Infection of amniotic fluid during pregnancy on ultrasound. Leakage of amniotic fluid: causes and recommendations for action. Amount of amniotic fluid

03.05.2019

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 is 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

The reasons for the leakage of amniotic fluid in different periods are 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 the ovum is expelled, 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 occurs for various 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, such as pyelonephritis, autoimmune pathologies, can also indirectly cause water outflow.
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, intensive growth of the uterus begins. 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 there are no obvious reasons for the early onset of labor.

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 have a 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 can occur both after physical activity and during 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

In preterm 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 in the later stages, 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 a RAP (unloading obstetric pessary) - a foreign body - the amount of 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	Like 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 secretions, 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 discharge and water 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 onset of water leakage for a child ahead of time are as follows:

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 is able to suspect or even accurately determine the leakage of amniotic fluid at home, then the sooner she seeks medical help, the better, since the condition 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.

Most of the time that the baby spends in the womb, he is under the protection of the placenta or, as it is also called, the amniotic sac. Amnion constantly produces amniotic fluid, in which the baby will be until the very moment of his birth. Such a liquid protects the baby from bacteria and viruses, creates favorable conditions for its development, allows it to stay warm and comfortable during the most important and crucial months of its life.

The temperature of the amniotic fluid is maintained by the body at a constant level and is about 37 ° C, provided that the woman is healthy. As for the amount of fluid, this indicator is constantly changing and directly depends on what week of pregnancy the expectant mother is in. It is also worth noting that the larger the baby becomes in the womb, the more fluid the amnion produces. The rate of amniotic fluid during pregnancy is 1-2 liters at the 36th week of the term, but in the following days this figure may decrease slightly, because during preparation for childbirth, the body begins to actively remove fluid.

Among the components of the amniotic fluid, you can find a wide variety of components, for example, proteins and carbohydrates, hormones and enzymes, fats and salts, various vitamins and glucose. Amniotic fluid also contains oxygen, carbon dioxide, immunoglobulin, baby waste products and many other substances. The composition of the liquid is always unstable and changes at least every 3 hours. In addition, the composition of the water also depends on the gestational age, because at different periods of development, the crumbs require different substances.

Why amniotic fluid is needed

The role of amniotic fluid in the process of growth and development of the fetus is difficult to overestimate, because thanks to the many functions that this substance performs, the child is not only under constant protection, but also has the opportunity to be born. Read more about the functions of amniotic fluid below:

One of the purposes of amniotic fluid is the metabolism between maternal and child organisms. Those components that the baby needs for his development and maintenance of life come to him precisely through the amniotic fluid. Processed food, being excreted from a tiny organism, also first enters the amniotic fluid, and only then is completely removed from the woman's body. The waste products that enter the liquid also include the upper scales of the epidermis, particles of the original lubricant, the hairs of the child and the components of the mother's blood.
The second important function of the amniotic fluid is its ability to protect the unborn baby from all sorts of harmful factors in the outside world. Due to the constant temperature of the waters, the child in the womb will not be able to freeze, moreover, he is not afraid of physical influences such as blows, compressions, pressure. Amniotic fluid eliminates the risk of squeezing the umbilical cord, gives the baby the opportunity to move freely in the mother's abdomen.
The female body also made sure that the amniotic fluid was always absolutely sterile. Due to the fact that viruses, bacteria and other pathogens do not penetrate into them, the baby is reliably protected from diseases. Sterility is mainly maintained by constant renewal of the composition of the liquid, which occurs at least every 3 hours.
Amniotic fluid not only helps the baby grow and develop in a safe environment, but is also directly involved in the delivery process. Firstly, the so-called anterior waters, by their pressure on the uterus, provide a better opening of its cervix. Secondly, while the baby is trying to be born, the amniotic fluid protects him until the very moment of birth. Thirdly, during the passage of the child's birth canal, water plays the role of a lubricant, facilitating this process.

