Amniotic fluid leakage signs 39. How to stop amniotic fluid leakage? Treatment of amniotic fluid leakage

Everyone knows that the baby is in the womb in amniotic fluid which is called amniotic fluid. They are very important for the fetus and its proper development, which is why their outpouring should occur only during the birth of the baby. If the amniotic fluid begins to leak before the appointed time, then this situation can cause premature birth or other complications. The article will discuss how to determine the leakage of water during pregnancy, and what this problem is fraught with for the mother and baby.

Who is warned is armed, or why it is important to know the enemy in person

Leakage or outpouring of amniotic fluid is referred to by doctors as a stage normal delivery that occurs when the cervix in the uterus is fully dilated. If he was noticed before the start of the process of the birth of the baby, and even more so when the pregnancy is premature, then it can lead to infectious complications and early labor activity. Therefore, how to determine the leakage of water during pregnancy should be known to each future mother.

What is an outpouring

It is different, depending on the time when it happened:

Timely - when the uterus opens completely, and the first stage of labor ends.
Early - when water is poured out before the start of the first stage of labor.
Early - leakage occurs before the baby is born, but the cervix in the uterus is not yet fully opened.
Belated - the waters pour out after the cervix opens and the second period begins labor activity(this happens when the amniotic membranes are too hard).
high gap membranes- the membranes are torn above the cervical pharynx.

The ideal situation is when the amniotic fluid is poured out in a timely manner. But if the pregnancy is full-term (from 37 weeks), then any of the above options is favorable, in the case when the birth is normal.

Danger

The danger for mom and baby is early rupture if the pregnancy is premature (up to 37 weeks), therefore, in order to avoid such a situation, you need to know how to determine the leakage of water yourself, or consult a gynecologist on this issue.

Functions of the amniotic fluid

Functions of amniotic fluid:

Protect the fetus from infections that can get to it through the mother's vagina.
Prevent clamping of the umbilical cord, thus allowing blood to circulate freely between mom and baby.
Protect the child from adverse factors from the outside: falls, shocks and other things. And also allow the fetus to move freely.
To create a biologically active environment through which the child can exchange with the mother various chemicals he needs.

When a rupture occurs, all of these functions fail, but the most dangerous complication in this case will be that the fetus may be infected. This is due to the fact that the integrity of the membrane is broken, which means that the amniotic fluid becomes unsterile, allowing various viruses that are dangerous to the fetus to enter.

About the reasons

Often an early discharge occurs because:

The mother has an inflammatory process.
The cervix is not completely closed and cannot withstand the intrauterine pressure of the baby on it.
The pregnant woman was injured.
The expectant mother narrow pelvis or other abnormalities leading to poor compression of the adjacent part of the fetus.
Polyhydramnios is found, or the mother bears several fetuses.
During pregnancy, tests were prescribed for genetic indications or any other that violate the integrity amniotic sac.

If possible, it is better to refuse amniocentesis, chorionic biopsy and cordocentesis or trust an experienced doctor.

Anything that can lead to effusion and have a negative effect on pregnancy should be avoided. How to identify water leakage? This should be explained by the doctor at the first scheduled examination. future mother. If the outpouring still happened, urgently call an ambulance.

How to determine the outpouring of amniotic fluid

You can talk about premature leakage if the pregnant woman notices copious discharge of a liquid similar to transparent gel or water. But if there is a high gap, the discharge may not be noticed. It must be distinguished from urination, which occurs in pregnant women due to a decrease in muscle tone in the pelvis, as well as from ordinary discharge, which becomes more abundant due to changes in the vaginal mucosa. How to spot a leak amniotic fluid need to know in advance to avoid various problems.

A test can be done to help determine if a spill has occurred or not. They are sold in pharmacies. If the pregnant woman does not know how to determine the leakage of water, and there is no certainty as a result of the test, you should consult a doctor.

Gynecologists often prescribe next test which can be carried out at home. In order to do this procedure, you must:

Go to the toilet to bladder was empty, and take a shower, while washing the external genitalia.

Lie on the bed on a napkin prepared in advance white color lying in this position for about two hours. If an outpouring occurs, the diaper will get wet, and the result will be obvious.

How to determine the leakage of amniotic fluid and distinguish it from discharge and urination can be seen in the table.

Difference between early discharge of amniotic fluid and secretions

signs	amniotic fluid	Vaginal discharge	Urination
How long does the outpouring last	Always until childbirth
Discharges and their consistency	cold or liquid	Thick, more like sour cream	liquid
Smell	Liquid with a peculiar odor	It all depends on the nature of the discharge.	Smell like urine
Color	Normally a clear liquid, but it may have green tint, be reddish, brown. If the color is unnatural, you need to call a doctor.	whitish	Yellowish liquid

If a pregnant woman does not know how to determine the leakage of water, or is not sure what she saw after the test, you need to go to the gynecologist, he will help you figure it out. As additional method your doctor may order a cytology or amniotic fluid test.

It will determine the specific protein that is contained in the amniotic fluid. If it is detected, then a pattern of crystals resembling a fern is formed on the glass.

How to treat premature effusion

If the expectant mother is not sure how to determine the leakage of amniotic fluid, the gynecologist will help her with this, and when it is detected, she will prescribe treatment. As such, it does not exist. Depending on the period at which the pregnant woman is, a certain tactic will be chosen by the doctor, and he will also tell the future mother how to determine the leakage of water and monitor this condition.

