Pregnancy is not only a joyful period, but also a restless one; it does not always pass serenely. Expectant mothers often face a wide variety of complications. Some of them cause only minor discomfort and go away on their own, while others can lead to serious consequences and require immediate medical attention. One of these complications is leakage of amniotic fluid.
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Gynecology
obstetrician-gynecologist at the Nova Clinic network of reproductive and genetics centers
The reasons for leakage of amniotic fluid can be very different. Most often the selection amniotic fluid caused by some inflammatory process in the body.
Leakage can also be caused by isthmic-cervical insufficiency, anatomical abnormalities in the structure of the uterus, abdominal trauma and many other factors. Sometimes the exact cause cannot be determined.”
According to our expert, leakage of amniotic fluid is very dangerous, since it is associated with a high risk of stillbirth, death in the perinatal period, as well as the development of various diseases in newborns.
“Further tactics for managing pregnancy in case of leakage of amniotic fluid largely depends on the period. The higher it is, the better the prognosis,” adds the doctor.
The role of amniotic fluid
Firstly, amniotic fluid (amniotic fluid) fills the amniotic sac, creating a comfortable and safe environment for the developing fetus throughout pregnancy. Thanks to the amniotic fluid, the fetus can move freely and actively, while the water softens its movements, protecting the mother from sudden shocks.
Secondly, the waters form a kind of shock-absorbing barrier that protects the baby from external influences and from being compressed by the walls of the uterus.
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In addition, sterile amniotic fluid participates in the child’s nutritional processes and does not allow pathogenic organisms from the external environment to penetrate into the fetal bladder. The waters are renewed every few hours, while constantly maintaining an optimal chemical composition.
By the end of pregnancy, the volume of amniotic fluid reaches 1.5 liters. Normally, the membranes rupture and waters are released during the first stage of labor at least 38 weeks into the pregnancy. In 10–15 percent of pregnant women, the integrity of the amniotic sac is disrupted long before the due date, which can lead to serious consequences for the mother and the child.
Signs and diagnosis
Massive discharge of water is difficult to confuse with something else, since a large volume of liquid is poured out at a time. But in some cases, a hidden rupture of the fetal bladder occurs, the membrane is torn in its upper or side part and water can leak in small quantities. Sometimes a woman does not notice the leakage for a long time.
The main sign of leakage of amniotic fluid is watery discharge, which increases with physical stress and changes in body position.
Sometimes, especially in late pregnancy, leakage can be easily confused with normal vaginal discharge, which may become heavier and thinner than usual towards the end of pregnancy. There are also frequent cases when leakage of water is confused with urinary incontinence - the enlarged uterus puts pressure on the bladder, and during physical stress, laughter or sudden movements, urine can be involuntarily released in small quantities.
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If water leaks in large quantities, the pregnant woman’s abdomen may decrease in volume, and sometimes there is also a decrease in the height of the uterine fundus.
Due to the fact that amniotic fluid is colorless and has no specific odor, minor leakage may go unnoticed for a long time, and even a doctor is not always able to recognize the problem. For diagnosis in this case, special tests are prescribed. Most often, this is a cytological analysis of a smear from the posterior vaginal fornix, designed to determine the presence of elements of amniotic fluid in the vaginal discharge.
If there is excessive leakage, diagnostic methods such as a routine vaginal examination and a cough test can be informative (physical stress when coughing causes increased leakage).
If other methods do not give an accurate result, in cases where the pregnant woman’s condition raises concerns for her and the fetus’s life and health, the amniocentesis method is used - in this case, a safe, non-toxic dye is injected into the cavity of the amniotic sac, and a clean tampon is placed in the patient’s vagina.
The staining of the tampon is 100% likely to indicate water leakage, but the amniocentesis method is dangerous in itself, since during its implementation the integrity of the membrane of the amniotic sac must be broken.
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It is rare for a woman to independently determine whether amniotic fluid is leaking. If you have any suspicions, the most in a simple way the “clean diaper” method becomes a confirmation or refutation of them. To do this, the pregnant woman needs, after completely emptying her bladder and thoroughly washing herself, to simply wipe herself dry and lie down on a clean, dry diaper for 30–60 minutes. If after this a wet spot is found on the diaper, you should immediately seek medical help.
There are also special tests that make it possible to determine water leakage with a high degree of probability at home. The test consists of a swab, a bottle of reagent and a test strip. The tampon is inserted into the vagina for a while, and then placed in a bottle with a solution. After this, you need to lower a test strip into the bottle, on which lines will appear indicating rupture of the membranes or its absence.
One strip means the absence of a gap, two confirm its fact
Causes and consequences of amniotic fluid leakage
The causes of ruptured membranes are usually the following:
- Inflammatory and infectious diseases of the pelvic organs, causing the membranes of the amniotic sac to become thinner and lose elasticity. These may be such common diseases as colpitis or endocervicitis
- Isthmic-cervical insufficiency. If the cervix does not close completely, the amniotic sac may protrude into the cervical canal. In this condition, it can easily become infected and damaged.
- Multiple pregnancy. In this case, the walls of the uterus and the membranes of the fetal bladder are subjected to heavy load
- Developmental anomalies, benign or malignant formations uterus
- Significant exercise stress, physical violence, abdominal trauma
Leakage of amniotic fluid is a serious complication of pregnancy, requiring immediate medical attention and hospitalization. The fact is that violation of the integrity of the bladder threatens premature onset of labor and infection of the fetus - the baby, not protected by a sealed bladder and the barrier of amniotic fluid, is defenseless against infections.
Pregnancy is a hectic time, full of worries and alarming symptoms. One cause for concern is the fear of not recognizing amniotic fluid leakage. Women are often interested in the symptoms and mechanism of this phenomenon: how to distinguish when amniotic fluid leaks out and when the discharge is completely natural and does not require concern. In many cases, such leakage goes unnoticed only because the woman confuses the release of amniotic fluid with intense, natural vaginal discharge. Often in practice there are moments when women worry absolutely in vain. The discharge that they mistook for amniotic fluid turns out to be natural discharge or urine.
Therefore, it is so important to have at least basic knowledge in this area and independently distinguish between pathological and normal discharge. The course of further actions depends on this. If amniotic fluid actually leaks, you need to act immediately - call ambulance, consult a doctor. If the liquid is of a different nature, you should make sure of this as quickly as possible and not worry for an extra minute.