In addition to the above useful functions, amniotic fluid also has an important diagnostic value. After conducting certain water tests, the doctor can find out a lot of necessary information regarding the health of the child and the characteristics of his development. Thanks to diagnostics, it is possible not only to establish the sex of the baby and his blood type, but also to obtain information about possible hereditary diseases or other abnormalities, the development of which can be prevented even at the stage of pregnancy.

Volume, composition, degree of transparency, color and consistency - all these parameters of the amniotic fluid can be found with the help of the necessary tests. In addition, in the case of some pathologies, when emergency delivery is required, with the help of such a diagnosis, it is possible to establish the degree of readiness of the child for the birth. Based on the data obtained, a decision is made on the use of special medical equipment to support the life of the baby for a certain period.

Amniotic fluid pathologies

oligohydramnios during pregnancy

The condition when there is little amniotic fluid during pregnancy is called oligohydramnios. Such a pathology can occur if the amnion produces less fluid than is excreted from the body. It should be said that such a disease is not so common and accounts for no more than 1% of cases in the total number of pregnancies. Oligohydramnios is a serious problem that requires attention and timely treatment. If this phenomenon is not eliminated, certain complications may arise:

Firstly, the pressure of the amniotic fluid on the uterine canal is significantly reduced, which, in turn, leads to difficulties in the delivery process.
Secondly, oligohydramnios is fraught with such complications as premature birth. A child who was born before the due time will need special medical care.
Oligohydramnios is also dangerous because the baby is not able to move normally, which increases the risk of breech presentation of the fetus.
Hypoxia is considered a very frequent companion of this pathology - a lack of oxygen necessary for a child. Hypoxia results in growth retardation and fetal abnormalities.

As a rule, it is not possible to notice such a pathology on your own, since oligohydramnios has almost no symptoms that are physically palpable. Occasionally, a woman with a similar problem may feel slight pain in the abdomen, but often this manifestation is simply absent. You can identify the disease with the help of ultrasound, which is why the timely delivery of tests and the passage of planned ultrasounds are so important for a pregnant woman.

If it is possible to detect oligohydramnios before a period of 28 weeks, an examination of the body of the expectant mother will allow you to find out the cause of the pathology and, if possible, eliminate it. So that the child does not suffer from a lack of oxygen, it is important to start treatment as soon as possible - this will allow gas exchange and uteroplacental blood flow to be established. In the process of therapy, the doctor monitors the baby's condition and sometimes, in case of emergency, prescribes an early caesarean section.

Let us examine in more detail what are the causes of oligohydramnios during pregnancy:

the presence of hypertension in the expectant mother;
significant overweight pregnant;
infections and inflammatory diseases;
violations of the development of the placenta;
inflammation in the pelvic organs;
polycystic kidney disease of the fetus, anomalies in the development of its genitourinary system.

Polyhydramnios during pregnancy

Approximately as rare as oligohydramnios, the opposite pathology, polyhydramnios, can also occur. This problem occurs in 1-1.5% of pregnant women and is an excess of amniotic fluid relative to the norm.

Polyhydramnios is of two types:

Chronic polyhydramnios is characterized by the fact that the amount of amniotic fluid arrives gradually. If the pregnant woman is healthy and feels fine, the doctor may prescribe her diuretics - special medications that are responsible for removing fluid from the body. In addition, the doctor prescribes a certain diet, which involves reducing the amount of salt in the diet. It is important to follow all the recommendations of the doctor, because polyhydramnios can lead to unpleasant consequences. An excessively enlarged uterus oppresses the rest of the organs, disrupting their work. In addition, polyhydramnios sometimes causes circulatory disorders in the female body, it makes labor difficult and can cause heavy bleeding after childbirth.
The second type of polyhydramnios is acute. It is characterized by a sudden increase in amniotic fluid that occurs over several hours. As a rule, such a disease makes itself felt by the following symptoms: abdominal pain, severe swelling, shortness of breath. With such a pathology, a woman needs hospitalization. While in hospital, the pregnant woman observes bed rest, which makes it possible to reduce the risk of preterm birth. If acute polyhydramnios is characterized by the incessant presence of water and threatens the health of the woman and her baby, abdominal amniocentesis can be used as a remedy for the problem. During this operation, the placenta is pierced and excess fluid is removed to the outside.

