plug
The mucus plug is like a gel sealant inside the cervix which
protects the foetus from infection by sealing the mouth of the uterus. Expulsion
of the mucus plug is also sometimes called “bloody show”. The mucous discharge
is usually brownish yellow, sometimes pinkish in colour. Along with a general
increase and thickening of discharge that may occur as the pregnancy nears
labour, there can be quite a lot of mucous when the mucous plug loosens, which
can be a sign that labour is imminent. Although it could be a matter of hours,
days or even weeks until the cervix becomes fully dilated.
Bleeding in Pregnancy
There are many reasons why vaginal bleeding may happen during
pregnancy. Some of these reasons have already been covered. It is not unheard of
for women to experience some
bleeding during early pregnancy around the time
they would normally have their menstrual cycle. In some cases this can continue
throughout the pregnancy. There can also be some bleeding in the very early
stages of pregnancy at the implantation stage of the fertilized egg. Bleeding
can also occur later on due to the placenta embedding itself in the lining of
the uterus.
Bleeding in early Pregnancy
Other reasons why bleeding could occur in the first trimester
are threatened miscarriage and ectopic pregnancy. In the case of threatened
miscarriage, bleeding can be brown spotting, blood stained discharge or bright
red bleeding. There could also be abdominal pain. A midwife or doctor should be
consulted if there is any vaginal bleeding. The highest time of risk for
miscarriages is immediately after implantation. It is estimated that 50% of all
fertilized eggs fail to remain in place. This results in many unnoticed
miscarriages as the eggs simply come away with normal or slightly delayed
periods. It is thought that 80% of all miscarriages happen in the first 12 weeks
of pregnancy, often around the times when the monthly cycle should be.
Ectopic pregnancy is where the embryo is implanted outside
the womb, usually in the fallopian tube. This is a potentially very dangerous
condition which could lead to haemorrhaging if not diagnosed in time.
Abdominal
pain, caused as the tube becomes distended, tends to happen around the second
month of pregnancy, and vaginal bleeding is often also present. A scan will be
taken to confirm any diagnosis of suspected ectopic pregnancy.
Bleeding in later stages of Pregnancy
Any bleeding that takes place after 28 weeks is known as
ante-partum haemorrhage and could be caused by one of two potentially serious
conditions.Placenta praevia occurs when a low lying placenta blocks the entrance
to the cervix. This complication affects approximately 0.5% of pregnancies.
Women who are at greater risk of placenta praevia include those who have had
caesarean delivery or an abortion.
Placental abruption occurs when the placenta comes away from
the wall of the womb. This occurs in about 1% of
pregnant women.
A major factor
in this complication is maternal hypertension.If bleeding suddenly occurs in the
late stages of pregnancy, the women should lie down and arrangements should be
made to immediately get her to hospital.
Zac trained as a
sonographer at Leeds in 1996. He worked at Pinderfields hospital Wakefield,
Queens Park Hospital Blackburn, Huddersfield Royal Infirmary and Liverpool
Womens Hospital as a sonographer before joining General Elecctric as an
ultrasound applications specialist. In this role Zac travelled throughout
the north of England demonstrating and teaching the latest ultrasound
techniques to sonographers and doctors in obstetrics and general ultrasound.
It was with his time at GE healthcare that Zac was introduced to the Voluson
730. It is the class leader in 3d/4d technology and as such the only choice
for Inner-Vision. Zac has lectured to ultrasound students at the
universities of Liverpool, Leeds and Lancaster