It is necessary to understand that amniotic fluid refers to the liquid that acts as the habitat of the fetus. It provides reliable protection, supplies nutritional components, and removes decay products and toxins. Also, thanks to this environment, the child is completely safe and protected from the damaging effects of mechanical factors. The liquid promotes a comfortable position in which the walls of the uterus do not compress the fetus, provides turgor, serves as a shock absorber of movements, and ensures normal and complete formation.
The fluid with membranes has bactericidal properties, which prevents contamination by microorganisms from the external environment.
The reservoir of this fluid is the fetal bladder, the development and formation of which occurs as the child develops. The amount of fluid also increases as the baby develops, up to 1-1.5 liters by the expected date of birth. It is formed by the sweating of maternal blood components through the placental vessels.
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ICD-10 code
O42 Premature rupture of membranes
Epidemiology
Despite the fact that this phenomenon occurs, a lot is said and written about it, it does not occur very often. Leakage is observed in approximately one case out of 30,000. There is constant debate among scientists and practitioners regarding how much amniotic fluid should be taken as normal. Doctors agree that the volume is directly dependent on the gestational age and is approximately 35 ml in the tenth week. By the fourteenth, this volume increases approximately 3 times and averages 100 ml. At the twentieth week, this volume is 400 ml. The largest volume of fluid is observed at week 38 - approximately 1000-1500 ml. Immediately before the baby is born, these numbers decrease and reach approximately 1000 ml.
The composition of the amniotic fluid is quite interesting: approximately 98% of it is formed by water, the rest is substances dissolved in it. In 85 women, water flows out on time, in 15% it occurs prematurely.
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Causes of amniotic fluid leakage
The ability to take the right measures is directly proportional to the knowledge of the reasons why amniotic fluid leaks. The problem is that determining the exact cause of a leak is a rather complex and time-consuming process. It is not always possible to identify one specific cause.
Knowing the causes of leakage is necessary in order to be able to take the right measures. Define exact reason leakage is quite difficult. Especially when the amount of water is insignificant. Research on this issue is still being carried out by scientists from different countries world, and there is still no exact answer. Most researchers identify a number of reasons that may directly or indirectly influence this phenomenon. On average, there are five main reasons.
Most researchers are inclined to assume that leakage is a consequence of infectious and inflammatory diseases affecting both external and internal reproductive organs. These processes are closely related to the development of pathogenic microflora. As a result, the placenta and fetal membranes soften. The process may result in severe bleeding, and the fetus may be subject to hypoxia.
The process can also begin because the fetus is not presented correctly and the pelvic area is narrowed. This causes leakage and is accompanied by a slow dilatation of the cervix. Also, if there is cervical insufficiency (which is observed in a quarter of pregnant women), water will leak. The amniotic sac protrudes and becomes highly vulnerable, which significantly increases the risk of developing an infectious process. The amniotic cavity becomes inflamed, inside which pathogenic microflora develops.
The effects of chemicals, narcotics, harmful substances, nicotine, pathological lesions of bone tissue, large fetal size, twins lead to cervical insufficiency, which can cause leakage.
Often, leakage begins because the woman underwent invasive testing methods. Taking amniotic fluid has a particularly negative effect if the woman has had a chorionic villus biopsy.
After sex, intense discharge is observed, often mistakenly confused with amniotic fluid. It must be remembered that natural vaginal discharge is quite intense. After sex they intensify. Additionally, sperm is added to the entire fluid. In addition, semen contains prostaglandins, which stimulate additional mucus synthesis. Leakage occurs only when there is a possibility of miscarriage or excessive tone. During sexual intercourse, arousal occurs and tone increases. For your own peace of mind, it is better to get tested.
Risk factors
If a woman has an infectious process in the genital area, she automatically falls into the risk group. Especially if problems arose long before the woman became pregnant. Women in labor with congenital uterine defects and cervical insufficiency require increased attention, since the cervix loses its ability to resist the pressure of a growing child. With polyhydramnios and multiple pregnancies, some of the fluid may leak.
Pathogenesis
The pathogenesis is based on the pathological condition of the cervix, in which it does not close sufficiently and part of the fluid is discharged. In this position, microorganisms easily penetrate into the cervix, causing an inflammatory and infectious process. As a result of vital activity and the proliferation of microorganisms, the inflammatory process spreads further, the walls of the uterus become thinner, and the fetal membranes also become thin and lose their elasticity. They are not capable of fully performing their functions. The process worsens, and fluid begins to be released through the cervix. It can be released in drops, almost imperceptibly, or abundantly. For more later During pregnancy, leakage can occur as a result of the pelvic floor muscles relaxing and the outflow of fluid becoming impossible to control.
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Symptoms of amniotic fluid leakage
It is quite difficult to detect leakage if a woman is on early stages. Firstly, the volume of liquid is still small. Secondly, all the discharge increases, which can confuse a woman and confuse sensations. Amniotic fluid can be recognized by its clear or greenish tint and the absence of any odor. The discharge intensifies if you lie down in a horizontal position. They are involuntary and cannot be controlled.
In the later stages, it is much easier to detect leakage; more precisely, it cannot be ignored: there is a copious separation of fluid, about 0.5 liters. At these stages, the liquid already acquires a slight specific odor and is accompanied by contractions. This is a sign of impending labor, which usually occurs within the next 3 hours.
First signs
If wet spots appear on your underwear, these are the first signs. At the initial stages, the amount of liquid is insignificant, later - abundant. If at first the liquid may leak out in small drops and may not be noticed, then later the liquid pours out and has an unusual odor.
Norm of amniotic fluid leakage
Normally, fluid should be released only when labor has already begun. It shouldn't be there at other times. Water flows out through the genital tract. This should occur no earlier than 38 weeks. 500 ml of liquid is poured out at a time. The smell comes out unusual, specific. All this is accompanied by contractions, the strength and intensity gradually increases.
Sensations when leaking amniotic fluid
There is a feeling of sudden or gradual leakage of fluid from the female genital tract. There are no specific sensations observed. There is no pain, burning or itching. If fluid leaks just before labor, the leak is immediately followed by contractions, which can be painful.