Among the causes of pathology are the following:

diabetes mellitus in a pregnant woman;
the conflict of Rh blood of mother and baby;
carrying twins;
the child has a genetic disease;
infection to the fetus in utero;
disruption of the fetal bladder, which manifests itself in excessive production of amniotic fluid, even in early pregnancy.

Leakage of amniotic fluid during pregnancy

Another pathology of amniotic fluid is their leakage. This condition is characterized by the appearance of copious liquid discharge from the female genital tract. From ordinary secretions, amniotic fluid is distinguished by transparency, colorlessness, a very liquid consistency, and the absence of odor. Often, leakage of amniotic fluid during pregnancy does not show any symptoms other than the aforementioned discharge. But the expectant mother may not pay attention to such manifestations, because during pregnancy, abundant vaginal discharge is the norm.

In the event that a woman suspects a similar pathology in herself, she should immediately see a doctor. The specialist will prescribe tests that will determine the nature and origin of the discharge, after which the leakage of water can be refuted or confirmed. By the way, in pharmacies you can find special tests with which such an analysis is carried out independently. But it is recommended to use this method only if it is absolutely impossible to see a doctor for any reason. In addition, if the analysis gives a positive result, the pregnant woman one way or another will have to go to the hospital for inpatient treatment.

If a similar phenomenon has made itself felt after the 36th week of the term, doctors can stimulate childbirth, and the baby will be born prematurely for only 1 week. If the leakage of water happened in the early stages, the woman needs hospitalization in order to maintain the pregnancy for the maximum possible period. During hospitalization, strict bed rest should be observed. In some cases, when the period is too short and it is not possible to keep the pregnancy for a long time, the situation is fraught with abortion.

The most common causes of amniotic fluid leakage are genital tract infections. To avoid such a risk, it is very important to monitor your health, follow the rules of personal hygiene, engage only in safe sex and periodically take tests for the presence of pathogenic flora in the vagina.

Amniotic fluid green

Transparency, colorlessness, odorlessness and liquid consistency are characteristics of normal amniotic fluid. Slightly turbid amniotic fluid during pregnancy can be observed at the very end of the term and are also considered the norm, since their appearance is due to the presence of epidermal flakes and lubricant flakes that enter the liquid from the baby's body. But in the event that the amniotic fluid has acquired a greenish tint, we can talk about pathology. The green color of the amniotic fluid is often due to particles of the original feces, which the baby releases if he lacks oxygen. Hypoxia is considered one of the most dangerous conditions of the fetus, because it not only interferes with the normal development of a small organism, but sometimes causes irreparable consequences.

Possible reasons why amniotic fluid may turn green are described below:

If during the entire pregnancy the waters were normal and turned greenish already in the process of childbirth, very often this can cause stress for the baby. Experiencing childbirth, the baby sometimes secretes meconium, due to which the liquid acquires a characteristic shade.
As mentioned above, the cause of this pathology during pregnancy can be such a dangerous condition as fetal hypoxia. It is caused by over-term pregnancy. If the baby is in the womb for too long, the amniotic sac ages and does not perform its functions properly. Because of this, the baby experiences a lack of oxygen.
Sometimes a greenish tint in the amniotic fluid indicates an infection. This happens if the expectant mother has had a cold, flu, bronchitis, suffered an infection of the genitourinary system or some other inflammatory disease.
Very rarely, genetic diseases of the fetus can become the cause of an abnormal shade of amniotic fluid.

Green waters can be dangerous for a child if he swallows contaminated fluid. If such a phenomenon was detected in late pregnancy, a woman may be prescribed a caesarean section. If such a pathology was detected in the early stages, the causes of the condition should first be identified and measures taken to eliminate them. Since the amniotic fluid is often updated, it will be enough to eliminate the causes of the pathology in order to correct the situation.