How to determine the leakage of water at 38 weeks of gestation can be understood by general condition. If at this time contractions begin during leakage, you should not worry, this is a normal process. Worse, if they are not there, then the obstetrician stimulates with the help of the drug "Oxytocin". But if the doctor noticed the immaturity of the cervix, hormone therapy is prescribed before it ripens.

If there are contraindications for natural delivery, a caesarean section is prescribed.

If the pregnancy is premature, everything will depend on the timing. At the 35th week, if there is no infection, the doctor waits, because every day is very important for the baby. During this time, the respiratory system is formed, and the expectant mother herself is in hospital, and she is given: antibiotic therapy, prevention of hypoxia in the baby, and they also do an ultrasound scan to monitor the condition of the child, and all the necessary tests in this case.

After 35 weeks, when the baby's respiratory system is considered ready, expectant management is not used. Depending on whether the woman is ready for childbirth, the doctor determines whether it will be natural appearance baby to light or caesarean section.

About prevention

What should be the prevention of premature rupture? First, it is necessary to use preservation therapy and treat isthmic-cervical insufficiency. Secondly, to carry out sanitation of the birth canal and timely identify other inflammatory processes in the mother's body.

About the consequences of early leakage

It can proceed without consequences if the pregnancy is full-term, there are no infections, and the birth is normal. The closer to childbirth there was an outpouring, the more favorable the forecasts will be.

About complications

Often early leakage amniotic fluid happens due to:

Infection of the baby in the uterus.
Weakness of labor activity.
The development of complications arising from infections in the mother.
Early onset labor.

The outpouring of amniotic fluid is very dangerous for both the mother and the fetus, so every expectant mother should know how to determine it, because this knowledge can save not only her life, but also the unborn baby.

During pregnancy in the mother's womb, the fetus is surrounded by amniotic fluid, which is commonly called amniotic fluid. They have importance in relation to the development of the fetus, therefore, their outflow during normal occurs only in certain period tribal activity.

If the waters begin to recede prematurely, this threatens with premature resolution and becomes a serious risk factor. You need to understand the dangers similar situations for woman and baby. The question of how to understand that the waters have broken should be studied by every expectant mother.

Symptoms of loss of amniotic fluid

Many women, even at the beginning of their term, are interested in how to understand that the waters have broken. The physiology of a woman is designed in such a way that during the third trimester of pregnancy, the discharge is more abundant, and this is the absolute norm. It is necessary to identify the nature of such manifestations, which should be done by the gynecologist leading the pregnancy. But the expectant mother, for the sake of her own safety and the health of the baby, must herself be able to determine that the premature discharge of fluid has begun. It is important to know and understand what is happening in the body: leakage of amniotic fluid or discharge.

The main symptoms that can make you wary lie in the following factors:

The outpouring of fluid increases with a change in position and movement.
If there has been a significant rupture of the fetal bladder, the fluid begins to flow down the legs. A woman, even with the effort of her genital muscles, cannot stop the flow.
If the damage to the bladder is microscopic, leakage is determined solely by a smear in antenatal clinic or specific tests.

External differences

It is possible to distinguish two conditions - leakage of amniotic fluid or discharge - by appearance lumps on underwear or hygiene products. The waters have a transparent color (sometimes with a pinkish, greenish, brownish tint) and are a bit cloudy. The discharge may have a thicker consistency and a white, yellowish-white, brownish tint. Amniotic fluid, which is far from transparent, should also alert the expectant mother.

Special home check tests

To understand what is really happening (leakage of amniotic fluid or discharge), tests that are specially designed to test women at home will help. The most effective are two research methods, the essence of which is as follows:

Before checking, you must go to the toilet, wash intimate area, pat dry with a towel. After that, it is recommended to lie down on a clean, dry sheet or diaper. If stains appear on the surface of the fabric after twenty minutes, there is a high probability of premature outflow. The reliability of this technique is about 80%.
The possibility of loss allows you to identify special accessories. Gaskets for the outpouring of amniotic fluid can be purchased at a pharmacy for an average of 300 rubles.

Special testing tools

Some pharmaceutical companies produce special pads for amniotic fluid leakage. According to external characteristics, this is a completely standard hygienic package. The main difference is that each product contains special reagents. They help to reliably determine even the smallest fraction of the outpouring.

The test is quite simple: the product is attached to underwear and left for 12 hours. The reagents react exclusively with amniotic fluid and stain the pad aquamarine. The study allows you to distinguish the presence of discharge from the main problem. The hygiene bag simply won't change color.

At the first signs of outflow, you should immediately contact a gynecologist, because such a condition can threaten the health of the fetus and mother. It is also better to consult a doctor if a woman is concerned about any suspicions. Only a specialist can help unnecessary fears and reliably establish whether a woman has amniotic fluid leakage or discharge, which are a sign of healthy functioning of the body. In any case, you need to carefully listen to your condition.

How to recognize amniotic fluid leakage with a high level of confidence?

Gives high performance professional techniques examinations. During a medical examination, a more detailed diagnosis is carried out. Manipulating special tool- a gynecological mirror - the obstetrician examines the cervix. It is likely that the woman will have to specifically push. If at this moment it starts copious excretion fluid, the amniotic sac may be damaged, and the doctor determines how the amniotic fluid is leaking. Depending on the results of the study, further tactics of action are built.

Additional manipulations

The medical test for amniotic fluid leakage is to determine the pH level of the vagina. If the environment is normal, high acidity will be detected. With the loss of amniotic fluid, it becomes slightly alkaline or neutral. Similar method also allows you to determine the presence of various infectious diseases.