Leakage of amniotic fluid in the 1st, 2nd, 3rd trimester
The only way out of the situation is abortion. Until now, there are no cases of conservation in practice that would be successful. Most attempts ended in severe sepsis of the mother and fetus. Leakage is accompanied by the active spread of pathogenic microflora and the inflammatory process, the walls of the amniotic cavity become thinner and lose their elasticity. In many cases, leakage is the result of a woman falling. Also often observed in people who have been subjected to violence.
Up to 20 weeks, leakage is always accompanied by inflammation. At this stage, it is impossible to save the baby. Even if it was possible to save, the newborn had multiple disorders, often incompatible with life.
Leakage in the second trimester still carries a number of risks and life-threatening consequences. Optimal conditions are created for the infection to penetrate inside, spread and multiply. As soon as there are all grounds for making a diagnosis, an ultrasound scan is prescribed. Using ultrasound, they determine how mature the fetus is and determine the degree of its readiness to exist outside the mother’s body.
With a sufficient degree of development of the kidneys and respiratory organs, labor begins to be stimulated. This is the best option because it allows you to save the child’s life. If the child is not yet mature enough, it is necessary to prolong the pregnancy and wait for the fetus to be ready for birth.
If amniotic fluid leaks in the third trimester, an ultrasound is performed, which makes it possible to assess the degree of fetal maturity. If the fetus is ready to exist outside the uterus, labor is stimulated. If the fetus is not mature enough, pregnancy is prolonged.
Leakage of amniotic fluid at 38, 39, 40 weeks of pregnancy
During any of these periods, labor can be expected to begin, so if fluid leaks, you should expect early labor. Usually, contractions and further labor begin immediately after the fluid is released. If this does not happen, labor must be induced after some time to avoid complications. The baby is ready to be born.
Leakage of amniotic fluid without contractions
Contractions usually begin immediately. But there are cases when there are no contractions for a long time.
If fluid leaks, you need to quickly go to the maternity hospital, where you must tell the doctor the exact time when the fluid began to leak.
This is information by which the doctor determines the child’s condition and potential threats. In some cases, after effusion there are no contractions. This period can last up to 72 hours. Usually, if there are no contractions within 12 hours after the water breaks, stimulation is performed. If there is a risk of infection, stimulation is carried out after 5-6 hours.
Leakage can occur both at night and during the day. Usually, overnight leakage is indicated by wet marks on the sheet.
Stages
There are three stages of amniotic fluid leakage - leakage on early stage pregnancy is the most dangerous and often ends in forced abortion.
Leakage in the middle stage of pregnancy is also dangerous and carries a risk of infection to the fetus. When the baby is mature enough, labor is artificially induced. If the baby is not yet ready for independent existence, the pregnancy is prolonged.
In the third, late stage, leakage is relatively safe. Usually at this time the fetus is already mature and labor begins: natural or artificially induced. If the fetus is immature, pregnancy is prolonged until maturity.
Forms
Leakage of amniotic fluid can develop within normal limits, or it can be pathological. In the first case, this phenomenon is part natural birth, occurs at a time when the first stage of labor is nearing its end. In this case, the cervix dilates completely or partially. If the leakage is pathological, leakage can occur at absolutely any stage, even in the first trimester. There are 5 main types of leakage: timely, premature, earlier, delayed and leakage due to a high cervical rupture.
Complications and consequences
Involves unpredictable consequences. They will not exist only if the fetus is full-term and is already able to live an independent life, outside the uterus. If the pregnancy is premature, serious consequences and complications can be observed, including intrauterine infection of the fetus and infectious damage to the body. A common complication is chorioamnionitis. Endometritis also often develops, during which the uterus itself becomes inflamed. The consequence is the spread of the infectious process throughout the body.
Why is leakage of amniotic fluid dangerous?
Leaking is an unsafe process. The danger lies in the fact that only part of the liquid remains, and the rest loses its ability to function normally. The fetus becomes vulnerable, and the risk of developing infection and sepsis increases. As a result, both the fetus and the mother may die.
This is due to a violation of the natural barrier, which protects the fetus from infection and mechanical damage. Various microorganisms can penetrate through this barrier: viruses, bacteria, fungi. The umbilical cord may be compressed, resulting in disruption of normal metabolism. The conditions under which free movement and full development of the fetus are possible are violated. The synthesis of necessary components, tightness and sterility are disrupted.
Diagnosis of amniotic fluid leakage
Diagnosis can be carried out independently, or at a medical consultation. Assess the nature of the discharge that remains on the sheets and underwear. Commercial test systems are sold. For example, special pads, express tests, the action of which is based on the difference in pH. Amniotic fluid is characterized by the highest acidity. The system contains an indicator that reacts to the liquid that falls on it. In this case, the shade of the indicator and the medium changes.
Special laboratory and instrumental research methods are available at a doctor’s appointment.
How to detect leakage of amniotic fluid at home?
You should resort to a small test. You need to keep your bladder empty. The perineum should be clean and not wet. There should be a bedding on the bed white fabric. You should lie down on it, lie quietly, without moving, for about an hour. After this you can get up. If there is no discharge, there is no need to worry.
Express tests for leakage of amniotic fluid
Most tests are easy to use and not at all complicated. Their principle of operation is to determine the level of acidity. The indicator interacts with various environments, resulting in chemical reactions. Initially tests yellow color. When the indicator is exposed to natural vaginal secretions with a pH of 4.5, no reaction occurs. Because it initially corresponds to this level of acidity. The reaction occurs when other liquids enter, then a color change occurs.
For example, urine has a pH of 5.5, which corresponds to a greenish-blue hue. The highest acidity level is in amniotic fluid, pH = 7. When they come into contact with the indicator, it turns an intense blue-green color.
Strips for detecting leakage of amniotic fluid
A method that makes it possible to clarify the nature of the discharge. The appearance of two stripes indicates the presence of leakage; one strip indicates that the secreted fluid is not amniotic. If there are no stripes, the test is unsuitable or carried out incorrectly. The procedure must be repeated.
Test for leakage of amniotic fluid
Instructions for the test for leakage of amniotic fluid
Specialists and manufacturers have developed a special step-by-step instruction. You need to prepare the test, print out the packaging, read the instructions. The test contains a special test tube with a solvent.
