Leukorrhea in Pregnancy

Galuh Ajeng Kusumawati 1. Medical Faculty of Trisakti University . !e"artment of !ermatology and #enereology$ dr. Mintohardjo %avy &os"ital

'orres"ondence( Galuh Ajeng Kusumawati$ e)mail( galuh*ajeng+yahoo.com

ABSTRACT ,eukorrhea -white discharge$ fluor al.us/ is the name given to the sym"toms of fluid from the vagina that are not in the form of genital .lood . Under normal conditions $ the cervical glands "roduce a clear li0uid that comes out $ mi1ed with .acteria $ cells were detached and vaginal secretions of the 2artholin gland . 2esides vaginal discharge also caused due to the activity of .acteria that live in the vagina is normal . 3n women $ vaginal discharge is a natural thing from the .ody to rid itself $ as a lu.ricant and defense of various infections . Under normal conditions $ the vaginal secretions a""ear clear$ cloudy white or yellowish when dry on clothing . The secretions of non ) irritants $ do not interfere $ there is no .lood $ and has a"& of 4.5)6.5.%ormal vaginal flora include 'orine.acterium$ 2acteroides$ 7e"tostre"tococcus$ Gardnerella$ Mo.iluncuc$ Myco"lasma and 'andida s"". %ormally witha "& of acidic "rovide "rotection functions "roduced .y the lacto.acilli. Keywords( candidiasis$ .acteria vaginosis$ trichomoniasis$ "regnancy

INTRODUCTION 3ntrauterine or "erinatally transmitted 8T!s can have severely de.ilitating effects on "regnant women$ their "artners$ and their fetuses. All "regnant women and their se1 "artners should .e asked a.out 8T!s$ counseled a.out the "ossi.ility of "erinatal infections$ and "rovided access to treatment$ if needed.1

3n 7regnant women commonly increased vaginal discharge which in many instances is not "athological. 9ccasionally$ an infection caused .y a microorganism or misdistri.ution of .acterial "o"ulation that com"romise normal vaginal flora resulted to trou.le some leukorrhea. 'ervicovaginal infections during "regnancy can threat the well.eing of the mother and fetus. :arly detection is im"ortant .ecause maternal "hysiological alterations may ham"er the diagnosis of infections and the management$ on the other hand the "resence of the fetus may limit treatment. The "ossi.le side effects of cervicovaginal infections on the fetus have .een the focus of several investigations for the "ast several years. 3nfections of the lower genital tract can have a direct effect on thefetus$ while others "redis"ose indirect fetal damage$ secondary to "remature la.or and;or "remature ru"ture of mem.rane.

DISCUSSION The main causes of vaginal infections during "regnancy include .acterial vaginosis $ thricomoniasis$ candidiasis. 2acterial vaginosis is a clinical syndrome resulting from a change in the normal vaginal flora. The normal lacto.acilli dominant vaginal flora is re"laced .y an over growth of endogenous organisms. The etiology of 2# is com"le1 and the commonly associated organisms include Gardnerella vaginalis$ Myco"lasmahominis$ Mo.iluncus s"eies and anaero.ic Gram negative rods and "ositive cocci. Accumulating evidences that 2# causes "regnancy com"licatations such as "reterm la.or -7T,/$ "remature ru"ture of mem.rane -7<9M/$ chorioamnionities and "ost "artum endometrities has .een shown in several studies from develo"ed countries. Foamy leucorrhea with "urities and irritation can .ecaused .y trichomonas vaginalis. 8ome evidences showed that trichomonas vaginalis were at increased risk of having "reterm la.or$ low .irth weight infant and "remature ru"ture of mem.rane -7<9M/. 'andida al.icans may sometimes cause an e1tremely "rofuse$ irritating discharge$ and .ecause of increasing of estrogen and de"osition of glycogen and other su.strates in the vagina the num.er of stricken women during "regnancy increased. 3n some women such as "regnant women it is likely to .e recurrent.

!ifferential !iagnose(6
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Vulvovaginalis Candidiasis Tricho oniasis Bac!eria Vagina

#aginal and or vulva De"ini!ion

8yndrome which is the vaginal flora The lower urogenital changes occurring re"lacement of the infections caused .y normal lacto.acilli in the vagina .y tract infection 'andida genus with & 9 "roducing anaero.ic .acteria. lowerin women various clinical caused .y manifestations that can Trichomonas take an acute$ chronic$ or vaginalis e"isodic.