In the event that the pregnant woman's green waters have departed, the delivery process should be started as soon as possible in order to eliminate the risk of oxygen starvation and the associated consequences.

Amniotic fluid tests during pregnancy

There are several ways to assess the condition of amniotic fluid during pregnancy, the simplest of which is considered to be ultrasound. This procedure does not harm the health of the woman and her fetus, but is the least informative. With the help of ultrasound, you can only visually determine the transparency of the liquid and determine its amount. For more detailed information, other studies are being conducted, which we will consider in more detail:

Amniocentesis is a complex procedure in which fluid is taken directly from the amniotic sac. To do this, the woman's stomach is pierced with a special tool and a small amount of amniotic fluid is drawn out. The procedure is performed under local anesthesia. Then this material is sent for research, where immunological, biochemical, cytological and hormonal analyzes are carried out. Depending on the location of the amniotic sac, doctors determine the puncture site, and during the procedure, an apparatus for ultrasound diagnostics is used. Amniocentesis is performed if there is a conflict between the Rh blood of the mother and the child, as well as if there are suspicions of chromosomal pathologies, hypoxia, and genetic diseases. Such an analysis is also carried out when the age of the future woman in labor exceeds 40 years, and also in the case when it becomes necessary to determine the maturity of the child's lungs. Amniocentesis is not used if a woman has any inflammation in her body, if the pregnant woman suffers from pathologies in the development of the uterus or from diseases of the genitourinary system. If there is a threat of miscarriage, the procedure should also be abandoned.
Amnioscopy is another method for determining the state of the amniotic fluid. During the procedure, the doctor inserts an amnioscope into the cervix and examines the lower pole of the placenta and amniotic fluid. Using the procedure, you can set the amount of amniotic fluid, examine its color and identify the presence of hypoxia in the fetus.

Amniotic fluid during pregnancy. Video

The fetal bladder in which your unborn baby grows and develops is called the amnion. From the very beginning of pregnancy, it provides the baby with the conditions for intrauterine life. And one of the most important tasks of the amniotic sac is to produce a fluid called amniotic fluid. It fills the entire cavity of the amnion and performs a number of vital functions for the fetus. The waters form the first habitat of the fruit, so their importance cannot be overestimated. Thanks to the amniotic fluid, the baby feels comfortable (there is always a stable temperature here - 37 degrees, quiet and cozy) and protected (water prevents the ingress of microorganisms from the outside world, as well as any other negative effects on the fetus from the outside).

Amniotic fluid is released continuously, but unevenly. With an increase in the term, its volume also increases, reaching its maximum at approximately 36 weeks of gestation, while averaging 1000-1500 ml. Then, just before the birth, the amount of fetal water may decrease slightly, which is explained by the increased excretion of fluid from the mother's body.

Composition of amniotic fluid

At different stages of development of the baby, not only the quantity, but also the composition of the amniotic fluid changes. It is also unstable and quite complex. Fetal waters contain proteins, fats, carbohydrates, hormones, enzymes, vitamins, microelements, carbon dioxide, oxygen, immunoglobulins, antigens and other substances that determine the fetal blood type. They can also get products of the sebaceous glands (flakes of the original lubricant that covers the baby's body), skin, hair, and even substances from the mother's blood. There is a constant exchange of substances between the fetus, amniotic fluid and the mother's body.

The baby urinates directly into the amniotic fluid, which, by the way, is updated every 3 hours, all the time maintaining the composition necessary for a small one.