It is necessary to collect biological material to be examined. To do this, you need to take a tampon and make a smear yourself, collecting vaginal discharge on it. After this, the swab is placed in a test tube with a solvent and the further reaction is observed. The first reaction occurs within 1 minute. If amniotic fluid is released, it contains placental immunoglobulin. It is he who reacts with the solvent.
After this, you need to place a special indicator, presented in the kit in the form of a strip, into the test tube. The result will be known after 5-10 minutes. If there is amniotic fluid, a blue-green color will appear.
Amnishur test to determine the leakage of amniotic fluid
Testing should be carried out in accordance with standard instructions for using such systems. The reaction manifests itself as a change in color if placental microglobulin is present in the smear. The main reaction occurs in a test tube between the reagent, a swab with a smear and an indicator.
The method is absolutely reliable and effective; it is used both in home practice and in professional practice to detect the leakage of amniotic fluid. The advantage of the test is that it reacts even to minimal amounts of liquid, which makes it possible to detect pathology long before the first visible signs appear.
Gaskets for leakage of amniotic fluid
Today you can buy special gaskets that make it possible to determine the cause of leaks. Externally, the pads are the same as ordinary sanitary pads, the difference is that they contain an indicator that reacts to even a slight release of amniotic fluid. The test is unusually simple: a pad is attached to your underwear and left for the whole day. Then their condition is checked. If there is leakage of amniotic fluid, the pad changes color, becoming blue-blue. If it is any other discharge, there is no change in color.
Frautest for leakage of amniotic fluid
A test produced by FRAUTEST, whose products are used in professional obstetric practice and are recognized by specialists all over the world. The test is available in the form of pads, which include an indicator. Ingress of amniotic fluid is characterized by a change in the color of the test system. The test takes 12 hours.
Grandmother's method for determining leakage of amniotic fluid
Analysis for leakage of amniotic fluid
Sometimes it can be quite difficult to make a correct diagnosis. Difficulties arise even when the inspection is carried out by a professional. Therefore, the basis of diagnosis is analysis, which allows you to obtain absolutely accurate results. Even instrumental diagnostics do not give accurate results.
Color of amniotic fluid when leaking
Color is an important diagnostic sign by which the doctor determines many things. Normally, amniotic fluid is clear. Cloudiness and different color indicate various pathologies. If a yellow tint and slight turbidity appear, you also don’t have to worry, since such a picture is considered as a variant of the norm.
If a reddish tint and minor inclusions appear against the background of yellow water, the process is accompanied by contractions - we can safely say: labor has begun.
Green color of the water is a negative sign; the fruit is seriously damaged. Talks about defecation in the womb, deficiency, and the likelihood of developing intrauterine pneumonia. Possible hypoxia.
The appearance of a dark brown shade is a catastrophic situation. In 99% it indicates intrauterine fetal death. The urgent question of saving the mother's life is urgent. However, at present, this pathology is quite rare, since women regularly visit the doctor and such pathology can be noticed in a timely manner.
The appearance of a red color indicates bleeding.
Smear for leakage of amniotic fluid
To carry out the analysis, you need to take an ordinary smear from the vaginal environment and apply it to a glass slide. If, when the smear dries, it forms a structure shaped like a fern leaf or a maple leaf, it is amniotic fluid.
Instrumental diagnostics
It is preferable to focus on test results, since instrumental diagnostics are not very informative.
Ultrasound to determine amniotic fluid leakage
An ultrasound is performed. This study makes it possible to indirectly confirm the diagnosis. Based on the results of the ultrasound, a diagnosis is made: oligohydramnios or polyhydramnios, which does not directly indicate a leak.
Differential diagnosis
A differentiated diagnosis is carried out, during which amniotic fluid, urine or normal vaginal discharge are differentiated. Laboratory diagnostics prevails over instrumental ones.
The smell of amniotic fluid when leaking
Amniotic fluid has no odor. In late pregnancy, they may have a slight specific odor.
How to distinguish leakage of amniotic fluid from discharge?
These two types of discharge can be distinguished by their appearance. The waters are clear and slightly cloudy. Vaginal discharge is thicker and mucous, has a different shade, often white or yellowish.
Leakage of amniotic fluid or urinary incontinence
Amniotic fluid leaks constantly and cannot be controlled by muscle effort. Urine has a yellow tint and the smell of urine, which cannot be said about amniotic fluid. They are usually colorless and odorless. With pathology, amniotic fluid acquires green, brown, red and other shades.
Cervix with leakage of amniotic fluid
The cervix dilates directly during labor. Leakage does not depend on the conditions of the cervix, but is determined by the condition of the amniotic sac. Most often, leakage is observed when the cervix is closed, but sometimes it is open.
Treatment of amniotic fluid leakage
There is no treatment for leakage of amniotic fluid. The doctor determines the likelihood of infection and, in accordance with this, takes further actions: prolongs the pregnancy or stimulates labor. Antibacterial therapy may sometimes be used to prevent infection. They also use products aimed at relaxing muscles, the uterus, general health-improving agents, and vitamins.
What to do if amniotic fluid leaks?
If leakage of amniotic fluid is detected, you must immediately call an ambulance or consult a doctor. At the same time, it is important to remain calm and not panic. If hospitalization is offered, under no circumstances should you refuse. Only with constant medical supervision and proper treatment can further development of the pathology be prevented.
How to stop leakage of amniotic fluid?
It is impossible to stop the leakage of amniotic fluid. You can only consult a doctor in a timely manner and take the necessary measures to prevent infection and maintain pregnancy.
Medicines
Any medications must be taken strictly according to the doctor’s recommendation, preferably during inpatient treatment. Drugs that regulate uterine tone are extremely dangerous and have many side effects. Many of them are taken under strict supervision blood pressure, pulse, electrocardiogram indicators.
In order to ensure prolongation of pregnancy, ginipral is taken, which reduces excessive uterine tone. It contracts less frequently and less intensely. The active ingredient is hexoprenaline sulfate. Tablets contain 500 mg of active ingredient. First, take 1 tablet at a time. every 3 hours, then every 4-6 hours. The daily dose is 4-8 tablets. Taking the pills should be accompanied by constant monitoring of the heart function of the mother and fetus. If the heart rate is more than 130 beats/min, the dosage is reduced. The drug has numerous side effects, both for mother and baby. Up to cardiac and respiratory failure, hypoxia. In newborns, anemia, acidosis, and hypoglycemia are possible.