Often, an obstetrician conducts a cytological examination - this is a special test for amniotic fluid. The substance to be separated is applied to the glass. After drying, it is determined what it is: water or physiological secretions. At the 40th week of the term, the technique is not used

If the doctors justified their suspicions, at the end an ultrasound examination is performed to determine the exact amount of amniotic fluid. If their volume is less than normal, oligohydramnios is diagnosed.

Risk factors

Infectious lesions of the genital tract that occurred even before the onset of pregnancy or in the early stages.
Malformations of the uterus (mostly congenital).
cervical insufficiency. The cervix is poorly closed and cannot cope with the pressure from the growing fetus.
Polyhydramnios. The diagnosis is made after an ultrasound examination.
Chorionic biopsy, cordocentesis, amniocentesis. Genetic disorders.
Mechanical injury received while waiting for the baby.
Insufficient pressing of the presenting part of the fetus. Most often observed in women with a narrow pelvis and in the presence of anomalies in its development.
Multiple pregnancy.

What is a norm?

Healthy pregnancy and childbirth next sequence events: when the 38th, 39th, 40th week of pregnancy comes, labor can begin at any time. When one of the contractions proceeds, the bubble in which the amniotic fluid is enclosed breaks, and they come out in one stream. If this does not happen, the obstetrician performs a forced puncture, which is called an amniotomy.

Classification

Depending on the time when the outflow occurs, and on how the amniotic fluid leaks, the following classification has been developed:

Timely. Starts at the end of the first birth period with full or almost full disclosure of the neck.
Premature. When it's 39, before the onset of stable labor.
Early. Leakage during labor but before cervical dilatation.
belated. Occurs due to the high density of the fetal membranes. The effusion begins in the second birth period.
High rupture of shells. Occurs at a level above the cervical os.

IN ideal outpouring must be precisely timely. But in terms of full-term pregnancy, the period of which exceeds 37 weeks, any option may be favorable if, as a result, normal labor activity develops. Similar state considered dangerous if the period is less than 37 weeks.

Why is leakage dangerous?

In order to understand all the consequences that threaten premature rupture, it is necessary to understand the functions that amniotic fluid carries:

Barrier to infection. Infection through the mother's genitals can get to the child in a vertical way.
Prevention of compression of the umbilical cord. The waters help create a free flow of blood to the baby.
mechanical function. The fetus receives protection from negative external influences such as bumps or falls. Conditions are created for the free movement of the baby.
biologically active environment. There is a constant exchange and secretion of chemicals between mother and baby.

In the event of the development of disorders, all functions suffer, but the most dangerous complication intrauterine infection becomes, because leakage occurs due to loss of integrity of the membranes. As a result, the tightness of the medium is lost, protection from external influences is lost, and sterility is violated. Viruses, bacteria, fungi can penetrate the fetus.

If a leak is found...

If an outflow occurs during this, it can cause infection of the fetus with various infections, which, without barriers, can overcome all protection. As soon as the obstetrician makes sure that there is leakage, the woman is sent for ultrasound diagnostics. This study helps determine the degree of maturity of the baby in the womb. If the kidneys and respiratory system of the fetus are ready for full-fledged functioning outside the uterus, this is done to prevent infection of the child with an infection.

If the fetus is not ready for independent life, measures are taken to prolong the pregnancy - doctors will expect the fetus to be ready for childbirth. The therapy is as follows:

Purpose antibacterial drugs. This will help prevent intrauterine infection.
Strict bed rest. Rest and a stable position facilitate the therapy.
Permanent monitoring of the health and condition of the child, as every day is considered important. The baby has every chance to grow to a viable state in the mother's womb. An assessment of its blood flow, perturbation is carried out.
Mother passes laboratory research body temperature is measured.
If there are no signs of infection, continue expectant tactics. Can be prepared respiratory tract child to independent functioning, for which they can be assigned hormonal preparations. It is not dangerous, all activities are aimed at maintaining the health of the mother and child.

Instead of a conclusion

Premature leakage of water can be prevented if a woman, in the presence of risk factors, carries out appropriate prevention. For example, it is implemented timely treatment cervical insufficiency, when a suture can be applied to the cervix, a special one is introduced. In some cases, conservative therapy, sanitation of the genital tract and other potential infectious foci (pyelonephritis, caries, tonsillitis) are carried out. The most favorable prognosis is formed with effusion in full-term pregnancy. However, the expectant mother should not panic, it is advisable to remain calm and follow all the doctor's instructions.

Not all expectant mothers, especially pregnant women for the first time, know what amniotic fluid leakage is. But this is a serious symptom, often requiring urgent action. The life of a woman and a child may be in danger. Not everyone has such a pathology, but knowledge is not superfluous, especially when carrying a baby.

Function, appearance, smell and color of amniotic fluid

Amniotic fluid is a cozy environment that surrounds the baby inside the mother's tummy throughout pregnancy. They fill the entire fetal bladder and are produced by its walls. Waters have a very important function - they protect the child from infection from the genital tract. They prevent tissue fusion or flattening of the umbilical cord, allow the baby to feel free and move actively. In addition to protective functions, amniotic fluid (the second name for amniotic fluid) is involved in metabolic processes- it is from it that the child receives a significant part of the nutrients.

