White Vaginal Discharge Does Not Require 24-Hour Observation
White vaginal discharge is a normal physiologic finding in pregnancy and does not require 24-hour observation following minor trauma, making option D the correct answer. 1
Indications for 24-Hour Observation After Minor Trauma
The American College of Obstetricians and Gynecologists clearly defines high-risk features that mandate extended monitoring to 24 hours in pregnant trauma patients at ≥23 weeks gestation 1:
Findings Requiring 24-Hour Observation:
Vaginal bleeding - This is a concerning sign that may indicate placental abruption, which occurs in approximately 1% of pregnancies and is associated with worse perinatal outcomes 2, 3
≥6 contractions per hour (sustained contractions >1/10 min) - Regular uterine contractions suggest preterm labor or uterine irritability from trauma 3, 4
Significant uterine tenderness - This finding is highly associated with pregnancy complications, with a 19.3% complication rate when present versus 0.9% when absent 3, 5
Additional high-risk features include: rupture of membranes, abnormal fetal heart rate patterns, high-risk mechanism of injury, or serum fibrinogen <200 mg/dL 3
Why White Vaginal Discharge is Excluded
White vaginal discharge (leukorrhea) is a normal physiologic finding during pregnancy caused by increased estrogen levels and cervical gland activity 4. It does not indicate trauma-related complications such as:
- Placental abruption
- Preterm labor
- Uterine rupture
- Fetomaternal hemorrhage
Standard Monitoring Protocol
For pregnant trauma patients ≥23 weeks gestation without high-risk features 1, 3:
- Minimum 4-6 hours of continuous electronic fetal monitoring is required even after minor trauma
- Patients may be discharged if monitoring remains reassuring and no high-risk features develop
- The presence of any high-risk feature (vaginal bleeding, contractions, uterine tenderness) extends observation to 24 hours 1, 3
Clinical Pitfall to Avoid
Do not confuse white vaginal discharge with clear fluid (which could indicate rupture of membranes) or bloody discharge (which requires extended monitoring) 3. In cases of vaginal bleeding at ≥23 weeks, defer speculum or digital examination until placenta previa is excluded by ultrasound 3.