Salbupart is a drug that significantly reduces the contractile activity of the uterus. The drug is administered intravenously. One ampoule is mixed with 500 ml of saline solution and poured in at a rate of 5 drops per minute.
Bricanil – relieves spasms, hypertonicity, provides muscle relaxation. Used when there is a threat of spontaneous miscarriage or cervical insufficiency. The drug is prescribed 2.5 - 5 mg 3 times a day (1-2 tablets).
Partusisten is a drug prescribed to relax smooth muscles. Administered intravenously. The optimal dosage is individual and varies widely from 0.5 to 3.0 mcg/min. When performing an infusion, 2 ampoules of the drug (10 ml) are added to a physiological solution with a volume of 230 ml.
Utrozhestan and leakage of amniotic fluid
Discharge formed when the suppository melts is often confused with leakage of amniotic fluid. To get an accurate answer, it is better to test for leakage of amniotic fluid.
Vitamins
A pregnant woman, both during the normal course of pregnancy and during pathology, requires vitamins. It is recommended to take vitamins in the following daily concentrations:
- vitamin H – 150 mcg
- vitamin C – 1000 mg
- vitamin D – 45 mg
- vitamin K – 360 mcg.
Physiotherapeutic treatment
When prolonging pregnancy, some physiotherapeutic procedures, for example, ultrasound, can be used. Physiotherapy is used to relax smooth muscles (electrical procedures), to eliminate and prevent further spread of the inflammatory and infectious process. Electrophoresis is also often used, which ensures deep penetration of drugs into organs.
Traditional treatment
When turning to folk remedies for treating amniotic fluid leakage, it is better to first consult a doctor. Folk remedies effective and safe when used correctly, as well as as part of complex therapy.
One of effective means medicinal baths that help relax the muscles of the uterus. Baths are carried out at home. The duration of the bath is 15-20 minutes, the frequency of use is 3-4 times a week. A bath with pine extract has proven itself well. To prepare a bath, make a decoction of pine needles separately, about 2-3 liters. Then fill the bath, set a comfortable temperature and pour in the pine needle extract. If desired, you can add a few branches of pine needles and cones. After taking a bath, do not dry yourself immediately, wait 3-5 minutes until the moisture is absorbed by the skin.
Therapeutic rubdowns have a positive effect. For this purpose, salt concentrate is used. Approximately 1 teaspoon of salt is dissolved in a glass of water. Making water room temperature, wipe the body with the resulting solution. The duration of rubdowns is 5-10 minutes. You can’t wipe yourself off right away; you should wait until all the moisture is absorbed. Salt helps remove toxins and excess fluid. Blood pressure decreases, metabolic processes are normalized.
Oriental incense combined with relaxing, meditative music has a long-lasting relaxing effect. It is recommended to light candles and incense sticks. Place it in a circle around the room. Turn on calm, relaxing music. Lie down in the center of the circle, close your eyes and try to relax as much as possible. It is necessary to feel every cell of the body, feel how they relax, become light and motionless. At the same time, you should let go of all thoughts and worries. Just enjoy the aromas and music without doing anything or thinking about anything. Moving is also not recommended. You need to listen to your heartbeat, breathing, and try to feel the baby’s movements. The duration of this procedure is at least 30 minutes. Conducted daily for at least 1 month.
Herbal treatment
When treating with herbs, it is necessary to carefully study their properties. It is better to first consult with a doctor who will help you accurately and correctly select the necessary remedy, dosage and correctly include it in complex therapy.
Blue cornflower herb helps to relax and reduce the tone of the uterus. To prepare a decoction, approximately 5 grams of herb is poured into a glass of boiling water and drunk throughout the day.
Chamomile herb has an anti-inflammatory effect. To prepare a decoction, approximately 15-20 grams of herb are poured into 2-3 cups of boiling water and drunk throughout the day. You can also include chamomile in your tea by simply adding a few tablespoons of the herb to the teapot.
A decoction of nettle and stevia is useful. Herbs are taken in equal parts and mixed together. To prepare the decoction, you need to take 30-40 grams of herb, pour 1-2 cups of boiling water. Drink as tea throughout the day. You can add sugar or honey to taste.
Homeopathy
Homeopathic remedies, contrary to popular belief, are not safe. They can have numerous side effects. Some homeopathic remedies may have an abortifacient effect. Therefore, it is important to take precautions. First of all, you need to consult a doctor for advice, and only after that take any medications.
- Nutrient mixture
Prepare a mixture of equal amounts of dried apricots, raisins, prunes, and figs. The specified substances are ground through a meat grinder, add 25 pieces of finely chopped walnut. Season the resulting mixture with honey. Infuse for 3-4 days, consume 1 tablespoon 1-2 times a day. Has an immunostimulating effect, relieves fatigue and weakness. Increases the body's performance and endurance.
- Rose hip decoction
Rosehip decoction is drunk in its pure form or added to tea to taste. Helps eliminate swelling and remove excess fluid from the body. Saturates the body with vitamins and nutrients.
- “Healing” mixture
To prepare the mixture, take approximately 200 g of juicy aloe leaves. Add approximately 250 grams of honey and 400 grams of grape wine. Leave for 7 days in a dark place. Drink 1 teaspoon 3 times a day. Helps reduce fluid outflow, stabilize the body, and normalize metabolism.
Remedy for increased fatigue and excessive fluid secretion
It is recommended to take powder from dried lemongrass fruits, 0.5 grams per day, pouring honey on top. The course of treatment is 30 days. Increases performance, improves well-being, eliminates swelling and excessive discharge of the female genital tract.
Surgery
If delivery is necessary, and it is impossible to carry out childbirth through natural means, an operation is performed C-section. If labor has already begun and there is no rupture of water, an amniotomy is performed, in which the amniotic sac is punctured, resulting in the release of fluid.
If the pregnancy is full-term and the baby is ready for independent existence outside the uterus, the prognosis is favorable. Then labor is induced, or caesarean section. If the respiratory system of the fetus is immature and is not ready for independent existence, pregnancy is prolonged and expectant therapy is carried out. The prognosis can be either positive or negative. Infection and sepsis may develop, which increases the risk of death of both mother and fetus.
If leakage of amniotic fluid occurs early in pregnancy, the prognosis is poor. An abortion is required, it is impossible to save the child, and there is a threat to survival. Otherwise, the closer to birth the leakage begins, the more favorable the prognosis.
