A pregnant patient at 12 weeks' gestation complains of yellow vaginal discharge. Laboratory tests reveal bacterial vaginosis. The clinician should recognize that bacterial vaginosis is:

Question

A. A normal finding in pregnancy
B. Associated with preterm labor and delivery
C. Diagnosed by a nitrazine test
D. Often accompanied by vaginal bleeding

Answer 1

ANS: B
Observational studies have demonstrated an association between bacterial vaginosis and certain adverse pregnancy outcomes, such as preterm labor, preterm delivery, premature rupture of membranes, and spontaneous abortions. Bacterial vaginosis can be treated with antibiotic therapy, but cure rates are erratic and recurrences are common. There is currently conflicting evidence on whether screening and treatment of asymptomatic bacterial vaginosis in high-risk pregnant women actually reduces the incidence of preterm delivery. The USPSTF therefore neither recommends nor discourages routinely screening these women (2008). However, the USPSTF does state that screening is not recommended in pregnant women at low risk for preterm delivery, but treatment is appropriate for symptomatic bacterial vaginosis infections (such as with patient complaints of vaginal discharge). Trichomoniasis is less common than other forms of infectious vaginitis during pregnancy, but vulvovaginal candidiasis occurs in 10% of women during the first trimester and in one-third to one-half of women during the third trimester (Rein & Liang, 1999).
Subjective
Inquire whether there have been multiple or new sexual partners, whether sexual activity has recently been resumed, whether there has been any recent douching or antibiotic use, or whether there is a history of abnormal Papanicolaou (Pap) smears. Further assessment should explore the presence of any vaginal discharge, perineal or vaginal sores or lesions, or UTI symptoms. Worrisome symptoms include excessive, malodorous, discolored, itchy, or irritating vaginal discharge; fever; abdominal pain; dysuria; or bleeding or pain after sexual intercourse.
Objective
The examination should begin with an inspection of the external genitalia. A pelvic examination should assess for vaginal discharge, signs of vaginal infections (including herpes), and any other vaginal or cervical abnormalities. A normal saline and potassium hydroxide test (wet mount) should be conducted from secretions of the vaginal pool to check for fungal organisms, trichomonas, clue cells, and bacteria. A gonorrhea and chlamydia specimen for culture should be obtained. A nitrazine test (done to evaluate a change in the pH) or fern test should be done to evaluate for a rupture of membranes. A Pap smear should be done if it has not been done previously in the initial obstetrical evaluation to assess for dysplasia, carcinoma, or human papillomavirus.