Vaginal discharge

Many women have increased vaginal discharge throughout pregnancy. This discharge, called leukorrhea, is thin, white and mild smelling or odorless. It's caused by the effects of hormones on the vaginal lining, which must grow dramatically during the pregnancy. It may increase throughout the pregnancy, becoming quite heavy. The high acidity of the discharge is thought to play a role in suppressing growth of harmful bacteria.

In the last few weeks of pregnancy, you may have a discharge that's blood tinged or a thick or stringy mass. This is probably the mucous plug that protects the cervix during pregnancy (see also Bloody show).

You'll also have a temporary vaginal discharge after giving birth. This discharge, called lochia, is caused by hormone shifts and will occur whether you had a vaginal or Caesarean birth. The discharge varies in amount, appearance and duration. Initially it's bloody, then it becomes paler or brownish after about four days and white or yellowish after about 10 days. You may occasionally pass a blood clot. This postpreg-nancy discharge can last from two to eight weeks. The amount should gradually diminish.

A discharge may also be a sign of a vaginal infection, which can be triggered by pregnancy hormones or medications such as antibiotics. If your vaginal discharge is greenish, yellowish, thick and cheesy, strong smelling or accompanied by redness, itching or irritation of the vulva, you may have a vaginal infection. Bacterial vaginosis is one common type of vaginal infection. It causes a foul-smelling gray to greenish discharge, and it's associated with preterm labor. It's treated orally or vaginally with metronidazole (Flagyl, MetroGel). Two other common types of vaginal infection during pregnancy are candidiasis (see also Yeast infections) and trichomoniasis. Neither presents a direct hazard to your baby, and both can be treated during pregnancy.

A steady or heavy watery discharge may be a sign that your membranes have ruptured (your water has broken). A vaginal discharge that's bloody or thick and mucus-like may indicate a problem with the cervix.

■ Prevention and self-care for vaginal discharge

To deal with the normal increased discharge of pregnancy, you might want to wear panty liners or a light sanitary pad. To reduce your risk of getting an infection:

• Do not douche. Douching can upset the normal balance of microorganisms in the vagina and can lead to a vaginal infection called bacterial vaginosis.

• Wear cotton underwear.

• Wear comfortable, loosefitting clothing. Avoid fabrics that don't breathe, tight slacks, exercise pants and leotards.

• There's some evidence that you can reduce your risk of yeast vaginal infection by eating 1 cup a day of yogurt containing live Lactobacillus acidophilus cultures.

■ When to seek medical help for vaginal discharge Contact your health care provider if:

• You have abdominal pain or fever with a discharge.

• The discharge becomes greenish, yellowish or foul smelling.

• The discharge is thick and cheesy or curd-like.

• The discharge is accompanied by soreness, redness, burning or itching of the vulva.

• You have a steady or heavy discharge of watery fluid.

• The discharge is bloody or unusually thick.

• You've just had amniocentesis, and you have an increased vaginal discharge. This could indicate an amniotic fluid leak.

If you've already given birth, call your health care provider in the following situations:

• You're soaking a sanitary napkin every hour for four hours — don't wait the four hours if you become dizzy or notice increasing blood loss; call right away or go to the emergency room.

• The discharge has a foul, fishy odor.

• Your abdomen feels tender or your bleeding increases, and you're passing numerous clots.

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