A pregnant woman faces various kinds of difficulties throughout the entire period of bearing her baby. The remarkable thing is that many people carry a child without serious problems and postpartum complications. However, there is a percentage of women who are unlucky enough to have a certain type of pregnancy pathology. An example of such a pathological condition is leakage of amniotic fluid, which is dangerous to life and health baby circumstance.
In terms of its composition, amniotic fluid is a complex liquid that contains many nutrients and other substances:
- proteins;
- carbohydrates;
- lipids;
- vitamins;
- enzymatic, hormonal systems;
- mineral components;
- immunoglobulins;
- gases (oxygen, carbon dioxide);
- fetal skin lubrication;
- vellus hair.
Main functions of amniotic fluid
The main functions of amniotic fluid are:
- Providing the child with all the necessary nutrients in addition to the main source of nutrition through the placenta and umbilical cord. All necessary substances are absorbed skin baby, and in later stages of pregnancy the baby himself swallows a small amount of amniotic fluid and receives some of the nutrients orally.
- Maintaining a constant temperature(within 37 degrees), as well as constant pressure.
- Providing a protective function in relation to the baby - reducing the force of shocks from the outside, mitigating vibrations inside the fertilized egg.
- Protective antibacterial function mediated by the presence of antibodies in the composition of water.
- Ensuring free movement and the movements of the child in the womb.
- Reducing the intensity of sound exposure from outside.
Thus, amniotic fluid is vital for the baby at any stage of intrauterine development.
How does normal rupture of amniotic fluid occur?
Normally, during any pregnancy, there comes a moment when the amniotic fluid begins to flow. This happens in the form two main options.
- In the first option, the fetal membranes, tearing in the center, provide instant outpouring about 250 ml of amniotic fluid. The tear occurs right near the exit of the uterus. At such a moment, a pregnant woman feels a sudden wetness of her underwear and clothes.
- In the second option, the rupture of the baby’s membranes occurs on their lateral part, that is, above the exit from the uterus. This ensures that there is no immediate expiration, as well as gradual leakage of amniotic fluid in small quantities over a period of time.
As mentioned above, amniotic fluid can be released only when the integrity of the amniotic membrane of the fetus is damaged. Amniotic fluid leaks are a rather dangerous phenomenon., first of all, for the child.
- Firstly, if the medical care it threatens miscarriage or even spontaneous abortion. Secondly, there is a risk from the walls of the uterus and asphyxia of the child.
- Thirdly, leakage of water can provoke disturbances in the normal labor process, that is, its reduced or increased intensity. A particularly important consequence is the formation of respiratory distress syndrome in a newborn premature baby.
Causes of amniotic fluid leakage
During the normal course of pregnancy, amniotic fluid will be released only after the end of the first labor period, that is, after the cervical canal has sufficiently opened. But in some cases, the wife observes leakage of water in more early period carrying a baby. Thus, leakage of amniotic fluid is considered to be its early expiration earlier in the course of pregnancy.
The list of etiological factors that can cause leakage of amniotic fluid includes:
- The presence of cervical insufficiency, leading to “protrusion” of the bladder in which the fetus is located, which only increases the risk of the child contracting an infectious principle.
- Infected genital organs of the mother, which leads to increased ripening of the cervix and high rates of production of specialized enzymes that can provoke detachment of the placenta and softening of the membranes of the fetus.
- Small transverse dimensions of the pelvic ring of the expectant mother.
- Incorrect position of the baby in the womb.
- The presence of development of several embryos in the uterine cavity (multiple pregnancy).
- Abnormal structure of the uterus (uterine septum, congenital shortening of the organ).
- Chronic general somatic diseases (anemic syndrome, dystrophic changes in organs and tissues in various manifestations).
- Alcohol abuse, smoking history.
- Incorrectly planned and illiterately carried out invasive diagnostic techniques in the prenatal period.
Symptoms of amniotic fluid leakage
How do amniotic fluid leak? In almost all cases, symptoms of amniotic fluid leakage appear in the late stages of gestation. In the early stages, the appearance of such signs is also possible, however, their determination is quite difficult due to the small amount of fluid released. There is so little of it that, mixed with normal vaginal discharge, it will go completely unnoticed by the woman.
In certain cases, a pregnant woman may mistake the minimal discharge that has occurred as a manifestation of urinary incontinence. In the later stages of pregnancy, leaks will be distinguished by their abundance, and the woman will not confuse them with anything else. Often the amount of discharge increases with tension in the pelvic muscles or active change of position.
What does amniotic fluid look like? Amniotic fluid can have a different character. In some cases it is a colorless transparent liquid, and in others it is reddish, with a brown or green tint, with a pronounced odor, which clearly indicates the presence of a pathology from pregnancy.
How to diagnose amniotic fluid leakage
Currently, there are many methods that make it possible to accurately determine the presence of excessive secretion of amniotic fluid at the first suspicion of the mother. Developed by specialized tests for amniotic fluid using indicator test strips.
One such test for amniotic fluid leakage is Frautest amnio. The essence of it is that a pregnant woman wears a special pad on her underwear, which contains a test strip. When you feel the pad getting wet, it is removed, the strip is taken out and placed in the case included in the kit for half an hour. Next, the color of the strip is assessed: if it turns yellow-green, the test can be considered positive.
The formation of such a color reaction is associated with determining the acidity of a woman’s discharge, or to be more precise, amniotic fluid has an alkaline reaction, and ordinary vaginal discharge has an acidic reaction. This allows us to distinguish them from each other. The main advantage of the Frautestamnio amniotic fluid test is its ease of implementation and highly sensitive reaction to even minimal traces of amniotic fluid in the discharge.
Another type of test "AmniSure ROM" is based on a method for determining alpha microglobulin protein, which is highly specific for the composition of amniotic fluid. The kit includes a swab, a vial of solvent and a test strip.
After collecting the secretions using a swab, it is placed in a test tube for one minute. Next, the test strip is immersed in the same test tube, and the results are read from this strip on a clean, light surface. The presence of two stripes indicates the presence of amniotic fluid in the pregnant woman’s discharge.
In addition to quick tests, the following are used: research techniques, How:
- Collection of a woman’s gynecological history, information about pregnancy, examination and instrumental examination.