The composition of the amniotic fluid is unstable and complex. It includes:

vitamins;
fats;
hormones;
proteins;
carbohydrates;
enzymes;
immunoglobulins;
trace elements;
antigens;
carbon dioxide.

With the development of pregnancy, the composition of the water changes. In the first months, it is a liquid similar to blood plasma, and on recent weeks most of it is the urine of the fetus, particles of its epidermis, vellus hair, primordial lubricant.

In the first trimester, the waters are colorless and transparent, and by the end of pregnancy they become cloudy. Amniotic fluid may have specific smell but not very intense.

Green, reddish or brown waters, sometimes with a sharp, bad smell occur during intrauterine infection.
Normally, amniotic fluid last trimester pregnancy cloudy and colorless

Why amniotic fluid leaks

Ideally, the amniotic sac should be intact before delivery. If the amniotic fluid begins to leak long before the due time, it means that microcracks, ruptures have formed in the membranes surrounding the fetus, the bladder walls are too thin. The reasons for this phenomenon may be:

infections, including diseases of the genitourinary system, suffered by a pregnant woman;
inflammatory processes in the vagina or uterus;
some chronic diseases;
in which the cervix does not hold the fetus inside sufficiently;
multiple pregnancy;
abdominal trauma during pregnancy;
neoplasms on the uterus;
pathology of the structure of the uterus or pelvic bones;
puncture of the fetal bladder during amniocentesis or other manipulations;
bad habits of a pregnant woman - excessive smoking or drinking alcohol.

Constantly wet clothes - a reason to see a doctor

How and when should the discharge of water occur?

Normally, the water leaves if the cervix is ready for the birth of the baby (opened) or the rupture of the fetal bladder has occurred. This happens in the first stage of childbirth. , will "tell" the place of the bubble rupture. Mostly this happens right above the cervix, then the outpouring is plentiful and simultaneous. If the rupture site is covered by the uterine wall, then the leakage is slight, gradual, and can be mistaken for discharge or uncontrolled emission of urine.

The phenomenon when the fetal bladder ruptures before the cervix is ready for childbirth is called premature rupture of the membranes of the fetus or early discharge of water.

Consequences and risks of water leakage

In the second half of pregnancy, premature discharge of water occurs for the following reasons:

trauma;
penetration of infections;
inflammatory processes.

All these problems can cause a violation of the integrity of the amniotic sac. This means that the sterility of the environment, surrounding the child, is under threat. Through microcracks, microorganisms can enter the water, causing severe pathologies in the fetus. At the end of pregnancy, this threatens with premature birth. How closer woman is located by the date of birth of the baby, the more favorable the prognosis.

The closer a woman with an outpouring of water is to the expected date of delivery, the more favorable the prognosis of a normal delivery

In the second trimester of pregnancy, such a pathology is especially dangerous, since its treatment is not always possible. Until the 22nd week, abortion is recommended due to high risk the development of multiple pathologies in an unborn baby. After this period, the chances of maintaining a pregnancy increase, but it is important to determine how much time has passed since the rupture of the amniotic sac.

In the last trimester, they try to prolong the pregnancy as long as possible, at least until the 37th week. The woman is shown staying in a sterile maternity unit under the supervision of a doctor. The condition of the fetus is monitored, the expectant mother is prescribed drugs that prevent the infection from penetrating into the amniotic fluid, contributing to the rapid maturation of the baby's lungs. If infection, placental abruption, or deterioration of the fetus occurs, an urgent delivery is performed. After the 37th week, hospital observation is indicated. If the situation worsens, stimulation of labor is possible.

Diagnostics

If you suspect a leak of amniotic fluid, you should immediately contact your gynecologist. He will conduct an examination and, if necessary, appoint studies. During a routine examination with a mirror, leakage is difficult to detect, so the doctor may ask you to change position or cough. However, if the liquid leaks in small quantities, when viewed "by eye" you can make a mistake.

Laboratory methods

Methods laboratory diagnostics are as follows:

cytological examination;
microscopy;
nitrazine testing.

To study the amniotic fluid, the doctor, along with other diagnostic methods, will prescribe a cytological examination

Examination under a microscope has beautiful name- "fern symptom". When dried, the amniotic fluid crystallizes, forming a pattern resembling the leaf of this plant. The informativeness of the method is no more than 80%. Sometimes discharge from the cervical canal and even the fingerprints of a negligent worker who took the smear are taken for amniotic fluid. In addition, both false positive and false negative results are possible.

For cytological examination, the material is stained, after which elements that differ in color are determined. These may be particles of skin, primordial lubrication, meconium, or baby hair that are in the amniotic fluid. The presence of these particles indicates damage to the fetal bladder.

Nitrazine testingdetermines the acidity of the analyzed material. The environment of the vagina is normally acidic, amniotic water is neutral or slightly alkaline. If the amniotic fluids leak out through the vagina, their environment changes to acidic. The nitrazine test method may be erroneous as some infectious diseases also change the environment of the vagina.

The reliability of the test is reduced if the bubble burst happened a long time ago.

Is it possible to see the leakage of water on ultrasound

The informativeness of ultrasound in this case is insignificant - if there is no massive rupture of the bubble and a maximum decrease in the amount of liquid, it will not show water leakage in small portions. However, if an existing problem is suspected, an ultrasound scan is recommended to rule out oligohydramnios. The study is carried out several times to assess the dynamics and danger of the problem.

