Amniotic fluid is homogeneous. Leakage of amniotic fluid: how to keep the pregnancy? The main pathologies of amniotic fluid

09.05.2019

The embryo in the uterus develops inside a special bubble - the so-called amnion - and is surrounded by amniotic fluid. Its second name is amniotic fluid. They perform nutritional and protective functions. For any problems associated with the amniotic fluid (leakage and others), it is possible to diagnose the pathology of pregnancy.

More about this substance

Amniotic fluid is formed by "sweating" blood plasma from the vessels of a woman, and in the last stages, the embryo itself (its kidneys, lungs and skin) begins to take part in their production. The composition of this liquid includes proteins, fats, carbohydrates, hormones, enzymes, vitamins, micro and macro elements - everything that is necessary for nutrition and full development fetus.

On the other hand, the embryo itself gives it the products of its vital activity, which are then excreted excretory system mother. In the early stages of pregnancy, the amniotic fluid is close in composition to the blood plasma of a woman, and closer to childbirth, it becomes more and more fetal urine, its epithelial cells, vellus hair, and sebaceous gland secretion.

The volume of this important substance normally ranges from 0.6 to 1.5 liters, increases during pregnancy, and slightly decreases before childbirth. The amniotic fluid completely fills the bladder, but at the same time allows the embryo to move freely. She looks like ordinary water, sometimes with a pinkish, greenish or brownish tint, but normally always colorless and transparent.

Main functions near amniotic fluid:

saturation of the developing organism of the child with all the necessary nutrients;
removal of slags from it;
thermoregulation;
defence from mechanical damage, including from squeezing the umbilical cord, and sharp sounds;
prevention of any infections: the liquid is always sterile and is completely renewed every 3 hours, which prevents its stagnation and the growth of bacteria;
diagnostics of the course of pregnancy, including the ability to determine the blood group, Rh factor and the sex of the unborn child;
stimulation of childbirth: they begin when the amniotic fluid pours out and puts pressure on the cervix, from which it opens and lets the born out;
washing the birth canal, which facilitates the passage through them.

Possible problems

If during pregnancy there is some kind of threat to the fetus, this is necessarily reflected in the state of the amniotic fluid. The main signs that there are pathologies:

polyhydramnios: the volume is more than 1.5 liters, the causes are problems in a woman with a heart, liver, kidneys, Rh conflict;
oligohydramnios: the volume of fluid is less than 0.5 liters, as a result, the embryo moves a little, and the pregnant woman experiences pain in the abdomen;
green, yellow or brown amniotic fluid: indicates fetal hypoxia (the baby throws out a lot of meconium, which is why this color occurs) or intrauterine infection;
pink or red color: appears with placental abruption;
leakage is one of the most serious violations that threaten preterm birth.

What does amniotic fluid look like? important question. Its features help to identify pathology.

For diagnosis using this substance, the following methods are used:

Ultrasound (estimated quantity and uniformity);
amnioscopy (examines the color of the liquid);
amniocentesis (puncture of the bladder and taking its contents for various studies (biochemical, hormonal, etc.)).

To avoid complications, a woman needs to regularly visit a gynecologist who observes her and conscientiously take all the necessary tests.

If fluid leaks

Normal leakage of amniotic fluid begins after 37 weeks of pregnancy. Pathological often occurs in the second trimester, when the fetus has not yet fully formed and may not survive outside the mother's body. Reasons for this:

suffered by a woman inflammatory diseases(especially genital) or viral infections;
neoplasms in the uterus;
isthmic-cervical insufficiency (the cervix is not tightly closed);
malposition of the fetus and narrow pelvis mothers;
woman's bad habits and chronic diseases.

Also thinning of the membranes amniotic sac and fluid incontinence can cause mechanical influences(fall or strong blow), physical activity. Often this pathology occurs in multiple pregnancies.

A sign of leakage is the discharge of fluid from the vagina, similar to urinary incontinence. Sometimes it comes out a lot, which scares the lady. However, the liquid can be released literally drop by drop and not cause any inconvenience to the pregnant woman. All this does not always indicate pathology. By the end of pregnancy, the discharge normally becomes larger, and due to the relaxation of the muscles of the pelvic organs, urinary incontinence is indeed possible.

Symptoms to watch out for:

discharge increases with a change in body position and movement;
they cannot be stopped by muscle tension (urination is possible);
it is the liquid stain that remains on the linen or pad, while normal discharge have a thick consistency.

To find out if this is really a leak, you need to empty your bladder, wash yourself, wipe yourself dry and lie down on a clean diaper. If an odorless wet spot appears within 15 minutes, then the fears were justified. In this case, you need to urgently go to the antenatal clinic.

More precisely, the problem is determined by a special test, which is similar to a regular gasket. You need to walk with him for 12 hours. If during this time it turns green-blue, it means that amniotic fluid is really released.

Only a doctor can definitively determine a leak with a cervical smear or urinalysis. If the study found elements of amniotic fluid, hospitalization is necessary. In no case should it be abandoned, because if the bladder is not tight, the infection easily penetrates there, the fetus dies, and the woman has serious complications (sepsis).