- Taking a smear from the vagina.
- (ultrasound).
- Carrying out amniocentesis with dye injection.
All therapeutic measures are aimed at preserving the life and health of the baby. But patient management tactics with full-term and premature pregnancy differs significantly.
Prevention of leakage of amniotic fluid
- Timely detection and treatment of cervical insufficiency.
- Timely conservation therapy for the fetus (prevention of spontaneous miscarriage).
- Sanitation of chronic foci of infection in a woman’s body, including in the genital tract.
A lively discussion consisting of your questions and advice to each other is welcome. Share your own experience and clarify any unclear points on this topic. Your active discussion of the problem of premature leakage of amniotic fluid during pregnancy benefits not only you, but also all readers.
Most pregnant women are very sensitive to their condition at the time of bearing a child. And such a decision is not without meaning, because no matter how wonderful the doctor is, he only sees you once every 7-10 days at an appointment. And if the expectant mother does not talk about her ailments or the sensations that bother her, then you may miss the moment when prompt intervention from a specialist and the provision of qualified assistance are required. Water leakage during pregnancy refers precisely to such conditions when the woman is the first to sound the alarm and, sometimes, forces the gynecologist to prescribe additional tests. What signs should alert an expectant mother? Should we insist on additional tests? We will try to understand this issue in order to help all expectant mothers recognize this condition in time.
Doctors call amniotic fluid the fluid in which the baby is located during development in the mother's womb. They protect the fragile body from pressure from the abdominal wall and internal organs, and also protects the baby from various infections. Amniotic fluid is found in the amniotic sac. Its rupture occurs after the onset of labor and is one of the signs of the onset of labor. But in some cases, a woman notices leakage of water, but there are no other symptoms of impending labor. Why does this happen and what reasons can lead to this?
Causes
Experts identify several reasons that can lead to amniotic fluid leakage at different stages of pregnancy:
- Infectious diseases characteristic of the genital area. Colpitis, endocervicitis.
- Inflammatory processes occurring in the genital tract.
- Neoplasms of the uterus. These can be either benign ( different kinds fibroids), and malignant tumors, regardless of their location.
- Prenatal diagnostic methods such as chorionic villus biopsy or amniocentesis.
- Impact of external factors. The most common include falling or the use of physical force. Trying to climb onto a stepladder or stool to change curtains, traveling on crowded public transport during rush hour, when passengers can inadvertently hit you in the stomach...
- Etc.
Premature leakage of amniotic fluid can be caused by one of the above factors or several. Try to keep their impact to a minimum.
What should an expectant mother be wary of?
Symptoms of amniotic fluid leakage can often be confused with heavy vaginal discharge, which occurs in the last stages of pregnancy. Also, slight urinary incontinence, which is also quite common in late pregnancy, can be misleading.
Many women notice stains appearing on their underwear. They will be colorless and do not have the characteristic urine odor. It is also quite difficult to confuse them with vaginal discharge, since the waters do not have a mucous base.
In order not to miss this pathology, experts advise abandoning dark underwear and switching to lighter cotton models. Be sure to use panty liners. This way, you will not only protect your laundry from getting dirty, but you will also be able to notice the regularity of discharge. Leakage of water does not only occur when laughing or coughing, like urinary incontinence. If you are at rest or lying in bed, you will not be immune from this process. It is on this feature that the test is based, which can be done at home.
Test to determine the problem
To avoid unnecessary worries and start treatment on time, doctors advise performing a simple test at home at the slightest suspicion. It will help diagnose the condition expectant mother and consists of several stages:
- Going to the toilet. You should empty your bladder as much as possible. This is necessary in order to exclude urinary incontinence during the test period.
- Going to the bathroom. Wash your genitals thoroughly and dry with a soft, clean towel. Not even a drop of moisture should remain. All procedures should be done gently, but quickly enough.
- Place a clean, light sheet on the bed. And then you undress and lie down. It is necessary to lie in a calm state for at least 15-20 minutes. If during this period transparent or slightly greenish spots appear on the sheet again, you should immediately call an ambulance.
Carrying out such a test will allow you to determine with a high degree of probability that amniotic fluid is leaking. Even if, upon examination by a specialist, it turns out that you were mistaken, it is better to play it safe, because the consequences of such a condition can be very dire. After the woman is taken to a medical facility, doctors will perform several diagnostic procedures aimed at establishing the pathology.
At home, you can also perform a nitrazine test, which is based on changes in the pH of the vaginal environment. As a rule, the environment is acidic, while the amniotic fluid is slightly alkaline.
Medical examination
Doctors will definitely conduct an examination using special diagnostic methods that help to accurately determine the presence of pathology.
The most popular and in a fast way diagnostics became a smear. During the examination, the gynecologist takes a smear, which reveals crystals and particles of amniotic fluid. But it does not allow you to determine the time of leakage of water, and the picture may also be blurred if there are traces of sperm in the vagina. Ultrasound can also help determine the level of amniotic fluid.
Treatment of this pathology
Depending on at what stage of pregnancy you notice water leakage, your doctor may take appropriate measures.
- In the early stages, water leakage, as a rule, goes completely unnoticed. The amount of liquid is still too small and the woman simply does not notice that water is beginning to be released. In the first trimester, this leads to abortion in 90% of cases.
- For a longer period, the specialist takes a wait-and-see approach, placing the woman in a hospital for constant monitoring of her condition and the condition of the baby. Every day that doctors manage to win back the baby in the womb plays a huge role in his development. The longer a woman carries a baby and the closer the natural birth date is, the greater the chance that the baby will be born healthier and more viable. If another 6 hours have not passed since the water leaked, then the specialist prescribes antibiotics, which are aimed at preventing infection of the child in the womb, since the fetal fluid is no longer protecting it.
- If the PDR is close enough, then the doctor may decide to stimulate the labor process if the leakage of water accelerates and ultimately leads to rupture of the membranes. If labor does not begin within 3 hours after the start of amniotic fluid leakage, then a course of medications is used to stimulate labor. Changing hormonal levels with the help of drugs accelerates cervical ripening.
The most important thing that the expectant mother should remember is that if amniotic fluid leaks, she will not be able to do anything. All that remains is to listen to the doctor’s orders and follow all his recommendations.