Ultrasound does not allow to accurately determine the process of discharge of amniotic fluid

Home method for checking for water leaks

Most affordable home method check for water leakage - the "clean diaper" method. A woman should thoroughly wash herself and lie down on a material that does not absorb liquid. For the purity of the study, it is important not to go to the toilet "in a small way." If after 1-2 hours wet traces are found on the diaper, then the water is leaking.

More modern version this method - pharmacy test pads impregnated with a special compound that reacts to amniotic fluid and is inactive with respect to other secretions. This pad is worn for 10-12 hours. If its color has changed, then you need to consult a gynecologist as soon as possible.

Option home diagnostics water leakage, known all over the world - special tests. On this moment they are available in two versions:

Test sensitive to placental microglobulin, which determines the presence of a rupture in the fetal bladder. With its help, leakage of water is determined in early pregnancy and with a high lateral gap, when there are few traces of amniotic fluid.
A test that detects the presence of insulin-like growth factor protein-1. It has less sensitivity, the most informative in the first 12 hours after damage to the amniotic sac.

Water leakage tests are available in two versions

The fact that amniotic fluid can leak, I learned from my gynecologist only during my third pregnancy and only because I was expecting twins. Sometime around week 30, I started having excessive discharge that caused my regular panty liner to be changed every 3-4 hours. I was in no hurry to give up the doctor, I decided to check everything myself first. The clean diaper method showed that everything was normal, but I was scared. I bought a test pad at the pharmacy (it looks like a regular one, only without wings), however, I couldn’t carry it for 10 hours, it somehow burned in the area where it was supposed to fit, possibly due to the summer heat. It turned out that there was no leakage, and the discharge was a banal thrush, which had to be fought throughout the pregnancy and several months after childbirth.

Treatment

There is no specific treatment for amniotic fluid leakage, but we can talk about a medical strategy that helps keep the problem within a framework that is safe for mom and baby:

to avoid premature birth prescribe tocolytics;
in case of water leakage that occurred before the 34th week, glucocorticoids can be prescribed to prevent distress syndrome (respiratory disorder of the newborn);
if the leakage of water does not stop, antibiotics are prescribed to prevent infection.

In each specific situation, the method of delivery is chosen - caesarean, vaginal delivery, stimulation if the pregnancy is considered full-term (after the 37th week for a singleton pregnancy and the 36th for a multiple pregnancy, but it is possible earlier when the situation threatens the life of the child).

Prevention of water leakage

Eliminate foci of infection - treat bad teeth, check for genitourinary infections, chronic tonsillitis, and other diseases;
if you suspect isthmic-cervical insufficiency, take necessary measures, and if necessary, apply a pessary or sutures to the cervix (after passing an ultrasound of the isthmic-cervical canal and confirming the urgent need for such actions, since these manipulations are not entirely safe);
take all measures to prevent injury to the abdomen - wear comfortable shoes(V winter period ice drifts are very useful, inhibiting sliding), clothes that do not fit the stomach, avoid excessive loads.

Water leakage can be prevented by eliminating foci of infection, one of which is dental caries.

Video: doctors' opinion about amniotic fluid leakage

Amniotic fluid is not just a water shell that protects the fetus from injury and allows the baby to move freely. Without amniotic fluid (and even if it is, but its amount less than normal) the child cannot fully develop. Therefore, a woman should know how to determine the leakage of amniotic fluid by simple symptoms and with the help of home tests.

Amniotic fluid is formed from the moment of conception. Gradually, their number increases, reaching a peak by the second trimester. By the time of delivery, amniotic fluid is not formed so intensively. Leakage of water during pregnancy can occur at any time. Up to 22 weeks, this is a sign of a miscarriage that has begun, after - the onset of childbirth.

Why amniotic fluid leaks

Causes of leakage of amniotic fluid in different terms different. Depending on this, the tactics of conducting a pregnant woman are built.

At the beginning of gestation

At this time, isolated leakage of amniotic fluid is rarely observed. More often, a miscarriage begins with bloody discharge and only then, as the uterus contracts and expulsion gestational sac amniotic fluid is released. It mixes with blood and is difficult to isolate separately.

In the middle and end of gestation

Even the slightest leakage of amniotic fluid before 22 weeks is considered the beginning of a miscarriage. After this period and up to 37 weeks, the release of amniotic fluid is a signal of the imminent onset of preterm labor. However, even at this time, the prognosis in many cases is not entirely favorable. After 37 weeks, the appearance of amniotic fluid is considered the norm and indicates the onset of labor.

Leakage of amniotic fluid is caused by different reasons, which can not always be established even after a thorough examination. The main ones include the following:

Infectious diseases. Sexual infections and TORCH-complex (recently transferred rubella, cytomegalovirus, herpes) are in 95% of cases the cause of premature leakage of amniotic fluid in the first and second trimesters. When the focus of inflammation is localized in the vagina and cervix, pathogens penetrate further into the cervical canal, uterine cavity, and fetal membranes. Infection of the membranes is the cause of premature rupture of amniotic fluid.
Chronic processes. serious chronic diseases, for example, pyelonephritis, autoimmune pathologies can also indirectly cause the outflow of water.
Rhesus conflict. With the incompatibility of blood groups of the fetus and mother according to the Rh factor, Rh sensitization occurs. In such a situation, the body tries to "get rid" of an unwanted pregnancy, which is the cause of water leakage.
Multiple pregnancy. When carrying two or more fetuses, a woman has an increased risk of developing premature birth due to excessive stress on the body. Often, multiple pregnancy is accompanied by isthmic-cervical insufficiency of the cervix (ICN, premature opening of the cervix). With monochorionic twins, triplets (one placenta for all), a “steal syndrome” may occur. As a result, one baby develops polyhydramnios, the other - oligohydramnios. All this is often accompanied by leakage of amniotic fluid.
Pathology of the cervix. ICI leads to premature outflow of water. At the same time, as the gestational age increases, the cervix cannot withstand the load and begins to open. The result - the fetal bladder prolapses (falls) into the cervical canal and its rupture occurs.
Manipulations on the neck. When applying an obstetric suture in case of insolvency of the cervix, an accidental puncture of the fetal bladder may occur, followed by outpouring of water.
diagnostic procedures. Amniocentesis (puncture of the uterus through the anterior abdominal wall and sampling of a small amount of amniotic fluid), cordocentesis (puncture of the umbilical cord for blood sampling or transfusion), chorionic villus biopsy (the procedure is similar to amniocentesis, but chorionic cells are harvested) due to their invasiveness are always accompanied by risk water leaks.
Myoma of the uterus. In the presence of several myoma nodes or even one large one, the extensibility of the myometrium decreases. And after 12-16 weeks begins intensive growth uterus. If the nodes "interfere" with this, the integrity of the fetal membranes is violated under pressure and water leaks.
Anomalies in the structure of the uterus. In this case, a similar picture develops, as with nodes. A uterine septum, one horn, or a saddle shape can lead to the outpouring of water.
Fetal pathology. If the baby has some kind of malformation, the likelihood of outflow of water before the onset of a full-term pregnancy is also higher.
Injuries. Injuries in the abdomen (blunt, sharp) can lead to compression of the amniotic sac and rupture of the membranes.
Thrombophilia. A change in the properties of connective tissue and blood leads to destructive transformations of the cervix and membranes, which provoke rupture of the fetal bladder.
Diabetes . Changes in metabolism, especially with sugar decompensation, increase the risk of preterm birth and amniotic fluid leakage.

Premature birth sometimes occurs against the background of specific circumstances, for example, infection, fetal pathology. But often clear reasons for early start labor activity is not detected.

What does it look like

Amniotic fluid leakage can look different. It all depends on the level of stress.

Abundant and medium discharge. When the bulk of the amniotic fluid flows out, which are located in front of the presenting part of the fetus (like a “wedge”), the woman notes that it “flows down the legs”, ordinary maxi pads cannot absorb all the amniotic fluid.
Minor discharge. With a high tear of the fetal bladder or when the layers of the membranes are displaced relative to each other, the defect zone may overlap and the amniotic fluid stops leaking. In this case, the amount of water may be insignificant - up to 200 ml or less. In such a situation, it is sometimes difficult to diagnose and confirm whether it was amniotic fluid or not.
Color and presence of impurities. Amniotic fluid can be with blood (in this case, it is necessary to exclude placental abruption), with an admixture of meconium - green or yellow (a sign of fetal hypoxia). Normally, the color of amniotic fluid during leakage should approach a transparent, with a milky tint, it may contain vellus hair of the fetus and particles of its epithelium - all this provides a kind of suspension.
Smell . Amniotic fluid does not pungent odor, let's say a slight sour. Fetid, unpleasant - a sign of infection of the membranes and, most likely, the baby.
With or without contractions. Water can leak both with the onset of uterine contractions and contractions, and without them.

Leakage may appear after physical activity, and against the background of well-being, for example, during sleep or after a night's rest. When the position of the body changes, the amniotic fluid may flow more abundantly.

So, the main symptoms of amniotic fluid leakage are as follows:

increased amount of vaginal discharge;
secretions are liquid;
appear periodically or leak constantly.

How to understand what kind of discharge

At premature pregnancy it is extremely important to distinguish true leakage from ordinary vaginal leucorrhoea. It is not always easy to do this without additional examination and dynamic observation. It is especially difficult to establish a diagnosis in the following cases.

With urinary incontinence. Even in young women, especially after repeated childbirth, the tone of the pelvic floor muscles can decrease, resulting in urinary incontinence - when straining, sneezing, coughing. This is especially characteristic of later dates when the uterus creates additional pressure on the bladder and pelvic floor. If the pregnant woman does not notice this, there may be an impression of water leakage.
With a pessary in place. After installing the RAP (unloading obstetric pessary) – foreign body- quantity vaginal discharge increases due to constant inflammation. They collect in the posterior fornix and may flow more profusely when turning the body. Sometimes it seems that it is water.
With inflammation in the vagina. The infectious process in the vagina is always associated with an increase in the amount of discharge. Depending on the nature of the inflammation, they can be transparent, white, yellow or green.
When the mucous plug comes off. When the moment of childbirth approaches and the cervix opens, mucus comes out, which during pregnancy “like a cork” closes the cervical canal from infection. Sometimes it is quite liquid in consistency and can resemble water.

By what signs it is possible to differentiate the leakage of water from other conditions, the following table shows.