Taking action

The most simple and effective solution leakage problems - labor induction, because the embryo inside the uterus is no longer protected from bacteria. However, this is not always possible. In the second trimester, his lungs had not yet developed enough for him to breathe on his own. Therefore, if leakage is detected at this stage of pregnancy, you should try to keep it until the fetus is ripe for independent living. Accordingly, the woman remains in the hospital until delivery.

In such a situation are carried out:

antibiotic therapy to prevent infection;
constant monitoring of the condition of the expectant mother and child: a woman’s temperature is measured, various laboratory research and at the same time blood flow, fetal movement are evaluated;
introduction hormonal drugs to quickly prepare the lungs of the embryo for independent breathing(but this is not always possible, but only if there is no infection).

In this case, the pregnant woman must observe bed rest, complete rest and follow all the doctor's instructions (every day is important!). It is often possible to extend the gestation period to optimal time and the baby is born relatively safely.

However, if the leakage of amniotic fluid occurs in the early stages, you have to have an abortion.

Prevention

To avoid such a pathology, a woman needs:

carefully monitor your health, ideally do it all your life: give up smoking and alcohol, do gymnastics, strengthen immunity;
at the stage of pregnancy planning, you should visit a gynecologist and carry out all necessary examinations, it is very important to check the condition of the genitals (whether the cervix is closed, whether there are hidden tumors or cysts);
when conception has already occurred, you need to eat right, observe the daily routine, avoid stress and physical exertion;
observe hygiene, including antiseptic treatment of the genitals;
at the slightest indisposition (not only if symptoms of leakage appear), consult a doctor.

amniotic fluid - essential substance which helps the embryo to live and develop inside the uterus. If they start leaking or some other problems, you need to go to the hospital to stimulate labor or maintain pregnancy.

In the formation and exchange of amniotic fluid, they take Active participation all structures of a single system "mother - placenta - fetus": maternal organism; amnion (cells lining the fetal membrane); fetus (fetal kidneys in last dates pregnancy produce an average of 600-800 ml of urine per day, which is excreted in amniotic cavity, while in 1 hour, on average, the fetus swallows 20 ml of water; fetal skin up to 24 weeks of pregnancy also participates in the metabolic processes of water, absorbing some of them until it becomes keratinized, after which the skin becomes impermeable to amniotic fluid).

Compound amniotic fluid during pregnancy changes. If in the early stages the amniotic fluid in its chemical composition is similar to the plasma (liquid part of the blood) of the mother, then by the end of pregnancy in in large numbers contains fetal urine. The amniotic fluid contains oxygen, carbon dioxide, electrolytes present in the blood of the mother and fetus, proteins, lipids, carbohydrates, enzymes, hormones, vitamins, biologically active substances, phospholipids, blood coagulation factors, epithelial cells exfoliated from the skin of the fetus, vellus hair, secretions of the fetal sebaceous glands, fat droplets, etc. The concentration of one or another component of amniotic fluid depends on the duration of pregnancy.

Volume amniotic fluid increases towards the end of pregnancy, reaching a maximum value at 38 weeks, then, closer to childbirth, it may decrease slightly. Normally, at 37-38 weeks of gestation, the volume of amniotic fluid is 1000-1500 ml, while at 10 weeks it was only 30 ml, and at 18 weeks - approximately 400 ml. With a post-term pregnancy, a decrease in the amount of amniotic fluid is noted, with various pathologies of pregnancy, a change in volume can occur both upward and downward.

Why is amniotic fluid needed?

Amniotic fluid not only provides the exchange of substances between the fetus and mother, but also performs the function mechanical protection you , protecting the fetus from external influences, also protecting the body of the fetus from being squeezed by the walls of the uterus and being a shock absorber in cases of mother's falls, that is, the amniotic fluid smooths out the push or blow transmitted to the fetus during blows to the stomach or falls. Of course, that the "degree of protection" in this case is not great, that is, when hitting a large force, the integrity of the fetal bladder can be broken.

The fetal bladder contributes to the opening of the cervix during childbirth, playing a role hydraulic wedge during the first stage of labor (during the opening of the cervix). It also protects the fetus from infection by being physiological barrier on the path of infection, which can enter the uterine cavity from the vagina and cervix.

Diagnostic methods using amniotic fluid

To diagnose the course of pregnancy great importance have the amount, color, transparency of amniotic fluid, their hormonal, biochemical, cellular composition, etc. Doctors have in their arsenal various methods diagnostics.

ultrasound. Much attention is paid to ultrasound amount of amniotic fluid , since a relationship was found between this parameter and the pathology of pregnancy: post-term pregnancy, preeclampsia (it is manifested by an increase in blood pressure, edema, the presence of protein in the urine), fetal hypoxia (a state of oxygen starvation of the fetus in the womb). The amount of water is estimated by the size of free areas of amniotic fluid (the so-called "pockets" or "packages").

Ultrasound can also assess homogeneity (uniformity) amniotic fluid.