Functions of amniotic fluid

The role of amniotic fluid in the intrauterine development and habitation of the child is simply huge! Throughout the entire period - from the very beginning of pregnancy and up to the moment the baby is born - they perform a number of important functions:

Metabolism: a significant part of the substances necessary for life enters the child's body just from the amniotic fluid. In return, the baby secretes waste products into amniotic fluid, which is excreted through the mother's excretory system.
Mechanical protection: the fetal bladder and water protect the baby from a variety of mechanical damage. They create a reliable "safety cushion". Also, amniotic fluid prevents squeezing of the umbilical cord and tissue fusion. In addition, the water makes possible the free active movement of the crumbs, which contributes to its intensive development.
Sterility: The amniotic fluid is always sterile and maintains a perfectly clean living environment. They protect the little one from penetration and exposure to infections. Interestingly, throughout pregnancy, the fetal fluid is updated every 3 hours, always maintaining the required chemical composition. And this process continues until their complete outpouring, when after the birth of a child, the so-called back waters flow out.
Participation in childbirth: amniotic fluid plays an important role not only during gestation, but also directly in childbirth. Actually, childbirth begins with the outpouring of the so-called anterior waters, which are located in the lower part of the fetal bladder. They press their weight on the cervix causing it to open. The waters maintain favorable conditions for the fetus during contractions, and when poured out, they wash the birth canal, which then makes it easier for the child to move along them.
Diagnostic value

Amniotic fluid contains a lot of important information about the condition and development of the fetus. The volume, composition, transparency, consistency, color of the amniotic fluid, which can be determined during laboratory tests, matter.

An analysis of the fetal waters can determine the blood type and gender of the child, warn of probable hereditary diseases, metabolic disorders, and the occurrence of hypoxia.

If you suspect the development of anomalies, pathologies and genetic disorders in the fetus, a pregnant woman is also recommended to do an amniocentesis to make sure that everything is fine with the baby.

The composition of the amniotic fluid informs about the degree of readiness of the baby for birth, when it becomes necessary to conduct an emergency birth, in particular, determines the stage of maturity of the respiratory system and lungs of the child.

Amniotic fluid pathologies

In order for the child to develop safely, the amniotic fluid must be present and maintained in a certain amount and condition. A change in its volume and chemical composition in some cases indicates violations and pathologies:

Polyhydramnios. They say about polyhydramnios when the volume of amniotic fluid exceeds 1.5 liters. Why this happens, doctors cannot find out exactly, but still identify a number of probable causes: nephritis, cardiovascular disease, diabetes mellitus, intrauterine infections, congenital malformations of the fetus, multiple pregnancy, Rh conflict. Most often, this pathology is found in the second and third trimesters. If polyhydramnios developed suddenly, then childbirth must be carried out urgently.
Low water. oligohydramnios is less common, but it is also dangerous for the fetus and negatively affects its development. Childbirth with oligohydramnios often occurs prematurely and passes with complications. With oligohydramnios, the volume of amniotic fluid does not exceed 500 ml. At the same time, the woman experiences constant pain in the abdomen, aggravated by the movement of the fetus, and the child's activity is reduced.
Water leakage. The fetal bladder must maintain its integrity until the birth itself, otherwise, the baby will not be able to survive. The rupture of the fetal bladder and the outflow of amniotic fluid mark the onset of labor and ideally should occur in a timely manner. Premature discharge of water indicates an early onset of labor and should be a reason for urgent treatment to the hospital. You should also tell your doctor about water leakage immediately if you suspect it. In this case, the fetal bladder bursts in the upper lateral part, and amniotic fluid leaks from the hole in small portions.
Green waters. Normally, fetal water is clear, like water. By the end of pregnancy, they may become a little cloudy and contain whitish flakes, because the baby “sheds”: fluffy lanugo hair and epidermal cells, as well as original lubricant, come off the skin. Such waters are normal and create a favorable habitat for the baby. But when the baby experiences a lack of oxygen (which doctors call fetal hypoxia), a reflex release of meconium from the rectum can occur. In this case, the waters turn green or brown and pose a certain danger to the crumbs.

Any of these conditions requires medical attention, so if you suspect any violations, you should contact your gynecologist. And for greater peace of mind - do not miss scheduled regular examinations and do not neglect referrals for examinations. I help control the state of amniotic fluid with ultrasound, CTG, blood tests for intrauterine infections, for Rh antibodies, for TORCH infections.

