GPAtlas🧭 When to suspect – abnormal vaginal discharge in pregnancy
Increased discharge is one of the commonest complaints of pregnancy. Most of it is physiological leukorrhoea – thin, white or clear, and non-offensive – driven by oestrogen and increased cervical and vaginal secretion.
Separate this reassuring picture from a pathological one.
Suspect a treatable cause when the discharge:
• changes in colour (green, yellow, grey) or consistency (curd-like, frothy)
• develops an offensive odour
• comes with itch, soreness, dysuria or dyspareunia
The common infective causes are:
• candidiasis
• bacterial vaginosis
• trichomoniasis
• the bacterial STIs (chlamydia, gonorrhoea)
The two clinical priorities in pregnancy are:
• first, to exclude an obstetric emergency hiding as “discharge” – ruptured membranes or an antepartum haemorrhage
• second, to confirm the cause with a swab rather than treat blind, because empirical treatment is less reliable and prescribing choices are constrained
| Discharge pattern | Most likely cause |
|---|---|
| Thin, white/clear, non-offensive, no itch | • Physiological leukorrhoea – normal • Reassure |
| Thick, white, curd-like ± vulval itch and soreness | Candidiasis (thrush) |
| Thin, grey-white, homogeneous, fishy odour | Bacterial vaginosis (pH > 4.5) |
| Yellow-green, frothy, offensive ± vulvitis | Trichomonas vaginalis |
| Mucopurulent ± cervicitis, contact bleeding, dysuria | Chlamydia or gonorrhoea |
| Clear, watery, continuous leak or gush | Suspect ruptured membranes (PROM) – not infection |
| Blood-stained | Suspect antepartum haemorrhage – not infection |
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