The presence of suspended matter in the water most often indicates infection.

Amnioscopy. This is an examination of the lower pole of the fetal bladder and amniotic fluid using a special device that is inserted into the cervical canal through the vagina. Such a study allows you to evaluate the color of amniotic fluid and their amount. With fetal oxygen deficiency, amniotic fluid acquires green color due to the admixture of meconium (original feces). Amnioscopy is carried out, as a rule, at the end of pregnancy, when the cervix is already preparing for childbirth and may miss the optical apparatus - the amnioscope.

Amniocentesis(from the Greek words "amnion" - the fetal membrane and "centesis" - piercing). This is a puncture (puncture) of the fetal bladder, the purpose of which is to take amniotic fluid for diagnostic studies: biochemical, hormonal, immunological, cytological, in order to have an idea about the condition of the fetus and determine the further management of pregnancy. The indications for this procedure are: rhesus conflict ; in this case, the content of bilirubin in the amniotic fluid is determined (it increases as the concentration of bilirubin secreted by the kidneys of the fetus increases, which serves as an indicator of the severity of the process); the study also determines the blood type of the fetus, the amount of antibodies to the Rh factor; suspicion of chromosomal pathology fetus; suspicion of chronic fetal hypoxia (oxygen deficiency); the need to determine the maturity of the lungs of the fetus when there is a question about early birth; this determines the concentration of phospholipids in the amniotic fluid and their ratio.

Amniocentesis is done under ultrasound control, through the anterior abdominal wall or the anterior or posterior fornix of the vagina: the puncture site is selected based on the location of the placenta. Before the operation, the bladder is emptied to avoid injury, the skin is treated with an antiseptic solution, local anesthesia is made with a novocaine solution, then the anterior abdominal wall, uterine wall and fetal bladder are punctured with a long thick needle; 15 ml of water is drawn into the syringe. The procedure is invasive (i.e. accompanied by a puncture of the abdominal wall, uterine wall, insertion into the uterine cavity), it may entail various complications(mainly a miscarriage or premature birth, amniotic fluid rupture, infection membranes, injury to the vessels of the fetus and as a result of this - internal bleeding, injured Bladder or maternal intestines). AT modern conditions these complications are very rare, due to the introduction of ultrasound - control, compliance with the rules of asepsis and antisepsis.

Amniocentesis is not performed if there is a risk of miscarriage or premature birth, with the location of the placenta or myomatous node on the anterior abdominal wall, malformations of the uterus, the results of smears and bacterial cultures from the vagina and cervical canal indicating the presence of an inflammatory process. After the operation, a therapeutic regimen is recommended for several days (up to 1 week), with preventive purpose prescribed drugs that relax the uterus, if necessary - antibiotics.

oligohydramnios during pregnancy

Oligohydramnios is a reduction in the amount of amniotic fluid to 500 ml or less as a result of an imbalance between their absorption and production. Most often, this condition occurs in younger pregnant women with increased blood pressure in the third trimester of pregnancy and in women with increased risk development of fetal malnutrition (lag in the size of the fetus from normal for this period).

First of all, if oligohydramnios is suspected, it is necessary to exclude birth defects fetal development, especially if it is detected in the second trimester (before 28 weeks) of pregnancy, because sometimes pronounced oligohydramnios can be combined with such defects as polycystic kidney disease or their absence. Oligohydramnios, as well as polyhydramnios, can be a sign of intrauterine infection of the fetus, so it is necessary to conduct an examination for hidden

that infection. Oligohydramnios may occur against the background of a decrease in the excretion of urine by the fetus into the amniotic cavity with chronic hypoxia, which is observed with intrauterine growth retardation of the fetus. In 40% of women with oligohydramnios, there is a lag in the size of the fetus from the norm. Due to a sharp decrease in the volume of amniotic fluid, compression of the umbilical cord (compression between the fetus and the walls of the uterus) may occur, which can lead to acute oxygen deficiency and fetal death; extremely rarely, adhesions (fusions) are formed between the walls of the uterus and the skin of the fetus.

Since the fetal bladder is “flat” in oligohydramnios, it does not perform the function of a hydraulic wedge, does not contribute to the opening of the cervix, as a result, there is a danger of weakness labor activity. Due to a violation of the active motor movements of the fetus in the uterine cavity, the frequency increases breech presentation, and, as a result, in some cases - cesarean section operations. More often to operational childbirth with oligohydramnios, weakness of labor activity and intrauterine fetal hypoxia result. Oligohydramnios can be primary (observed with whole membranes) and secondary, or traumatic (as a result of damage to the membranes with a gradual outflow of water, which sometimes goes unnoticed by a woman: amniotic fluid is mistaken for whites).

Diagnosis of oligohydramnios is mainly based on an ultrasound examination. However, during the examination, the doctor may pay attention to the fact that the height of the fundus of the uterus and the circumference of the abdomen are behind normal for a given period of pregnancy, reduced physical activity fetus, the uterus is dense on palpation, the parts of the fetus and the heartbeat are clearly defined. During vaginal examination during childbirth, a “flat” fetal bladder stretched over the fetal head is determined.