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From the moment of conception until birth, the mother’s body supports the life of the baby and protects him from harmful effects from outside. A safe environment is created with the help of the fetal bladder and the amniotic fluid that it contains. The child's shelter must remain intact until his birth, otherwise amniotic fluid may leak. You will learn how to detect leakage of amniotic fluid at home and what to do from the article.
What is water leakage?
This is an incomplete discharge of amniotic fluid caused by a violation of the integrity of the membranes. Water can seep out due to microcracks or ruptures.
The fluid may be released in very meager portions, and the woman may not even realize that she has started leaking. It happens that it is difficult to determine even during a gynecological examination. This condition can be established using certain diagnostic procedures.
It is important to understand that leakage can occur during any week of pregnancy. But it is considered safe only from the 37th week, when the baby is already considered full-term. In other situations, water leakage is a pathology that can be fatal to the unborn child. If it begins before the 27th week, the baby may be born with many developmental defects - blindness, deafness, cerebral palsy, breathing problems. Therefore, it is so important to go to the hospital as soon as the first symptoms appear. The situation can be improved by strict bed rest, treatment with tocolytics and antibiotics.
Causes
Water leakage can be caused by many factors. But to achieve the best effect from treatment, it is necessary to accurately determine the cause. The most common is urogenital infection. It provokes the appearance of many pathological changes. In addition, water leakage can be caused by:
- various inflammations in the female genital area;
- low and polyhydramnios;
- isthmic-cervical insufficiency;
- various injuries caused by blows or falls;
- hormonal imbalances;
- infectious diseases;
- inaccurate sexual intercourse;
- strong physical activity.
Expectant mothers who have harmful addictions, such as taking drugs and alcoholic beverages, and smoking, are at great risk.
Symptoms of leakage
The strength and frequency of amniotic fluid leakage depends on how badly the bladder is damaged. If the disturbance is minor, fluid discharge can easily be confused with urinary incontinence or increased vaginal discharge. This often happens in the third trimester.
Water leakage can be characterized by the following symptoms:
The discharge has become very profuse, watery and more frequent.
In its normal state, water should not have any color.
Fluid may leak when coughing, turning the body, or moving quickly.
The stomach drops a little.
The volume of the abdomen decreases if there is a large loss of fluid.
After going to the toilet, water is still released from the vagina because leakage occurs continuously.
Diagnosis of water leaks
There are many ways in which you can determine whether water is leaking or not. These include:
Test strip. You can buy it at any pharmacy, the price is quite high, but the result is reliable. If the test shows 2 stripes, it means water is leaking.
Test pad. It must be secured like a regular sanitary pad and wear for half a day. This test contains a special insert, which changes color if liquid leaks. This test does not give false results. However, the result may be affected by sperm remaining in the discharge after intimacy or by an infection.
Smear examination taken from the vagina. Traces of amniotic fluid after drying appear on the glass with a characteristic crystalline pattern. The reliability of this method is quite low, because the result may be affected by remaining traces of sperm and urine.
Amniocentesis. They puncture the amniotic sac to color the water with a special dye, which is completely harmless to the baby. If the vaginal discharge is the same color, it means there is leakage.
Dry sheet test. First, the pregnant woman needs to wash herself well and dry herself thoroughly with a towel, then lie down for 30 minutes on a dry sheet. If small wet spots remain on it, then water is leaking.
Carrying out an ultrasound. Using this method, only an indirect symptom is detected - a lag in the level of amniotic fluid for the current stage of pregnancy. This method is considered uninformative.
Diagnosis of amniotic fluid leakage must be timely. This determines how quickly the expectant mother will receive medical care.
Consequences of water leakage for a pregnant woman and for a child
Early leakage of amniotic fluid is a dangerous condition for both the pregnant woman and the child. The most threatening consequences include:
Rupture of the membranes due to the pressure of escaping water.
Intrauterine infection of the fetus. Inflammation affects mother and baby very quickly, literally within a day and a half.
Premature onset of labor. During this process, other obstetric complications may occur: bleeding associated with placental abruption, and prolonged or rapid labor.
The early birth of a premature baby is also fraught with serious consequences:
the lungs cannot work independently;
bleeding in the head may occur;
oxygen starvation often occurs, sometimes until asphyxia develops;
physical deformities that arise due to compression by the uterus of the child and a long stay in an anhydrous period.
The severity of the consequences directly depends on the time at which the water began to flow out. The most dangerous condition is leakage in the first and second trimesters, because the secreted fluid cannot be replenished, and it is very difficult to restrain this process.
If the water begins to leak before the 22nd week, then it is not possible to maintain the pregnancy. In this case, spontaneous abortion occurs or an abortion is performed for medical reasons. In the third trimester, the prognosis for pregnancy may be more positive. But this depends on many factors: timeliness of diagnosis and
hospitalization, correct treatment, adherence to strict bed rest.
The fetus begins to be defined as full-term after 37 weeks. In this situation, the breaking of water indicates the beginning of labor. 
Methods of treatment and what to do for the expectant mother
Therapy depends on the characteristics of the course of pregnancy and its duration. If the water breaks after 22 weeks, then every effort is made to maintain the pregnancy. The main method is watchful waiting. It is necessary to prolong the pregnancy as long as possible. This way the baby has every chance of being born full-term.
To prevent premature birth The patient is prescribed tocolytics and, if necessary, antibiotics. A pregnant woman must adhere to bed rest, as has been repeatedly noted above. Every 4 hours, the temperature and pulse are measured, and a blood test is taken daily to look at the content of leukocytes.
The quality and volume of leaking water is also under control. The condition of the fetus is also checked using a CTG study.
If the problem occurs before 34 weeks, then additional glucocorticoids are prescribed to “open” the baby’s lungs. If there is no improvement or the condition of the fetus has worsened, then the doctor chooses the method of delivery. It can be natural or surgical (caesarean section).
Prevention
To avoid premature rupture of water, doctors recommend doing the following:
- elimination of all foci that can cause infection (for example, dental diseases, tonsillitis, diseases of the genitourinary system, etc.);
- treatment of isthmic-cervical insufficiency;
- compliance with measures that eliminate the risk of miscarriage for any reason.
If there is even the slightest suspicion of leakage of amniotic fluid, you need to contact a gynecologist or call an ambulance. If you do this in a timely manner, your chances of giving birth to a healthy and full-term baby will increase.
