Question

28 yo at 28 wks gestation has leakage of fluid-wakes up in AM W/damp underwear&had intermittent clear vaginal discharge.Elevated 1 hr glucose challenge test but 3 hr GTT normal. Exam: no pooling of fluid in vagina. Thin clear discharge present in posterior fornix&on cervix. cervix is visibly closed&no lesions. vaginal pH 4.0. Wet mount microscopy shows epithelial cells. CAUSE of sx?

Answer 1

The symptoms described by the patient are likely due to normal physiological changes of pregnancy, presenting as increased vaginal discharge (leukorrhea). The absence of signs consistent with infection or PPROM on examination supports this conclusion. The elevated 1-hour glucose challenge result adds a consideration but is mitigated by the normal 3-hour GTT.

Step-by-step explanation:

The cause of the symptoms is unlikely to be preterm premature rupture of membranes (PPROM) due to lack of pooling, but may involve other conditions like vaginitis or physiological changes in pregnancy. The normal vaginal pH and presence of epithelial cells on wet mount microscopy suggest that the thin clear discharge is more likely a physiological discharge seen in pregnancy and not due to an infectious cause.

Considering the elevated 1-hour glucose challenge test but normal 3-hour glucose tolerance test (GTT), it is plausible the symptoms could be related to physiological changes rather than gestational diabetes. The cervical exam shows a closed cervix and no lesions, further supporting a non-pathological process. The pregnancy itself, with the increase in estrogen and changes in the vaginal flora, can lead to an increase in normal vaginal discharge (leukorrhea), which is typically thin, clear, or milky white and mild-smelling.