If oligohydramnios is detected before 28 weeks of gestation, comprehensive examination pregnant to determine possible cause and evaluation of the fetus. If fetal malformations are detected, pregnancy is terminated by medical indications. When combined with low water intrauterine hypoxia and fetal growth retardation, appropriate therapy is carried out up to 33-34 weeks of pregnancy, and if the treatment is ineffective and the fetus's condition worsens, early delivery. During childbirth, a “flat” fetal bladder is opened to prevent weakness of labor activity.

At severe forms placental insufficiency and intrauterine malnutrition the fetus may drip intra-amniotic administration of solutions of amino acids after the preliminary removal of the amount of fluid equal to the input. Attempts are also being made to paraplacental oxygenation of the fetus during childbirth to treat chronic fetal oxygen deficiency by introducing oxygenated amniotic fluid into the amniotic cavity. These methods have not yet been found. wide application and need further research.

Polyhydramnios during pregnancy

Not only a decrease in the amount of amniotic fluid is bad, but also its increase. Polyhydramnios is considered to be the volume of water exceeding 1500 ml. Most often this happens in multiple pregnancy, diabetes mother, Rh- conflict pregnancy, with intrauterine infection, anomalies in the development of the fetus.

With anomalies (malformations) of fetal development, the process of swallowing water by the fetus is disrupted, as a result of which the balance between their production and excretion changes. On examination, the height of the fundus of the uterus and the circumference of the abdomen exceed the normal for this period of pregnancy.

The fetus actively swims in the amniotic fluid, which can cause the umbilical cord to wrap around the neck and torso. If polyhydramnios is suspected, the doctor clarifies the diagnosis with the help of ultrasound, while excluding intrauterine infection, fetal malformations. Due to the strong stretching of the membranes with severe polyhydramnios, untimely outpouring amniotic fluid. Preterm birth is also possible. premature detachment normally located placenta, prolapse of small parts of the fetus (handles, legs) and the umbilical cord during the outpouring of water (therefore, after the outpouring of water, a vaginal examination is mandatory). If fetal malformations that are incompatible with life are detected, an abortion is performed. If the cause of polyhydramnios was intrauterine infection, treatment is carried out taking into account the identified pathogen. Childbirth with polyhydramnios may be accompanied by weakness of labor activity due to a strong stretching of the uterus, resulting in a decrease in its contractility and excitability. Based on the foregoing, it often becomes necessary to open the fetal bladder. This is done very carefully, the water is released slowly, after which a vaginal examination is performed to exclude the prolapse of the arms, legs, umbilical cord loops. AT postpartum period reducing drugs are administered to prevent postpartum hemorrhage, since the overstretched uterus is poorly reduced.

How is the outpouring of water

Normally, amniotic fluid is poured out in the first stage of labor (up to full disclosure cervix, but not before 4 cm dilatation of the cervix). At the height of one of the contractions, the bubble becomes tense and bursts. As a result, the anterior waters are poured out, which are located between the head of the fetus and the membranes of the fetal bladder. “Born in a shirt,” they say about children who were born with a whole fetal bladder. In modern conditions, if a woman gives birth not at home, but in a hospital, this is very rare (the exception is rapid delivery), since if the cervical dilatation is complete, and the bladder is still intact, then the obstetricians themselves open it: at birth “in the shirt”, the membranes block the access of oxygen to the fetus. The outpouring of water before the onset of labor (before contractions) is considered prenatal or premature, and if the waters poured out with regular contractions, but with insufficient opening of the cervix, they talk about early outpouring of waters. In these cases, it is necessary to monitor the flow waterless period: it should not exceed 12 hours, since with a long anhydrous period, the likelihood of infection of the membranes, uterus, and fetus increases. Therefore, in the event of an outpouring of amniotic fluid at home, a woman must immediately go to maternity hospital. With prenatal rupture of amniotic fluid, a glucose-vitamin-hormonal background is usually created; for this intravenous and intramuscular injection of glucose, vitamins, hormones that prepare the birth canal. If contractions do not start, induction is performed medicines intravenously with a dropper. In case of ineffectiveness of such therapy, a caesarean section is performed.

O high rupture of membranes they say when the fetal bladder breaks not in the lower pole, but above. If in doubt, is it water or just liquid vaginal leucorrhoea ( typical situation with a high lateral rupture of the membranes), you need to go to your doctor, after placing a “control” diaper to show the nature of the discharge. In doubtful cases, a vaginal swab is taken for the presence of amniotic fluid or an amnitest is performed .

