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Original Research (Original Article) 


Sarah Sami Almubarak et al, 2020;4(3):740–745.

International Journal of Medicine in Developing Countries

Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms

Sarah Sami Almubarak1, Asrar Humaid Alsofyani2, AlHababi Zahra Ahmed1, Ghaida Saleh Almahboob1, Fatimah Adam Alaswad3, Fatema Abdullah AlThkerallah1*, Betool Abdullah Alkwitem1, Maram Hussain Alfayez1

Correspondence to: Fatema Abdullah AlThkerallah

*King Faisal University, Hofuf, Saudi Arabia.

Email: fatma_tth [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 20 January 2020 | Accepted: 21 January 2020


ABSTRACT

Background:

Vaginal discharge is a common gynecological condition among women of childbearing age that frequently requires care. It affects about one-third of all women and half of pregnant women. This study is designed to investigate the prevalence of increased vaginal discharge during pregnancy, its associated symptoms and the doctor diagnosed causes among pregnant women in different areas of Saudi Arabia.


Methodology:

A cross-sectional study was carried out on pregnant women in different regions of Saudi Arabia, during the period from 1 May to 31 July 2019. Data were collected by using a pre-designed online disseminated questionnaire which includes questions designed to fulfill the study objectives. Risk factors were determined using the X2 test. A p-value of less than 0.05 was considered as statistically significant.


Results:

The incidence of increased vaginal discharge among the studied pregnant women was 72.2%. The most common associated symptom reported in our study was itching in 49.2% of cases followed by redness in 48.4%, dysuria in 36%, and swilling in 4.5%. The discharge was colorless in 39.1% of cases, whitish in 32.1%, and yellowish in 28.7%. As regards treatment, 66.3% had medical treatment and improvement occurred in 56%cases, recurrence after treatment occurred in 43.4%. The most common causes were fungal infection in 23.3% of cases, a bacterial infection in 22.6%.


Conclusion:

The incidence of increased vaginal discharge among the studied pregnant women was 72.2%. The most common causes were fungal infection in 23.3% of cases, a bacterial infection in 22.6%. Therefore, we recommend health education for pregnant women about the importance of treatment of the cases and following the preventive measures to prevent the recurrence.


Keywords:

Increased vaginal discharge, pregnant women, Saudi Arabia.


Introduction

Vaginal discharge may be an ordinary physiological or pathological event. Distinguishing abnormal from ordinary discharge is often challenging, both from the view of the patient and the health care provider. Vaginal discharge production may vary from woman to woman and may change in consistency and appearance depending on many factors (hormones, menstrual cycle, pregnancy, and infection) [1]. Abnormal vaginal discharge also predisposes important morbidity in the form of pelvic inflammatory diseases, loss of the pregnancy, premature labor, increase susceptibility to sexually transmitted infections, infertility, endometriosis, urethral syndrome, and low birth weight [2]. Vaginal discharge from the pathology may be of vaginal or cervical origin. Vaginal discharge may be associated with bacterial vaginosis (BV), Candida spp infection, and Trichomonas vaginalis (TV). Cervical discharge is generally caused by infection with Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma Genitalium. Main herpes simplex cervicitis may also occur as a vaginal discharge [3]. Chlamydia trachomatis, Neisseria gonorrhoeae, and TV are sexually transmitted diseases. Therefore, bacterial vaginosis and candida infections are non-sexually borne infections [4]. In pregnant females, vaginal discharge is also normal, genital mucosa becomes thinner during pregnancy and has a larger surface area that makes pregnant females more vulnerable to infection [5,6]. During pregnancy, pathological vaginal discharge can cause severe damage to pregnant females and their babies, including premature infection, low birth weight, chorioamnionitis, postpartum endometritis, and post-cesarean wound infection [7,8]. A cross-sectional study was carried out which included 233 pregnant females attending the obstetric clinic in the tertiary hospital of Western India found that; a total of 183 (78.54%) pregnant females had vaginal discharge on clinical examination and Candida albicans was the most common clinical diagnosis among them. Of 183 cases diagnosed clinically as vaginal discharge syndrome, 38 (20.7%) were tested positive in laboratory investigations. Out of 50 clinically negative cases, 9 (18%) were detected positive for one of the sexually transmitted infections (STIs) on laboratory testing [9]. A previous study included women living in the city of Rio Grande, Southern Brazil, who gave birth in 2010 reported that, of the 2,395 women studied, 43% had pathological vaginal discharge during pregnancy. The analysis showed that younger women of lower socioeconomic conditions, those with a history of abortion, vaginal discharge in a previous pregnancy, and treated for depression, anemia, and urinary tract infection during their current pregnancy, were more likely to have pathological vaginal discharge. Vaginal discharge during pregnancy was highly prevalent in the sample studied calling for proper risk factor management at the primary care level [10]. This study is designed to investigate the prevalence of increased vaginal discharge during pregnancy, its associated symptoms and the doctor diagnosed causes among pregnant women in different areas of Saudi Arabia.