Baby. However, unfortunately, the further deterioration of the environmental situation in the world as a whole, the increase in the number of unhealthy people lead to the fact that carrying a baby for 40 weeks without encountering any problem or getting sick turns out to be quite difficult, and this happens not so often. In the article we will talk about one of the complications - leakage of amniotic fluid. We will tell you how to understand that amniotic fluid is leaking, and what symptoms indicate this.

The role of amniotic fluid

Important! If you find any of these symptoms in yourself, you must immediately inform the gynecologist. A copious outpouring of fluid means that you need to call an ambulance.

Methods on how to determine the leakage of water during pregnancy are medical and independent.
The first ones are:

gynecological examination,
smear microscopy,
aminotest,
cytological study.

During a gynecological examination, the doctor may suspect leakage if he finds clear discharge in the area of the posterior fornix of the vagina of the pregnant woman.

In this case, he will ask the woman to cough, if after that the liquid flows from the cervical canal, then it is likely that the fetal bladder is damaged. The gynecological method is the most common and least informative.

When taking a smear, the analysis is placed on the glass. If there is a leak, after it dries, it will take the form of a fern leaf. The method is also uninformative, since a similar pattern can occur in the presence of sperm.

Aminotest is an analysis during which an indigo-carmine solution is injected into the woman's abdomen with a syringe. After 30 minutes, a swab is inserted into the pregnant woman's vagina.
Its staining indicates a rupture of the fetal bladder. Aminotest is accurate, expensive and painful. It has a number of side effects: the possibility of infection, the appearance of bleeding and other complications.

A cytological examination involves taking a smear from the zone of the posterior fornix of the vagina and detecting the presence of amniotic fluid in it.

Express test at home

There are two ways to determine leakage at home. At the first time, a woman needs to urinate, then wash well, wipe dry.

After she needs to take a diaper or a sheet and lie on it. The presence of wet spots after 15 minutes indicates a violation of the bladder membrane.
In pharmacies, you can buy a test pad for leakage of amniotic fluid. The pad has an indicator that allows you to distinguish amniotic fluid from other secretions and urine by pH.

It sticks to the underwear for 12 hours or until the moment when the woman feels the discharge.

After removing the gasket, check the color of the indicator. Staining it in bluish-green requires immediate medical attention.

What amniotic fluid looks like when leaking, you can see in the photo.

Danger of premature discharge of water

Premature leakage of a liquid medium from the fetal bladder carries a number of dangers for both the pregnant woman and the baby.

For woman

When there is a violation of the surface of the fetal bladder, its content becomes non-sterile, so there is a high risk of infection entering both the child and the uterus.

Infection of the uterus usually leads to the death of the child and provokes the development of severe septic complications in the mother.

Did you know? The uterus is a unique human organ that is able to increase in volume by about 500 times while carrying a baby, and then return to its original state. Thus, the weight of a woman's uterus in a normal state is approximately 40-60 g, the volume of her cavity is 5-6 cubic meters. cm, and by the end of pregnancy - 1-1.2 kg and 500 cu. cm respectively.

For the fetus

If the leakage began before the 20th week, then additional tests will be required in order to decide whether it makes sense to prolong.
Most likely, the cause of the complication was infection, and this is fraught with the development of a number of pathologies in him.

Often children in such cases are born blind, deaf, suffer from severe respiratory failure or cerebral palsy. Therefore, doctors often decide to terminate the pregnancy. Bladder rupture at 25-27 weeks is usually due to the development of a urogenital infection.

The council of doctors must determine the possible risks for the child and decide on the further preservation of the pregnancy or its termination. The risk of developing disability in the baby is quite high.

At a period of 38-40 weeks, a slight rupture of the bladder and the outflow of a liquid medium from it does not pose such a strong threat to the baby as in previous periods. Usually doctors at the moment resort to expectant tactics.