If the leakage of amniotic fluid is confirmed, but there are no contractions, the doctor decides on the further management of the pregnancy, depending on its duration. Until 34 weeks, obstetricians do everything possible to prolong the pregnancy, since the lungs of the fetus are immature and respiratory disorders may be found in the newborn after delivery. The woman is under constant supervision (body temperature is measured, a study of the content of leukocytes in the blood is carried out, clinical analysis blood, ultrasound, CTG - a study of fetal cardiac activity, a study of secretions from the genital tract for infections), the expectant mother is prescribed strict bed rest in stationary conditions, if necessary - antibiotic therapy, drugs that accelerate the maturation of the lungs of the fetus. If there are no conditions for prolonging pregnancy, for prevention and treatment respiratory disorders in newborns, a surfactant is used. In the absence of signs of infection and enough water in the fetal bladder by ultrasound, pregnancy can be extended up to 34 weeks. If, as a result of the study, it is found that the uterus tightly covers the fetus, and there are no waters, it is impossible to wait more than 2 weeks even in the absence of signs of infection (however, this situation is extremely rare). With a period of 34 weeks or more, with leakage of water, a woman is prepared for the upcoming birth.

Thus, the amniotic fluid is not only the habitat of the baby, but also helps to diagnose various "malfunctions" during pregnancy. Your doctor will monitor their number and, in case of deviation from the norm, will take the necessary measures.

Amnitest is a method by which the presence of α-microglobulin, which is not normally found in the vagina, is determined in the discharge from the vagina.

A sterile tampon is placed in the vagina for 5-10 minutes, then the result is determined using the test strip by the express method. If there is placental α - microglobulin in the contents of the vaginal secretion, a control strip appears in the test strip window.

Most of the time, while the baby is in the womb, amniotic fluid serves as a nutrient medium for it. Amniotic fluid (or amniotic fluid) fills the amniotic sac and performs many important functions. Thanks to the fetal waters, the baby is not afraid of any temperature changes or biological factors.

By the state of the amniotic fluid, doctors can determine whether the intrauterine development child. Therefore, at the slightest deviation in the composition of the fetal waters from the norm (or when they leak), urgent measures must be taken.

What is amniotic fluid?

The fetal fluid is the woman's blood that passes through the walls of the placenta. With the passage of time, their composition is constantly changing: if in the early stages the waters are similar in composition to the mother's blood plasma, then by the middle of the period traces of the fetus's vital activity appear in them. For a child, this does not pose a danger, since every 3-4 hours the water is renewed, and only useful material and elements.

Amniotic fluid is almost 97% water. Carbohydrates, proteins and fats are dissolved in it, as well as enzymes, proteins, mineral salts, immunoglobulins and antigens (molecules that determine the child's blood group).

In addition, alkaloids, special aromatic substances, were found in the amniotic fluid.

It is believed that the newborn freely finds the mother's breast precisely because the smell breast milk very similar to the smell of fetal fluid.

The amount of fetal water increases by the third trimester. The less time remains until the end of the gestation period, the more amniotic fluid fills the fetal bladder. By about 36 weeks, the amount of fetal water reaches a maximum - from 1 to 1.5 liters. Before childbirth, they become smaller due to the gradual outpouring.

In order to find out if you have a normal amount of amniotic fluid, as well as to exclude the possibility of polyhydramnios or oligohydramnios, you can use our table. It shows the amniotic fluid indices (AFI) corresponding to a certain week of pregnancy. All you need to do is compare with our indicators the index that your doctor determined during the test.

Table of the amount of amniotic fluid by week:

Leakage of amniotic fluid: symptoms and causes

Such pathology as premature effusion amniotic fluid, mainly found in pregnant women with inflammatory processes of the cervix or vagina. The outflow occurs due to the fact that the fetal membranes, which become thin and inelastic under the action of microorganisms, no longer hold the fluid inside the bladder.

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Leakage can also be caused by the following factors:

abdominal trauma;
excessive physical activity;
stress and fatigue;
sex during pregnancy.

In addition, the release of water can occur after prenatal diagnosis performed poorly. The examination includes procedures that require the insertion of a needle into the walls of the amniotic sac. With proper execution, the walls should not lose integrity.

Signs of amniotic fluid leakage are mild. In the third trimester of pregnancy, the discharge becomes more, which is considered the norm, therefore future mom is unlikely to be able to distinguish them from a possible outflow of fluid.

Symptoms that indicate premature outflow of amniotic fluid will be as follows:

the release of fluid increases with a change in position or walking;
moisture leaves constantly and in large quantities - panty liners not enough even for an hour;
Leakage of water can be determined by external signs: the amniotic fluid is transparent, sometimes it contains slight patches of pink, brown or green. By the third trimester, tiny flakes appear in the amniotic fluid - dying flakes of vellus hair (lanugo) of the fetus. Normal discharge is thicker and whitish.

How to determine the leakage of amniotic fluid?

The most common problem is the leakage of amniotic water in drops, in which the pregnant woman does not experience any discomfort. If the damage to the amniotic sac is microscopic, the only way to detect rupture is to test for amniotic fluid leakage.

Amniotic fluid tests are based on determining the degree of acidity (pH) of vaginal discharge. Normal discharge for pregnant women is acidic, while amniotic fluid is alkaline. If in vaginal secretion alkaline environment will be dominant, the test will show positive result.

Tests for amniotic fluid leakage look like a regular sanitary napkin, with an adhesive strip attached to underwear. As soon as you feel the wetness of the pad (the maximum use time is 10-12 hours), remove the indicator strip from the test and place it in the case that comes with the kit.