Table - How to distinguish water from other secretions

Criterion	Water	Allocations with a pessary	Discharge during inflammation	Mucus plug
Quantity	Usually a lot		Enough daily panty liners for personal hygiene	Not plentiful
Color	Normally clear, but may be bloody, green or yellow	Most often white or yellowish	Depending on the cause of inflammation - from transparent (with vaginosis) to yellow, white, curdled	Transparent, but may be interspersed with streaks of blood, whiter than the vagina
Smell	Usually not, but with inflammation, an unpleasant putrefactive	Sour, often unpleasant	"Fishy" with vaginosis and purulent, putrefactive - with other types of inflammation	Doesn't have
Consistency	watery	Creamy	dense	How egg white or thicker
Appearance time	Suddenly	2-3 weeks after insertion of the pessary	No pattern	Before childbirth, including premature
Do they pass	Only at high bubble burst	After removal of the pessary and sanitation	After treatment	Before childbirth, they no longer go away, but may decrease slightly

In order to recognize the leakage of amniotic fluid and distinguish it from other conditions, the following is carried out.

Looking in mirrors. In most situations, when examining the mucous membrane of the vagina and cervix in gynecological mirrors, it is possible to understand whether it is water or just discharge.
Smear. With a positive analysis, after staining the discharge, a “fern symptom” is detected - under magnification after drying, the picture on the glass slide resembles the leaves of this plant.
Amniotest. There are special test strips for determining the presence of amniotic fluid. They are based on a change in the pH of vaginal secretions when mixed with amniotic fluid. It is freely sold in a pharmacy, and a woman can perform it herself at home.
Fetal ultrasound. Identified oligohydramnios by ultrasound of the fetus is suspected of rupture of amniotic fluid is another symptom of "for". However, a normal amniotic fluid index does not exclude leakage, especially a high tear.
Laboratory methods. In some clinics, there are methods for identifying certain substances in the vaginal secretion, which appear only after the amniotic fluid enters them. However, the method is expensive and not always informative, so it is rarely used.

In doubtful cases, expectant tactics are used. The woman is being monitored in a hospital setting. The secretions are carefully monitored, ultrasound is performed in dynamics, a test and a laboratory study.

Management of pregnant women with leakage

If signs of amniotic fluid leakage are obvious or there is reliable confirmation of this process, the pregnant woman undergoes a series of examinations, after which further management tactics are established. In many ways, it depends on the period in which the water flowed.

1 trimester. Bloody issues and waters in this period begin together if the integrity of the fetal bladder is violated and the miscarriage progresses. Medical or surgical termination of pregnancy is indicated.
2 trimester. Until 22 weeks, any leakage of amniotic fluid equates to the onset of a miscarriage. Its further stimulation and subsequent curettage of the uterine cavity is carried out.
3rd trimester. Tactics is determined based on the period, condition of the mother and fetus. With the outflow of water up to 37 weeks, it is possible to prolong pregnancy from several days to a month or even more with simultaneous antibiotic therapy and the introduction of drugs for the maturation of the lungs of the fetus. There are methods to prevent further leakage of amniotic fluid, which helps to grow the baby in utero for some more time. Since the waters are re-produced every four to eight hours, their volume soon increases to normal values. With signs of detachment, inflammation, or according to the testimony of a woman, delivery can be immediate. The outpouring of water after 37 weeks is equated with the onset of childbirth.

Is it dangerous for the fetus

The outpouring of water during a full-term pregnancy is most often accompanied by the onset of active contractions on the following day. Therefore, at this time it is the least dangerous. When amniotic fluid leaks from 22 to 37 weeks, the severity of the baby's condition is determined by the cause that led to this, as well as the degree of outflow of water. The most favorable prognosis is with a high tear of the bladder without concomitant inflammation. In all other cases, the outpouring of water ends in premature birth.

The consequences of the start of water leakage for the child earlier due date the following:

increased risk of infectious complications- chorioamnionitis, congenital pneumonia;
hypoxia occurs- the outflow of water affects the uteroplacental blood flow, especially if it occurs against the background of what diseases of the woman;
there is a chance of being born prematurely- with the outflow of water in the early stages, it is difficult (up to 30-32 weeks) to keep the pregnant woman for more than a month;
parts of the body of the fetus may fall out - with a headless presentation, along with the waters, loops of the umbilical cord or parts of the fetus (usually arms, legs) may fall out through the opened neck, which can threaten his life.

If a woman suspects or even accurately determines the leakage of amniotic fluid at home, then how sooner will she apply for medical care, the better, since the state without amniotic fluid is dangerous for the fetus. It does not matter what the gestational age is when the water is poured out, only a specialist can determine the most appropriate tactic in each case.

Changes hormonal background that take place in female body during pregnancy, affect everything, including the nature of the discharge from the genitals. From the school biology course, each of us knows that normally they should not have color and smell, however, it turns out that this is not all.

During pregnancy, they should remain just secretions, and not drops of leaking amniotic fluid. How to distinguish one from the other and how to understand that water is leaking during pregnancy? We'll talk about this.

Much has been said about the role of amniotic fluid. This is both a barrier, and protection, and a habitat for the baby, therefore, their condition, or rather, the absence of signs of their leakage, should be closely monitored. How long can they leak? On any, and the leakage is not always significant, massive. Sometimes everything happens bit by bit.

The easiest way is in the later stages, especially just before delivery. There, water often comes out rapidly: the bubble bursts, and its contents pour out sharply. In total, about a glass of liquid comes out, so it is very difficult to confuse this process with something else.

In the early stages, everything is usually different: leakage is so insignificant that sometimes they do not attach importance to it, because it mixes with natural secretions. The situation is aggravated by the fact that during the pregnancy itself, the amount of these secretions increases. That is, a woman, as if she constantly feels moisture on her underwear, as a result of which she stops paying attention to it, but in vain. The condition is insidious and fraught with serious consequences.