Subjects and Methods

A cross-sectional study was carried out on pregnant women in different regions of Saudi Arabia, during the period from 1 May to 31 July 2019. The sample size was calculated using the sample size equation: n = z2p (1–p)/e2. Data were collected from the Saudi general female population. A multistage random sampling technique was followed. Data were collected by using a pre-designed online disseminated questionnaire which includes questions designed to fulfill the study objectives. Socio-demographic characteristics including age and educational status, family income, pregnancy order and area of residence. It also included questions about increased vaginal discharge during pregnancy, its odor, color, association with itching; doctor diagnosed causes, duration and treatment trials as medical treatment, herbal remedies or self-medication, and if there was recurrence after treatment in addition to the preventive measures as daily vaginal cleaning. The questionnaire had a brief introduction explaining the aims and significance of the study to the participants. Participants were informed that participation is completely voluntary. No names were recorded in the questionnaires. All answers were kept secret and safe. All the data were analyzed using Statistical Package for Social Sciences version 20. Descriptive statistics were used for the prevalence and quantitative variables. Risk factors were determined using the X2 test. A p-value of less than 0.05 was considered as statistically significant.

Table 1. Socio-demographic characteristics and prevalence of increased vaginal discharge of the studied pregnant women (N = 1,022).

Frequency Percent
Age group
  • < 21
46 4.5
  • 21–30
589 57.6
  • 31–40
302 29.5
  • 41–50
85 8.3
Total 1,022 100.0
Educational level
  • Basic
28 2.8
  • Secondary
216 21.1
  • University or more
778 76.1
Smoking status
  • No
990 96.9
  • Yes
32 3.1
Family income
  • Good
209 20.5
  • Very good
270 26.4
  • Poor
79 7.7
  • Moderate
359 35.1
  • Excellent
105 10.3
Pregnancy order
  • First
333 32.6
  • Second
245 24.0
  • Third
152 14.9
  • Fourth
106 10.4
  • Fifth
100 9.8
  • Sixth
68 6.7
  • Seventh or more
18 1.8
Geographical area
  • Eastern Province
701 68.6
  • The northern area
18 1.8
  • Western Region
100 9.8
  • Central Region
73 7.1
  • Southern area
130 12.7
Associated health problems
Diabetes
  • No
994 97.3
  • Yes
28 2.7
Hypertension
  • No
996 97.5
  • Yes
26 2.5
Obesity
  • No
836 81.8
  • Yes
186 18.2