The test result will be known in about 30 minutes. Special reagents, when detecting amniotic fluid, stain the strip in a yellow-green color. When using the gasket test, it is also possible false positive results. They appear when there is bacterial infections in a pregnant woman.

To avoid false result test for amniotic fluid leakage, it must be used no earlier than 12 hours after douching or sexual intercourse.

If the test gives a positive result, you should inform your doctor as soon as possible. Do not postpone going to the clinic even if the test did not reveal any leakage, but suspicions (discomfort, too copious discharge) stayed.

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Other pathologies of amniotic fluid

Color, quantity and chemical composition amniotic fluid indicates whether your baby is developing successfully. Violation of these indicators are serious reason for medical intervention:

1 Low water. This pathology threatens fetal hypoxia due to lack of oxygen and nutrients. The diagnosis is determined if the amount of amniotic fluid is less than 500 ml (for the 3rd trimester of pregnancy). The expectant mother can feel the signs of oligohydramnios on her own. Pain in the abdomen will be constant, aggravated by pushing the baby. In this case, the motor activity of the child will be quite low.

2
. Pathology is the amount of water that exceeds 1.5 liters in the 2nd and 3rd trimesters. With polyhydramnios, there is a risk of premature birth, as the cervix will dilate earlier due date under the weight of the water. With polyhydramnios, the fetus moves too freely, so there is also a danger of another complication - entanglement of the umbilical cord.

3 Suspension in the amniotic fluid. Availability fine suspension in the amniotic fluid is determined when the pregnant woman has infectious diseases(for example, ureaplasmosis) or her immunity is very low. The infection does not pose a threat to the child while in the womb, but the transmission of the disease can occur during. Most often, the problem is solved with the help of drugs that increase the immunity of a woman.

4 Amniotic fluid embolism. A very dangerous obstetric disorder in which amniotic fluid enters the circulatory system pregnant during childbirth. The mother may experience toxic shock due to foreign bodies that disrupt the operation of the system.

Embolism requires emergency drug therapy aimed at improving the balance of blood composition. If an embolism was diagnosed during childbirth, delivery is possible only by caesarean section.

“The causes of amniotic fluid leakage can be very different. Most often, the release of amniotic fluid is due to some inflammatory process in the body. Also, leakage can be provoked by isthmic-cervical insufficiency, anatomical anomalies in the structure of the uterus, abdominal trauma and many other factors. Sometimes it is not possible to determine the exact cause, ”explains Aza Balova, obstetrician-gynecologist of the network of centers of reproduction and genetics "Nova Clinic".

According to our expert, amniotic fluid leakage is very dangerous because it is associated high risk stillbirth, death in perinatal period, as well as the development of various diseases in newborns.

“Further tactics of pregnancy management in case of amniotic fluid leakage largely depends on the period. The larger it is, the better the prognosis, ”adds the doctor.

The role of amniotic fluid

Firstly, amniotic fluid (amniotic fluid) fills the fetal bladder, throughout pregnancy, forming a comfortable and safe environment for developing fetus. Thanks to the amniotic fluid, the fetus can move freely and actively, while the water softens its movements, protecting the mother from sudden shocks.

Secondly, the waters form a kind of shock-absorbing barrier that protects the child from external influences, from being squeezed by the walls of the uterus.

In addition, sterile amniotic fluid is involved in the processes of nutrition of the child and does not allow pathogenic organisms from external environment penetrate into the fetal bladder. The waters are renewed every few hours, while constantly maintaining the optimal chemical composition.

By the end of pregnancy, the volume of amniotic fluid reaches 1.5 liters. Normally, the fetal bladder ruptures and waters are poured out during the first stage of labor at a gestational age of at least 38 weeks. In 10-15 percent of pregnant women, the integrity of the membrane of the amniotic sac is broken long before the due date of delivery, which can lead to serious consequences for the mother and for the child.

Signs and Diagnosis

The massive discharge of water is difficult to confuse with something, since a large volume of liquid is poured out at a time. But in some cases, a hidden rupture of the fetal bladder occurs, the membrane is torn in its upper or lateral part and water can leak into a small amount. Sometimes a woman does not notice leakage for a long time.

The main symptom of amniotic fluid leakage is watery discharge, aggravated by physical stress and a change in body position.

Sometimes, especially on late term During pregnancy, water leakage can easily be confused with normal vaginal discharge, which by the end of pregnancy may become more profuse and thin than usual. It is also not uncommon for water leakage to be confused with urinary incontinence - an enlarged uterus presses on the bladder, and during physical exertion, laughter or sudden movements urine may be passed involuntarily in small amounts.

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If water leaks in large quantities, the pregnant woman's belly may decrease in volume, sometimes there is also a decrease in the height of the uterine fundus.

Due to the fact that the amniotic fluid has no color and a specific smell, their slight leakage for a long time can go unnoticed, and even a doctor is not always able to recognize the problem. For the diagnosis in this case, special tests are prescribed. Most often, this is a cytological analysis of a smear from the posterior fornix of the vagina, designed to determine vaginal discharge the presence of elements of amniotic fluid.