'. al.icans #!iology

T. vaginalis

G. vaginalis

oval 7arasites anaero.ic$ gram)negative rod)sha"ed s"ores$ sometimes there have 6 flagella$ 'atalasetest$ o1idase$ nitrate are "rominent in the moving like a wave$ reduction$ indole$ andall "ositiveUrease in an facultative anaero.es s"ore wall -.udding/ living referred to as atmos"here of "&5) &as round and "seudohy"hae gla.rata and "ara"silosis -5)1=>/ '. ?.5$ tem"erature '. 5=o' to die within a few minutes$ .ut at a tem"erature of =@ can last u" to 5 days

Clinical Sign

#aginal discharge can .e white or yellow$ odorless or a .it of a sour smell$ clum"ing like Acottage cheeseA or grains of cream #ulvar "ruritus$

3n acute cases 8ero"urulen yellowish vaginal discharge$ yellow) green 8ecretions smelled .ad and foaming
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#aginal"&B6.5 The discovery of clue cells on wet mount Amintest ;snifftest-C/ #aginal discharge attached to the wallof the vagina$ homogeneous$ grayish white

erythema$ irritation$ satellite lesions .urning$ dys"areunia Ty"ical "icture is the "resence of "seudomem.ranous form of yellowish white s"ots on the surface of the vulva or vaginal wall called Avaginal trushA

The walls of the vagina were swollen and reddish 9n the walls of the vagina and cervi1 of small a.scesses that a""ear as red granulation also called straw.erry a""earance !is"arenia 2leeding "ost)coitus 3n the case of chronic Milder sym"toms Usually not frothy secretions wet mount A smear with Gram stain$ Giemsa$ or 7a"anicolaou

'an.e considered also( More "iercing odor after intercourse A.normal menstrual .lood smells 3rritation of the vagina or around the vagina -itching$ .urning/ 5=> area sym"tomatic

Diagnos!ic Considera$ !ion

K9& e1amination e1amination of Gram The result when the-C/ "icture o.tained as Gram "ositive oval$ there are .udding.

wet mount 7resence ofclue cellsfound

,ooks rods Gram)negative rods that can not .e counted in num.er Amen smell-sniff test/C"&6.5)5. 8wa.( vaginal fluid taken from the vaginal forniks or also in "seudomem.ranous Thera%y 'lotrimaDole vaginal ta.lets 5== mg single dose or 'lotrimaDole vaginal ta.lets == mg for 4 days or KetoconaDole 1 == mg ; day orally for 5 days E or FluconaDole 15= mg single dose orally E E %ot allowed for "regnant women and MetronidaDole g single dose orally -can .e given to "regnant women/ or MetronidaDole 415== mg ; day$ orally$ for ? days All "atients should .e treated trichomoniasis -asym"tomatic or sym"tomatic/ 8e1ual "artners are also treated
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9ral metronidaDole 15==mg;day$ ?daysor Amo1icillin 615==mg;day orally$ 5daysor 'lindamycin 14==mg;day$ orally$ ?days

lactating

A.stinence$ until cured "atients and their se1ual "artners

!o1ycycline$ oflo1acin$ and levoflo1acin are contraindicated in "regnant women. &owever$ clinical e1"erience and "u.lished studies suggest that aDithromycin is safe and effective. <e"eat testing to document chlamydial eradication 4 weeks after com"letion of thera"y with the following regimens is recommended for all "regnant women to ensure thera"eutic cure$ considering the severe se0uelae that might occur in mothers and neonates if the infection "ersists. Fomen aged G 5 years and those at increased risk for chlamydia -i.e.$ women who have a new or more than one se1 "artner/ also should .e retested during the third trimester to "revent maternal "ostnatal com"lications and chlamydial infection in the infant. 7regnant women diagnosed with a chlamydial infection during the first trimester should not only receive a test to document chlamydial eradication$ .ut .e retested 4 months after treatment.1 PRO&NOSIS Usually the conditions that cause fluor al.us res"ond to treatment with in a few days. 8ometimes the infection will recurent. Fith health care will determine which treatment is more effective.1$6 CONCLUSION ,eukorea is a normal sym"tom of "regnancy. Most "regnant women e1"ress they e1"erienced e1cessive vaginal discharge. 7hysiologic leukorrhea can cleans the servi1. 7regnant women who have a vaginal discharge that is colorless$ odorless$ itching need re0uire immediate thera"y.1$6 R#'#R#NC#S
1. 'entres for disease control and "revention. Sexually transmitted diseases treatment

guidelines 2010. Gonorrhoea MMF< =1=.www.cdc.gov/mmwr . Moaiedmohseni 8.$ 2ashardoost ,.$ A..asi M. 'ervicovaginal 3nfections during Third Trimester 7regnancy. Tehran University of Medical Science Journals. =1 . #ol. H. "(11)1?
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3. Ghot.i 8h.$ 2ehesti M.$ AmiriDade 8.$ 'auses of ,eukorrhea. Shira !"Medical

Journal. ==?. #ol.I. "(5I)H6.

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