Results

Table 1 shows that most (57.6) of the studied women aged between 21 and 30 years old, 76.1% were highly educated, 3.1% of them were smokers, and 35.1% of them had moderate family income. Only 2.7% of studied women had DM, 2.5% had HT, and 18.2% were obese. Table 2 shows the incidence of increased vaginal discharge among the studied pregnant women as 72.2% positive. Table 3 shows manifestations, treatment characteristics, and preventive measures of increased vaginal discharge among the studied pregnant cases. The most common symptom reported in our study was itching 49.2% followed by redness 48.4%, dysuria 36%, and swilling 4.5%. The discharge was colorless in 39.1% of cases, whitish in 32.1% and yellowish in 28.7%. As regards treatment, our study reported; 68.7% of cases seeking medical care, 66.3% had medical treatment and improvement occurred in 56% of cases, recurrence after treatment occurred in 43.4%. Regarding causes of vaginal discharge; the most common causes were fungal infection in 23.3% of cases, a bacterial infection in 22.6%, and only 2.4% for sexually transmitted diseases. Table 4 illustrates the relationship between increased vaginal discharge with pregnancy and age, educational level, pregnancy order, diabetes, hypertension, obesity, and smoking among the studied pregnant women. It is clear from the Table 4 that increased vaginal discharge with pregnancy was significantly associated with the age group of pregnant women (p < 0.05).

Table 2. Incidence of increased vaginal discharge among the studied pregnant women, Kingdom of Saudi Arabia (KSA), 2019 (N = 1,022).

Increased vaginal discharge with pregnancy No. %
No 284 27.8
Yes 738 72.2
Total 1,022 100.0

Table 3. Accompanied symptoms, treatment characteristics and preventive measures of increased vaginal discharge among the studied pregnant cases, KSA, 2019 (N = 1,404).

No. %
Accompanied symptoms
  • Redness
357 48.4
  • Itching
363 49.2
  • Swilling
33 4.5
  • Dysuria
266 36.0
  • Color of the discharge
  • Colorless
289 39.1
  • Whitish
237 32.1
  • Yellowish
212 28.7
Smelling of the discharge
  • Not offensive
516 69.9
  • Offensive
222 30.1
Causes of discharge (after investigations)
  • Normal discharge
381 51.6
  • Fungal infection
172 23.3
  • Bacterial infection
167 22.6
  • Sexually transmitted diseases
18 2.4
Daily cleaning
  • With water
437 59.4
  • With water and soap
106 14.4
  • With vaginal cleaning solutions
182 24.7
  • Water and salt
7 1.0
Treatment
  • Seeking medical care
507 68.7
  • Lab. diagnoses
471 63.8
  • Medical treatment
489 66.3
  • Improvement of medical treatment
413 56.0
  • Recurrence after treatment
320 43.4
  • Herbal remedies
237 32.1
  • Improvement of herbal remedies
237 32.1

Discussion

Vaginal discharge is a common gynecological condition among women of childbearing age that frequently requires care affecting about one-third of all women and half of pregnant women [5,11]. It is the second most common problem after menstrual disorders [12]. Vaginal discharge may be a normal physiologic occurrence or a pathological manifestation. It is often challenging to distinguish abnormal from normal discharge, both from the patient’s and the health care provider’s perspective. Moreover, normal physiologic variations occur due to biological or hormonal changes [13]. During pregnancy genital mucosa becomes thinner and has a greater surface area making pregnant women more susceptible to infections [14]. Pathological vaginal discharge can cause serious harm to pregnant women and their children, including prematurity, low birth weight, chorioamnionitis, postpartum endometritis, and post-cesarean wound infection [7,15]. This is a cross-sectional study was conducted among 1,022 pregnant women from different regions of KSA, to investigate the prevalence of increased vaginal discharge during pregnancy, its associated symptoms and the doctor diagnosed causes among pregnant women in different areas of Saudi Arabia. According to the incidence of increased vaginal discharge among pregnant women, our study found that there was an increase in vaginal discharge with pregnancy in 72.2% of cases. These results were higher than another study conducted in the city of the Rio Grande, Southern Brazil among 2,395 pregnant women, which reported that 43% of them had pathological vaginal discharge during pregnancy [10]. Another study carried out among 400 pregnant women reported; the prevalence of abnormal vaginal discharge in pregnancy was 31.5% [16]. Similar to our results, in Western India, another study was conducted among 233 pregnant females found that (78.5%) of them had vaginal discharge on clinical examination [9]. Another study reported a high prevalence rate of abnormal vaginal discharge; the study was conducted among 206 pregnant women, the abnormal discharge was seen in (91%) of them [17]. Regarding the relationship between increased vaginal discharge with pregnancy and other variables, our study found that there was the only relation with age (p = 0.001) and it was most common among the age group 21–30 years by 61.9%. However, there was no relation with educational level, pregnancy order, diabetes, hypertension, obesity, and smoking (p > 0.05). Another study reported that abnormal vaginal discharge in pregnant was more common (45.8%) among those aged 20–24 years [16]. In contrast to our results another study showed that pathological vaginal discharge during pregnancy was significantly associated with; maternal age; living with a partner; household asset index; parity; vaginal discharge in a previous pregnancy; and diabetes, depression, threatened premature labor, urinary infection, and hospitalization during the current pregnancy [10]. Abnormal vaginal discharge is predominantly caused by the replacement of normal vaginal flora by pathogenic bacteria. The causes of abnormal vaginal discharge may be infective or non-infective. It is usually related to one of the three conditions, such as BV, vulvovaginal candidiasis (VC), and trichomoniasis [18]. We found that the most common causes were fungal infection in 23.3% of cases, a bacterial infection in 22.6%, and only 2.4% for sexually transmitted diseases. However, studies carried out in developing countries demonstrated that the vaginal discharge is caused by STIs in up to 90% of cases [19,20]. Pathological vaginal discharge includes secretions accompanied by itching, rash or soreness, persistent, increased discharge, burning during urination, white, clumpy discharge, a discharge that is heavier and thicker than usual and grey/white or yellow/green discharge [21]. The most common symptom reported in our study was itching 49.2% followed by redness 48.4%, dysuria 36%, and swilling 4.5%. The discharge was colorless in 39.1% of cases, whitish in 32.1%, and yellowish in 28.7%. As regards treatment, our study reported, 68.7% of cases seeking medical care, 66.3% had medical treatment and improvement occurred in 56% of cases, recurrence after treatment occurred in 43.4%.

