LEUKORRHEA

• Leukorrhea is an excessive normal vaginal discharge

• Leukorrhea during pregnancy is a normal physiologic process and occurs due to increased blood flow to the
vagina because of increased estrogen and progesterone levels.
• The production of this discharge varies from woman to woman and can change in consistency and appearance
depending on different factors
• Menstrual cycle, hormones, and pregnancy.
• The cervix and vagina become soft during pregnancy thus the body through the increased levels of progesterone
and estrogen, secrete more fluids to protect them from infections. This is why a mother will experience discharge
during pregnancy.
• The cervix makes small amounts of fluids to sweep away the dead cells which once lined the vagina.
LEUKORRHEA

• Towards labor, there’s increased discharge and this may be due to the baby’s head
pressing against the cervix. (it’s among the signs of labor)
• And then in the last weeks of pregnancy, the discharge may contain thick mucus with
streaks of blood (early sign for pregnancy).
• The abnormal discharge can be due to Sexually transmitted diseases thus calling for
screening of all pregnant women for STDs (center for Disease Control)
• Abnormal discharge may also be a sign of complication in the pregnancy. For example, a
bright red discharge could be a sign of placenta abruption.
LEUKORRHEA

• The normal appearance of the discharge should be clear creamy white which is odorless
• A slight tinge yellow may ne normal but yellow at most times indicates a sexual
transmitted infection (gonorrhea, chlamydia or trichomonasis vaginalis)
• At the beginning the discharge can be slightly pinkish due to implanation bleeding.
• The discharge shouldn’t present with itching, pain, swelling of the vulvar, burning or any
bad odor
INVESTIGATIONS

• In case of abnormal discharge, investigations are required, and the following tests can be
done to trace the cause.
• Pap smear test
• Urine test
• Blood test
• HIV serology
PARASITIC LEUKORRHEA

• This occurs due to trichomonas vaginalis

• It will present with symptoms of
• Itching
• Burning sensation
• And yellowish thick frothy vaginal discharge
INFLAMMATORY LEUKORRHEA

• It occurs due to inflammation of the vaginal mucosa and it’s triggered during a bacterial
infection (bacterial vaginosis).
• The discharge is yellowish in color with a fishy odor.
• This bacterial vaginosis can be associated with late miscarriages, preterm birth
• Management can be initiation of metronidazole 500mg oral twice a daily for 7 days,
clindamycin 300mg oral twice daily for 7 days.
WHEN TO SEE A DOCTOR OR HEALTH CARE

• If the discharge happens to present with the following, you should seek medical care
• Heavy or thick
• Itchy
• Foul smelling
• Accompanied by pelvic or lower abdominal pain
• Pain during urination.
MANAGEMENT OF LEUKORRHEA

• Wear pads or panty liners which absorb excess discharge, to make you feel comfortable,
however, tampons should be avoided because can introduce germs into the vagina.
• Bathe regularly and wear underpants with breathable cotton liners. This will keep you
clean and dry and maintain a balance of bacteria
• Do not douche to get rid of the discharge (if done can disrupt the normal Ph and bacterial
balance of the vagina thus causing an infection)
• Manage the infections if present after investigations and confirmation.
FREQUENCY OF MICTURITION

• Frequency of micturition during pregnancy is a normal physiologic change in the body and is due
to hormonal changes, and physical changes.
• After implantation, the body secretes HCG, and also the level of progesterone increases
• The elevated levels of these hormones increase blood flow to the pelvic region to support fetus
growth.
• Increased blood flow requires increased filtration, thus HCG also triggers the kidneys to
overwork.
• As pregnancy grows, the uterus expands thus putting extra pressure on the bladder which reduces
the volume of fluids it can hold.
• The pressure is also exerted on the urethra and pelvic floor muscles that support the
bladder thus increasing the urge to urinate.
• Frequent urination starts shortly after conception thus it’s also an early sign for
pregnancy.
• A frequent urination that presents with additions symptoms such as lower abdominal
pain, blood in urine, cloudy foul smelling urine, burning sensation during micturition may
indicate UTI
SYMPTOMS

• urinary incontinence may occur when

• Sneezing, coughing, laughing, exercising, lifting, walking
• Frequent but less volume of urine
MANAGEMENT

• Frequent micturition in pregnancy resolves after birth and the symptoms subsides in about 6
weeks after birth.
• Advise the client on the need to for performing Kegel exercises to strengthen the pelvic floor
muscles. Strengthening of these muscles also helps in preparation for labor.
• Educate and advise the pregnant mother to avoid specific drinks like those containing caffeine
• Avoid foods with natural diuretics e.g. hibiscus and dandelion
• Limit fluid intake at night but hydrate as recommended during the day since the demands for
hydration are increased in pregnancy.
MANAGEMENT

• Since frequency is a normal physiologic process during pregnancy, it resolves on it’s own
• But our emphasis is directed to the abnormal signs when present.
• In case of any abnormal signs(blood in urine, pain painful micturition), we assess for the
cause such as infection (UTI) and treat the infection.