Important! The longer the period of leakage of amniotic fluid lasts, the more serious complications can occur in the child and mother..

What to do if amniotic fluid leaks

If the problem was discovered by a woman on her own at home, then she should call an ambulance team or contact a antenatal clinic.
If a leak is detected by a gynecologist during a routine examination, depending on the specific situation, they will be prescribed treatment, recommendations will be given, additional tests will be prescribed, and a decision will be made on the further management of the pregnancy.

If a complication is detected in the period from the 20-22nd week, in most cases the child can be saved.

A waiting tactic is used, taking tocolytics and glucocorticoids (sometimes antibiotics), bed rest, sterile conditions, blood tests and vaginal cultures, daily monitoring of the volume and condition of the water.

Prevention of premature discharge of water

In order to prevent premature discharge of amniotic fluid, it is necessary:

timely treat infectious diseases of the genitourinary system, teeth, throat, kidneys;
to carry out timely treatment of istvico-church insufficiency;
adhere to preservation therapy if there is a risk of premature termination of pregnancy;
give up heavy physical exertion, be careful when walking, running to avoid falls;
observe personal hygiene.

Leakage of amniotic fluid is a serious complication of pregnancy. However, with its timely detection and treatment, the child in most cases is born full-term and healthy.

In order not to miss the problem, it is necessary to visit the gynecologist according to the plan, undergo the necessary examinations, be attentive to yourself and your body.

Amniotic fluid begins to form at a period of 5-6 weeks, and during pregnancy, their volume changes.

If at 5-6 weeks the volume of amniotic fluid is about 5 ml, then at the 38th week this volume is about 1 liter, and at the 40th week it is about 600 ml.

In this article, we will consider what amniotic fluid consists of, what they are for, what methods for studying amniotic fluid exist. We will also analyze common pathologies of amniotic fluid.

Why amniotic fluid is needed

Amniotic fluid plays a crucial role in the development and protection of the baby throughout pregnancy and in.

protection of the fetus from mechanical damage;
creating conditions for the movement of the fetus and preventing contractures of the limbs;
adhesion prevention;
the presence of amniotic fluid prevents squeezing of the umbilical cord;
amniotic fluid creates the necessary "purified" environment for the child, protects the fetus from infection. The volume of amniotic fluid is renewed every 3 hours, and thus this medium always remains "fresh";
creating conditions for the development of the lungs of the fetus;
fetal nutrition;
the baby "throws" all processed products into the amniotic fluid, and this makes it possible to remove these products through the mother's excretory system, thereby cleansing the child's body;
when the time of birth comes, the amniotic fluid with its weight acts on the cervix, forcing it to open. During childbirth, amniotic fluid makes it easier for the baby to move through the birth canal.

What is amniotic fluid made of

Throughout pregnancy, the composition and volume of amniotic fluid changes. The composition includes: epidermal flakes, vellus hair and the original lubricant of the fetus, proteins, fats, carbohydrates, enzymes, vitamins, glucose, hormones and waste products of the fetus.

Amniotic fluid, main indicators

Amount of amniotic fluid

Amniotic fluid is produced by the amnion (fetal bladder) throughout pregnancy. But the amount (volume) of water is not the same at different times. The largest volume of amniotic fluid is at about 36 weeks, and is about 1-1.5 liters. By the amount of amniotic fluid, such conditions as polyhydramnios and oligohydramnios are diagnosed. The amount of water is determined by . Approximate norms for the volume of amniotic fluid (depending on the gestational age) are shown in the diagram below.

amniotic fluid color

Normally, amniotic fluid is colorless, odorless, colorless, transparent, sometimes (normal variant) may be slightly whitish. Also, a small amount of white flakes is considered a normal indicator. The color of the amniotic fluid becomes clear when the water is poured out, or when the water leaks. The presence of "flakes" can be seen on ultrasound. With the outflow or leakage of amniotic fluid, dangerous symptoms are:

the unpleasant odor of the waters and their green color. Green "color" indicates oxygen starvation of the fetus, and requires urgent delivery (). Green waters become because, during oxygen starvation, the child releases original feces (meconium) into the waters and it colors the waters in a characteristic color.
bright yellow color - indicates the development of the Rhesus conflict, or incompatibility of the mother and child in terms of blood types. Requires urgent treatment in a hospital.
red color - indicates the onset of bleeding (due to premature detachment of the placenta or for other reasons). Urgent hospitalization of the pregnant woman is required, and, as a rule, urgent delivery.