How to check if water is leaking? Ideally, this can only be done with special tests, analyzes carried out in the laboratory. But there are ways in which the presence of a problem can be suspected. Take a look at yourself. If you notice that when you change the position of the body, while sneezing, coughing, the amount of discharge increases slightly, it's time to see a doctor.

You should suspect something was wrong and, seeing on the sheet after sleep wet spot. This happens in the second or third trimester, when the amount of amniotic fluid is large enough. By the way, if you feel leakage when coughing or sneezing, do not rush to panic. In women, especially after 30 years, muscles can weaken, resulting in minor urinary incontinence. There is little pleasant, but compared to the consequences that occur due to leakage of amniotic fluid, this is just a banal nuisance.

Finally, it is worth noting that the doctor at the reception can identify the problem. Drops in the region of the posterior fornix of the vagina will prompt him to think about the bad. If they are, a smear is taken and further research is carried out within the walls of the laboratory.

How to understand that water is leaking at home

Leakage is a problem in which, in some cases, even termination of pregnancy can be recommended. That is why you need to take care of your own health very carefully. How? To begin with, for the entire period of pregnancy, it is better to abandon bright, seductive (should be read: bikini, thong) underwear. Simply because there are no traces on them.

Another thing is ordinary cotton white panties. How to determine if there is a problem with them? When leaking, there will always be a wet spot on them, which, of course, is slightly darker colors the linen itself.

If the deadline has exceeded the first trimester, the matter can be so serious that even panty liner. Have you suspected this? You need to see a doctor immediately.

How else do you know if water is leaking? There are several ways:

Regular home. This is the simplest option, in which you need to set aside 20-30 minutes of free time, empty your bladder, even if there was no particular urge to urinate, and then lie down on the bed, having previously spread a white cotton sheet. If after 15 - 20 minutes spots appear on it, it is not worth excluding the presence of leakage.
Homemade, but more accurate. The disadvantage of the first method is that water under such conditions is easily confused with ordinary secretions. To be sure of your guesses, you need to take a pharmacy amnitest. In fact, it is a set of gaskets or strips soaked in a special liquid, and instructions for use.

How it works? It's simple: ideally, the expectant mother has an acidic environment, while the waters are neutral. Therefore, the test reacts to the presence of a neutral medium and indicates leakage if it turns blue-green. Of course, he does not react to urine and discharge.

Note! The presence of moisture on the sheet or confirmation on the test is not a sentence yet, and here's why. In the first case, a woman may have an increase in the amount of vaginal discharge, which will then give a wet spot. True, you can try to distinguish them by character.

The waters are usually clear and very similar to ordinary water (in consistency). Exceptions are cases when they have a pronounced or unexpressed yellowish, brownish tint. They indicate the presence of an infectious process and require immediate hospitalization.
The discharge is thick, whitish or mucous. Again, there may be exceptions in the form of giving them other characteristic shades, but you should immediately inform the doctor about this, because the health of the baby is at risk.
With urine, and so everything is clear: it is yellowish and with a specific smell.

Pharmacy tests can lie. This happens when under the influence certain conditions there is a change in the vaginal environment. For example, in the presence of infection, the acidic environment changes to alkaline or neutral.

In any case, the reliability of both methods is about 80%. They can be used, but there is no need to believe them unconditionally and, moreover, to panic. It is better to just contact a specialist and he will prescribe tests in which you can accurately obtain reliable results.

Why is water leakage dangerous?

Suspected a leak and still wondering what to do? Call your gynecologist immediately. Do you know why? It turns out that premature leakage (up to 37-38 weeks before the onset of labor) is a direct threat to the health and life of the baby. And it is not difficult to verify this by analyzing the functions of amniotic fluid.

Needless to say, the outpouring of amniotic fluid jeopardizes all the functions performed by them, and with them the health of the baby.

Prevention and treatment

Before deciding on the tactics of treatment, the doctor finds out why the water is leaking. Moreover, there are many reasons. Among them:

Infection. Under its influence, the cervix ripens faster, which means that enzymes are released that lead to placental separation and softening of the bladder walls. Needless to say, that in preterm pregnancy, the condition is dangerous for the development of hypoxia during childbirth, the appearance of massive bleeding.
Fetal presentation (or wrong position), narrow pelvis. Leakage for this reason is usually detected in the first stage of labor. Is it bad? Ask the woman in labor, who, because of this, will have to “enjoy” the process for a longer time in conditions of slow cervical dilatation, or even go for a CS.
Neck failure. It is diagnosed in every fourth and leads to a protrusion of the bladder and its increased vulnerability. As a result, the shells can be torn at the slightest mechanical impact.
Bad habits and chronic diseases in a pregnant woman (anemia, dystrophy).
Multiple pregnancy, abnormal development of the uterus (short, isthmic-cervical insufficiency, etc.).

During therapy, they try to remove the cause of leakage, but first of all, they look at how much time has passed since the tear of the membranes, they do an ultrasound to find out the condition of the fetus.

For short periods, if the leakage is insignificant, most often they just wait. A woman is prescribed bed rest, and, if necessary, special drugs to delay the onset of contractions and the birth itself. The goal is to survive the period of 35 - 36 weeks, after which the child becomes viable and can breathe on his own.

Along the way, antiseptic treatment of mucous membranes can be prescribed to exclude infection. If the waters come out completely, and anhydrous period was no longer than 6 hours, antibiotics are prescribed.

With leakage for a period of 39 - 40 weeks stimulate.