Table 4. Relationship between increased vaginal discharge with pregnancy and age, educational level, pregnancy order, diabetes, hypertension, obesity and smoking among the studied pregnant women, KSA, 2019 (N = 1,022).

Variables Responses Increased vaginal discharge with pregnancy Total (N = 1,022) p-value
Yes (n = 783) No (n = 284)
Age group <21 32 14 46 0.001
4.3% 4.9% 4.5%
21-30 457 132 589
61.9% 46.5% 57.6%
31-40 195 107 302
26.4% 37.7% 29.5%
>40 54 31 85
7.3% 10.9% 8.3%
Educational level Primary 19 9 28 0.811
2.6% 3.2% 2.7%
Secondary 154 62 216
20.9% 21.8% 21.1%
University or more 565 213 778
76.6% 75.0% 76.1%
Pregnancy order First 231 102 333 0.268
31.3% 35.9% 32.6%
Second 192 53 245
26.0% 18.7% 24.0%
Third 111 41 152
15.0% 14.4% 14.9%
Fourth 75 31 106
10.2% 10.9% 10.4%
Fifth 68 32 100
9.2% 11.3% 9.8%
Sixth 47 21 68
6.4% 7.4% 6.7%
Seventh or more 14 4 18
1.9% 1.4% 1.8%
Diabetes No 718 276 994 0.536
97.3% 97.2% 97.3%
Yes 20 8 28
2.7% 2.8% 2.7%
Hypertension No 720 276 996 0.439
97.6% 97.2% 97.5%
Yes 18 8 26
2.4% 2.8% 2.5%
Obesity No 599 237 836 0.225
81.2% 83.5% 81.8%
Yes 139 47 186
18.8% 16.5% 18.2%
Smoking No 716 274 990 0.349
97.0% 96.5% 96.9%
Yes 22 10 32
3.0% 3.5% 3.1%

Conclusion

The incidence of increased vaginal discharge among the studied pregnant women was 72.2%. The most common causes were fungal infection in 23.3% of cases, a bacterial infection in 22.6%. Therefore, we recommend health education for pregnant women about the importance of treatment of the cases and following the preventive measures to prevent the recurrence. Also, we recommend more detailed research studies must be conducted regarding this issue.


List of Abbreviations

KSA Kingdom of Saudi Arabia

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was done after verbal approval of King Faisal University.