At the beginning of labor, the amniotic fluid may have bloody streaks (in the main transparent volume). This is a variant of the norm, since micro-tears can occur when the cervix opens.

Biochemical, cytological and hormonal composition of amniotic fluid

The composition changes during pregnancy, and according to the composition of the amniotic fluid, specialists can draw conclusions about the condition of the fetus, as well as about the work of the mother-placenta-fetus system. Also, according to these indicators, various genetic pathologies can be diagnosed. For analysis, amniotic fluid sampling is needed, it is carried out using the amniocentesis procedure.

Transparency of amniotic fluid

A small amount of flakes in the amniotic fluid is considered normal. These "flakes" begin to be visible on ultrasound around the middle of the second trimester. By the end of pregnancy, their number increases. These are particles of the skin of the fetus, elements of the original lubricant.

Amniotic fluid, research methods

ultrasound. During an ultrasound, a specialist can check the transparency and volume of amniotic fluid. The presence of a large amount of flakes in the waters (in the third trimester) may be a symptom of fetal hypoxia. According to the results of ultrasound, the amniotic fluid index is also calculated and such pathologies of the amount of amniotic fluid as polyhydramnios and oligohydramnios are diagnosed.
Amnioscopy. During the amnioscopy procedure, amniotic fluid is examined visually using an amnioscope. Amnioscopy makes it possible to assess the color of amniotic fluid, as well as to determine the composition of impurities (meconium, lubricants, flakes, sometimes blood). During the examination, an amnioscope is inserted into the cervix. The procedure is performed without anesthesia, on a gynecological chair. Amnioscopy is performed with a whole.

Indications for amnioscopy: gestation of the fetus, chronic fetal hypoxia.

Contraindications to amnioscopy: inflammatory processes in the cervix,.
Amniocentesis.The procedure for the study of amniotic fluid, in which the fetal bladder is pierced and 20-25 ml of amniotic fluid is taken for analysis. With such a sampling of material, it is possible to conduct a hormonal, biochemical and cytological analysis of amniotic fluid. An indication for such a study may be suspicions (according to ultrasound) of genetic abnormalities of the fetus. The place for puncture is determined based on the results of ultrasound (the largest "free" pocket of amniotic fluid, without umbilical cord loops).

Of the listed research methods, ultrasound and amnioscopy are non-invasive methods (without a puncture), and amniocentesis is an invasive method.

Amniotic fluid, pathologies

By the volume of amniotic fluid, such pathologies are diagnosed.

Polyhydramnios is a pathology of amniotic fluid, during which amniotic fluid exceeds the norm in volume. In domestic medical practice, a volume of 1.5 liters is considered the norm (with a normal full-term pregnancy). In foreign practice, - 2 liters. Polyhydramnios can be acute and chronic (depending on the course and increase in symptoms). You can read in detail about the consequences, symptoms, diagnosis and causes of this pathology in the article.
Oligohydramnios is a pathology of amniotic fluid, in which the volume of amniotic fluid (with advanced pregnancy) is lower than 500 ml (in domestic medical practice), and less than 300 ml in foreign practice.There are moderate and severe oligohydramnios. To make a diagnosis (according to ultrasound data), the doctor calculates the so-called “amniotic fluid index”, IAF. According to the timing of occurrence, oligohydramnios can occur in the first, second, and third trimester. You can read in detail about the consequences, symptoms, diagnosis and causes of this pathology in the article.