White Vaginal Discharge Does Not Require 24-Hour Observation
White vaginal discharge is a normal physiologic finding in pregnancy and does not indicate trauma-related complications requiring extended observation. The correct answer is d. White vaginal discharge.
Indications for 24-Hour Observation After Minor Trauma in Pregnancy
The American College of Obstetricians and Gynecologists recommends extending monitoring to 24 hours when high-risk features are present 1. These specific features include:
Required Observation Criteria
Vaginal bleeding - This indicates potential placental abruption or other obstetric complications and mandates 24-hour observation 2, 1, 3
Sustained contractions (>6 per hour or >1 per 10 minutes) - Frequent uterine contractions suggest potential placental abruption or preterm labor and require extended monitoring 2, 1, 3
Significant uterine tenderness - This is a key clinical sign of placental abruption and necessitates 24-hour observation 2, 1, 3
Additional High-Risk Features Requiring Extended Monitoring
Beyond the options listed in the question, other factors warranting 24-hour observation include 1, 3:
- Rupture of membranes
- Atypical or abnormal fetal heart rate patterns
- High-risk mechanism of injury
- Serum fibrinogen <200 mg/dL
- Significant abdominal pain
Standard Monitoring Protocol
For pregnant trauma patients ≥23 weeks gestation without high-risk features, 4-6 hours of continuous electronic fetal monitoring is sufficient 2, 1, 3, 4. This shorter observation period applies to asymptomatic women with reassuring fetal heart rate patterns and no uterine contractions 5.
Why White Vaginal Discharge is Not Concerning
White vaginal discharge (leukorrhea) is a normal physiologic finding during pregnancy caused by increased estrogen levels and cervical mucus production. It does not indicate trauma-related injury, placental complications, or fetal compromise. Unlike the other options, it requires no specific intervention or extended observation period.
Common Pitfall to Avoid
Do not confuse normal white discharge with clear fluid (which could indicate rupture of membranes) or bloody discharge (which indicates potential placental abruption). Only the latter two require extended monitoring 3.