With profuse leakage, diagnostic methods such as a routine vaginal examination and a cough shock test can be informative ( physical stress when coughing causes increased leakage).

If other methods did not give an accurate result, in cases where the condition of the pregnant woman inspires fear for her and the fetus's life and health, the amniocentesis method is used - in this case, a safe non-toxic dye is introduced into the cavity of the fetal bladder, and a clean swab is placed in the patient's vagina.

Staining of the tampon with one hundred percent probability indicates leakage of water, but the method of amniocentesis is dangerous in itself, since during its implementation the integrity of the membrane of the fetal bladder has to be forced to break.

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It is rare for a woman to independently determine whether amniotic fluid is leaking. If there is any suspicion, most in a simple way to confirm or refute them becomes the "clean diaper" method. To do this, the pregnant woman needs, after completely emptying the bladder and thoroughly washing, just wipe dry and lie down on a clean, dry diaper for 30-60 minutes. If after that a wet spot is found on the diaper, you should immediately seek medical help.

There are also special tests that allow at home with a high degree of probability to determine the leakage of water. The test consists of a swab, a reagent bottle and a test strip. The tampon is inserted into the vagina for a while, and then placed in a vial with a solution. After that, a test strip should be lowered into the vial, on which lines will appear, indicating a rupture of the membranes or its absence.

One strip means no gap, two - confirm its fact

Causes and consequences of amniotic fluid leakage

The causes of rupture of the membranes are usually the following:

Inflammatory and infectious diseases of the pelvic organs, causing the membranes of the fetal bladder to become thinner and lose elasticity. It can be such common diseases as colpitis or endocervicitis
Isthmic-cervical insufficiency. If the cervix does not close completely, the fetal bladder may protrude into the cervical canal. In this state, it can easily become infected and damaged.
Multiple pregnancy. In this case, the walls of the uterus and the membranes of the fetal bladder are subjected to a large load.
Developmental anomalies, benign or malignant formations uterus
Significant exercise stress, physical abuse, abdominal trauma

Leakage of amniotic fluid is a serious complication of pregnancy that requires immediate medical attention and admission to a hospital. The fact is that the violation of the integrity of the bubble threatens premature onset childbirth and infection of the fetus - a baby not protected by a hermetic bladder and amniotic fluid barrier is defenseless against infections.

How longer period water leaks, the more dangerous the situation in which the mother and child are. If the rupture of the fetal bladder occurred on

Without amniotic fluid, the development of the baby inside the womb is impossible. It is truly " living water”, which gives the child a full life support.

Table big scheme
baby inside measurements
pain observation development
pregnant mother drinking

The amniotic fluid has official name- amniotic fluid, from the Greek "amnion", in translation "- the shell of the fetus." What amniotic fluid looks like is clearly shown in the photo.

It is impossible to overestimate the importance of the functions of the amnion in the formation of the embryo. You need to know how long the baby will continue to live without amniotic fluid in order to fully realize the significance of the life-giving fluid: no more than 6 hours and a maximum of 12 hours.

Protects the fetus from infections

Amniotic fluid creates a sterile microenvironment for the child, blocking the influence of adverse factors. They act as a shock absorber for mechanical external influence and a barrier to the penetration of viruses, microbes, infections. It is important to know how often the amniotic fluid is updated.

An amazing fact, but this happens several times a day - every three hours, and the composition changes depending on the stage of gestation.

On the initial stage amniotic fluid is similar to plasma, the fluid part of maternal blood. Closer to delivery, the amniotic fluid contains a large volume of urination of the embryo.

The amniotic fluid provides the baby with oxygen and carbon dioxide. They have a rich composition, saturated with electrolytes, proteins, lipids, carbohydrates, enzymes, hormones, phospholipids, bioactive substances, vitamins, epithelial cells and hyperechoic inclusions (waste products of the baby).

The amount of amniotic fluid and components depends on the period of gestation, the weekly indicators can be seen in the table below.

Color changes and effects

Amniotic fluid may change color depending on the health of the mother and baby. It is necessary to know what color amniotic fluid is when leaking or when leaving, in order to understand whether there is a risk of pathology or not.

First you need to be able to determine how amniotic fluid flows and how it drains. When the water leaves, the bubble ruptures and a decent volume of liquid is poured out, about 200 ml. Many women confuse leakage with normal secretions, so they may not immediately realize that they are at risk.

Leakage threatens with premature effusion, which means premature birth. What to do in such a situation? Studies of this problem show that leakage is fairly easy to diagnose. You can purchase a test, an amnicator with an indicator, which is easy to use and used at home.

What amniotic fluid looks like when leaking, we advise you to look at the photo. If a problem is found, it is necessary to contact your doctor, take tests and undergo the prescribed examination.

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color staining

White or clear amniotic fluid without pungent odor. But often there are cases of color changes that indicate the condition of the mother and child.

