Study case- Vaginal secretions

Question 1

25-yea r-old preg nant female a rrived at her hospital’s Labor and Del ivery beca use she feels she wi ll del iver soon. She c l a i m s t o be 30 weeks i nto her preg nancy and is havi ng “ odd “ sensations triggered by recent i ntercou rse. The L&D staff performed
a digital exami nation and then col lected a vaginal swab and send it to the laboratory for a feta l fi bronecti n test. The test demonstrates a positive resu lt; however, there was no event of preterm del ivery
with in the expected 7- to 1 0-day period . Del ivery occu rred normally at 34 weeks.

1. What may have caused the false-positive results obtained?
   =>
2. What other tests can be used to screen for ruptured of fetal membranes?
   =>

Answer 1

1. What may have caused the false-positive results obtained?
   => False-positive fetal fibronectin results may be obtained on specimens from patients in whom the cervix has been disrupted during sexual intercourse, digital cervical examination, vaginal probe ultrasound, or other disruptive events.
2. What other tests can be used to screen for ruptured of fetal membranes?
   =>. Traditional procedures for the diagnosis of rupture of fetal membranes (ROM) include pooling of amniotic fluid observed during speculum examination, nitrazine test, and a ferning test. Besides fetal fibronectin (fFN), other tests to detect ROM are AmniSure, which tests for placental alpha microglobulin-1 (PAMG-1) and the Actim PROM, which tests for insulin-like Growth Factor Binding Protein-1 (IGFBP-1).

Question 2

A 2 0-year-old preg nant female presented to the clinic com plaining of yellow g reen vaginal d ischarge. She stated that her partner was asym ptomatic. Va ginal secretions we re
coll ected for wet prepa ration and cervica l secretions were coll ected for molecu lar probes for gonorrhea and Chlamyd ia. The
wet prepa ration showed moderate wh ite blood cel ls and moti le flagel l ates with je rky movement. The patient was treated with metroni dazole

1. What infection does this patient have?
2. What risks does this infection pose to the developing fetus, if any?
3. What techniques are used to detect this organism?
4. What are the expected vaginal pH and amine test results in this case and why is the pH altered?

Answer 2

1. What infection does this patient have?
   =>Trichomonas vaginalis.
2. What risks does this infection pose to the developing fetus, if any?
   =>In pregnant women, Trichomonas is a risk factor for preterm rupture of membranes and preterm labor and delivery.
3. What techniques are used to detect this organism?
   =>The wet mount is helpful to detect the majority of cases of Trichomonas, but culture or DNA probe for Trichomonas is useful when the wet preparation is negative but trichomoniasis is strongly suspected.
4. What are the expected vaginal pH and amine test results in this case and why is the pH altered?
   =>In Trichomonas, the bacterial flora is also altered and the pH is abnormally elevated to 5.0 or 6.0. The amine or “whiff” test may also be positive with Trichomonas as well as with vaginosis due to the altered bacterial flora and vaginal pH.