Patient Presentation:
SD, an 18 year old teenager came to the labor and delivery unit
complaining of preterm contractions that had started three days prior to
arrival. She was 26 weeks pregnant, and it was her first pregnancy. She
had a history of genital herpes and asthma. She was taking albuterol as
needed for her asthma. Her vital signs were HR 87; BP 126/72; T 37.2
degrees Celsius; SaO2 99% on room air. When the patient was placed on the
external fetal monitor, the tocometer (contraction monitor) showed that
the patient was contracting every 2 to 3 minutes. When the resident put
the patient in lithotomy position to perform a speculum exam to see if her
cervix was dilated, a fishy smell permeated the room. The resident noticed
homogeneous, thin, grayish-white discharge that smoothly coated the
vaginal walls. When questioned, the patient stated that she had been
having an increase in thin, off-white discharge for the past three months.
She had assumed it was a normal sign of pregnancy. The patient did not
feel any of the contractions that were showing up on the external fetal
monitor.
Differential Diagnosis:
Diagnosis:
The resident took a sample of the discharge and placed it on the glass
side to examine it under the microscope. Clue cells were noted on the
saline wet mount. The patient’s cervix was long and closed which ruled out
preterm labor. The patient denied vaginal itching, and the discharge did
not look like yeast. A positive whiff test helped confirm the diagnosis of
BV.
Treatment/Prognosis:
Once the diagnosis was made, the patient was given a prescription for
metronidazole 250 mg orally three times daily for seven days. IV fluids
had been started because of the contractions. She stopped contracting
after a 1000ml bolus of lactated ringers. Approximately 30 percent of
patients with initial responses to therapy have a recurrence of symptoms
within three months and more than 50 percent experience a recurrence
within 12 months
Outcome:
The patient was sent home with her prescription later that day. Her
physician saw her in the office three weeks later. Her bacterial vaginosis
had resolved. She returned to the labor and delivery unit 14 weeks later
and delivered a 7 lb 4 ounce baby girl.
Case created by Sarah Davis, 2011.