Yellow: dirty or cloudy color a yellowish tint is considered the norm when water is discharged.
Yellow streaked with red or Pink colour: at good health the woman in labor has no worries. Veins warn that the uterus is ready for childbirth.
Red: indicates dangerous threat for mother and baby. Perhaps bleeding began in the child or in the mother, the blood could get into the amniotic fluid. This rarely happens, you should urgently call an ambulance.
Dark brown: This is evidence that a tragedy has occurred. In most cases, intrauterine death of the child occurred. In this case, they are trying to save the woman in labor, immediate placement in intensive care is necessary.
Green: Green amniotic fluid means the baby is in serious danger. This happens in situations where the amount of amniotic fluid turned out to be too small, or a bowel movement occurred inside the womb.

If meconium (original feces) enters the amniotic fluid, aspiration (inhalation) of the waste product by the baby may occur. This happens quite often, green amniotic fluid suggests that the baby needs help.

Provide free movement of the fetus

Quantitative characteristics

Without amniotic fluid, a child can stay in the womb for no more than 12 hours, this is as much as it is safe for the life of the baby.

The normal volume of amniotic fluid varies from 600 to 1500 ml. The amount of amniotic fluid affects the free movement and movement of the baby, normalizes metabolic processes, and protects the umbilical cord from compression.

The amount of amniotic fluid has different parameters, which depend on the week of pregnancy. For example, at week 10 - 30 ml., At week 18, an average of 400 ml, closer to 38 - from 1000 to 1500 ml.

There is a special table that shows the parameters corresponding to each week of the term.

week of pregnancy	Average normal rate in mm
16	121
17	127
18	133
19	137
20	141
21	143
22	145
23	146
24	147
25	147
26	147
27	156
28	146
29	145
30	145
31	144
32	144
33	143
34	142
35	140
36	138
37	135
38	132
39	127
40	123
41	116
42	110

With a significant deviation from the average value, tests and a full examination are prescribed.

The most common and safest examination is performed using ultrasound, but it does not give accurate results. Ultrasound is done for general characteristics mother and baby.

Reduce the force of shocks and pressure coming from outside

Biochemical, hormonal, immunological, cytological and other analyzes are taken during the examination by the method - amniocentesis. It is often necessary to identify chromosomal abnormalities on early term to prevent the birth of a sick child.

Amniocentesis is performed through a puncture amniotic sac. Contraindicated in genital infections, there is a risk of miscarriage. Every 1000th procedure ends tragically.

Consequences of deviations from the norm

With significant deviations from certain parameters corresponding to the healthy bearing of a child, there is a risk of pathologies in the mother and child.

The first complication is oligohydramnios. The reason is the weak production of amniotic fluid. It is quite rare, but can cause serious complications:

difficult childbirth;
premature delivery;
presentation of the embryo;
baby hypoxia.

The consequences of this pathology are anomalies and a delay in the growth and development of the child.

Perhaps the appearance of polyhydramnios, this is a significant excess of amniotic fluid. It happens chronic and acute.

In chronic cases, the mother feels well, drugs are prescribed to remove excess fluid. Additional individual recommendations are given regarding diet, etc., which must be strictly observed.
In acute - the rapid arrival of amniotic fluid, accompanied by acute pain in the abdomen, severe swelling, shortness of breath. There is a need to place a pregnant woman in a hospital, as there is a risk of premature birth. If the flow of water does not stop, an amniocentesis is performed to remove excess fluid.

Another pathology is leakage: the cause in most cases is the infection of the genital organs. With leakage, there is a risk of premature birth. Sometimes they are difficult to notice, it is recommended to carry out a verification test.

If there is a suspicion, you should immediately get an appointment with a doctor. It is often recommended to stay in a hospital for preservation, adherence to strict bed rest and doctor's advice.

The composition is quite complex and varies depending on the timing of pregnancy.

It is impossible to ignore the symptoms of the manifestation of pathologies, as well as to show an independent initiative for treatment at home. Such actions threaten the health of the baby.

Possible severe complication in a child after birth:

postpartum pneumonia;
the occurrence of diseases of the eyes, kidneys, skin;
belated development;
various forms of cerebral palsy.

There are cases when a child choked on amniotic fluid during childbirth. If it is a healthy clean liquid, then there is no particular risk to the health of the baby. Usually the child simply burps up the liquid that he swallowed.

But if meconium is present in the waters, then this threatens with serious complications:

postpartum bronchitis;
manifestation of infections gastrointestinal tract, the baby will suffer from diarrhea, vomiting and diarrhea;
lack of appetite, backwardness of physical development;
the rapid development of rickets, it is necessary to constantly monitor how much the baby weighs;
during the first year there is a restless state, capriciousness.

In order to avoid all sorts of complications, it is necessary to constantly visit experienced doctors who will professionally eliminate problems and help you bear a healthy baby.

Attention!

The information published on the site is for informational purposes only and is intended for informational purposes only. Website visitors should not use them as medical advice! The editors of the site do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor! Remember that only a complete diagnosis and therapy under the supervision of a doctor will help to completely get rid of the disease!