Author details

Sarah Sami Almubarak1, Asrar Humaid Alsofyani2, AlHababi Zahra Ahmed1, Ghaida Saleh Almahboob1, Fatimah Adam Alaswad3, Fatema Abdullah AlThkerallah1, Betool Abdullah Alkwitem1, Maram Hussain Alfayez1

  1. King Faisal University, Hofuf, Saudi Arabia
  2. King Khalid University, Abha, Saudi Arabia
  3. Mansoura University, Hail, Saudi Arabia

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How to Cite this Article
Pubmed Style

Almubarak SS, Alsofyani AH, Ahmed AZ, Almahboob GS, Alaswad FA, AlThkerallah FA, Alkwitem BA, Alfayez MH. Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms. IJMDC. 2020; 4(3): 740-745. doi:10.24911/IJMDC.51-1578948957


Web Style

Almubarak SS, Alsofyani AH, Ahmed AZ, Almahboob GS, Alaswad FA, AlThkerallah FA, Alkwitem BA, Alfayez MH. Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms. http://www.ijmdc.com/?mno=81887 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1578948957


AMA (American Medical Association) Style

Almubarak SS, Alsofyani AH, Ahmed AZ, Almahboob GS, Alaswad FA, AlThkerallah FA, Alkwitem BA, Alfayez MH. Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms. IJMDC. 2020; 4(3): 740-745. doi:10.24911/IJMDC.51-1578948957



Vancouver/ICMJE Style

Almubarak SS, Alsofyani AH, Ahmed AZ, Almahboob GS, Alaswad FA, AlThkerallah FA, Alkwitem BA, Alfayez MH. Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms. IJMDC. (2020), [cited March 29, 2020]; 4(3): 740-745. doi:10.24911/IJMDC.51-1578948957



Harvard Style

Almubarak, S. S., Alsofyani, . A. H., Ahmed, . A. Z., Almahboob, . G. S., Alaswad, . F. A., AlThkerallah, . F. A., Alkwitem, . B. A. & Alfayez, . M. H. (2020) Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms. IJMDC, 4 (3), 740-745. doi:10.24911/IJMDC.51-1578948957



Turabian Style

Almubarak, Sarah Sami, Asrar Humaid Alsofyani, AlHababi Zahra Ahmed, Ghaida Saleh Almahboob, Fatimah Adam Alaswad, Fatema Abdullah AlThkerallah, Betool Abdullah Alkwitem, and Maram Hussain Alfayez. 2020. Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms. International Journal of Medicine in Developing Countries, 4 (3), 740-745. doi:10.24911/IJMDC.51-1578948957



Chicago Style

Almubarak, Sarah Sami, Asrar Humaid Alsofyani, AlHababi Zahra Ahmed, Ghaida Saleh Almahboob, Fatimah Adam Alaswad, Fatema Abdullah AlThkerallah, Betool Abdullah Alkwitem, and Maram Hussain Alfayez. "Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms." International Journal of Medicine in Developing Countries 4 (2020), 740-745. doi:10.24911/IJMDC.51-1578948957



MLA (The Modern Language Association) Style

Almubarak, Sarah Sami, Asrar Humaid Alsofyani, AlHababi Zahra Ahmed, Ghaida Saleh Almahboob, Fatimah Adam Alaswad, Fatema Abdullah AlThkerallah, Betool Abdullah Alkwitem, and Maram Hussain Alfayez. "Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms." International Journal of Medicine in Developing Countries 4.3 (2020), 740-745. Print. doi:10.24911/IJMDC.51-1578948957



APA (American Psychological Association) Style

Almubarak, S. S., Alsofyani, . A. H., Ahmed, . A. Z., Almahboob, . G. S., Alaswad, . F. A., AlThkerallah, . F. A., Alkwitem, . B. A. & Alfayez, . M. H. (2020) Increased vaginal discharge during pregnancy: prevalence, causes, and associated symptoms. International Journal of Medicine in Developing Countries, 4 (3), 740-745. doi:10.24911/IJMDC.51-1578948957