Amniotic fluid how much it flows out. Participation of amniotic fluid in the birth process. Symptoms of the development of pathology

22.07.2019

Often we have to meet with the concern of expectant mothers that they will miss the leakage of amniotic fluid, the symptoms are unknown to them. Often, an increase in vaginal secretion is taken for amniotic fluid, or vice versa - leakage of amniotic fluid is regarded as normal discharge.
Amniotic fluid is a child's habitat for 9 months. A container for amniotic fluid is the fetal bladder, which forms in parallel with the development of the child. Amniotic fluid is formed by the sweating of maternal blood components through the vessels of the placenta. The amount of water increases during pregnancy and only before childbirth can a decrease in their volume occur. On average, the amount of amniotic fluid for childbirth is 1.0-1.5 liters. The role of amniotic fluid is difficult to overestimate: they contribute to the normal development of a growing organism, protecting the child from compression by the walls of the uterus, from external physical influences. The child can move freely in the uterine cavity, which contributes to his harmonious development. In addition, the membranes and amniotic fluid are a fairly reliable barrier to the penetration of pathogenic microorganisms from outside.
Normally, rupture of membranes and rupture of amniotic fluid occurs during the first stage of labor, at least 38 weeks of gestation. Usually, the recognition of this process is not difficult: a sufficiently large amount (about 0.5 liters) of amniotic fluid is poured out at once, they have a slight specific smell, their outpouring is accompanied by increasing contractions.
Premature rupture of amniotic fluid occurs, most often, during pregnancy, proceeding with inflammatory processes of the vagina and cervix. Under the influence of microorganisms, the membranes become thinner, lose their elasticity and cannot fully perform their functions.
As a result, amniotic fluid leaks, the symptoms of which are very difficult to determine on your own. Amniotic fluid can be released in drops over a sufficiently long period of time and not arouse any suspicion in a pregnant woman.
Even with a gynecological examination, it is not always possible to determine the leakage of amniotic fluid: the symptoms are very scarce. To obtain a reliable answer, a number of laboratory tests are carried out. The simplest is to conduct a cytological examination of a smear from the posterior fornix of pregnancy. When amniotic fluid leaks in the smear, in addition to the usual vaginal contents, there are elements of amniotic fluid.
In addition, recently, rapid tests for the qualitative determination of amniotic fluid have become widespread. Such a test can also be carried out at home, which protects a pregnant woman from unnecessary worries, or allows you not to waste time for a timely visit to a doctor.
Currently, the approach to premature rupture of amniotic fluid is unambiguous - only delivery in a short time. Attempts to maintain a pregnancy with impaired integrity of the fetal bladder did not justify themselves due to frequent septic complications in the mother and child.

Most of the time that the child spends in the mother's womb, he stays 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 remain 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 36 weeks 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 constituents 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. The amniotic fluid also contains oxygen, carbon dioxide, immunoglobulin, baby's 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 waters also depends on the duration of pregnancy, because at different periods of development, the baby needs different substances.

Why amniotic fluid is needed

The role of amniotic fluid in the 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. We will tell you more about the functions of the amniotic fluid below:

One of the purposes of amniotic fluid is the metabolism between maternal and child organisms. Those components that are required by the baby for his development and maintenance of vital activity come to him precisely through the amniotic fluid. Processed food, excreted from a tiny organism, also first enters the amniotic fluid, and only then is completely removed from the woman's body. Waste products that enter the liquid also include the upper scales of the epidermis, particles of primordial lubricant, baby hairs and components of the mother's blood.
The second important function of the amniotic fluid is its ability to protect the unborn baby from all kinds of harmful factors in the surrounding 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, squeezes, pressure. Amniotic fluid eliminates the risk of squeezing the umbilical cord, gives the baby the ability to move freely in the mother's belly.
The female body also made sure that the amniotic fluid is always absolutely sterile. Due to the fact that viruses, bacteria and other pathogens do not penetrate them, the baby is reliably protected from diseases. Sterility is mainly maintained due to the constant renewal of the composition of the liquid, which occurs at least every 3 hours.
The amniotic fluid not only helps the baby to grow and develop in a safe environment, but also directly participates in the process of delivery. First, the so-called anterior waters, by their pressure on the uterus, ensure 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 through the birth canal, water plays the role of lubrication, facilitating this process.

In addition to the above useful functions, amniotic fluid also has important diagnostic value. Having carried out certain analyzes of waters, 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 group, but also to obtain information about possible hereditary diseases or other deviations, 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 amniotic fluid can be found using the necessary analyzes. 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 the child's readiness for birth. Based on the data obtained, a decision is made to use special medical equipment to support the life of the baby for a certain period.

Pathology of amniotic fluid

Low water during pregnancy

The condition when there is little amniotic fluid during pregnancy is called oligohydramnios. This 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. Low water is a serious problem that requires attention and timely treatment. If this phenomenon is not eliminated, certain complications may arise:

First, 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 complications such as premature birth. A child born prematurely will need special medical attention.
Low water is also dangerous because the baby is not able to move normally, which increases the risk of breech presentation of the fetus.
A very frequent companion of this pathology is hypoxia - a lack of oxygen necessary for the child. The consequences of hypoxia are 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 palpable physically. Occasionally, a woman with a similar problem may feel minor pain in the abdomen, but often this manifestation is simply absent. It is possible to identify the disease with the help of ultrasound, which is why the timely delivery of tests and the passage of scheduled ultrasounds are so important for a pregnant woman.

If it is possible to detect oligohydramnios before 28 weeks, examination of the body of the expectant mother will make it possible 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 the 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's take a closer look at what are the causes of oligohydramnios during pregnancy:

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

Polyhydramnios during pregnancy

About as rare as low water, the opposite pathology can also occur - polyhydramnios. This problem occurs in 1-1.5% of pregnant women and represents 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 feeling normal, the doctor may prescribe diuretics for her - special medications that are responsible for removing fluid from the body. In addition, the doctor prescribes adherence to a certain diet, which involves reducing the amount of salt in the diet. It is important to adhere to all the doctor's recommendations, because polyhydramnios can turn into unpleasant consequences. An overly enlarged uterus oppresses other organs, disrupting their work. In addition, polyhydramnios sometimes causes circulatory disorders in the female body, it complicates labor and can cause profuse 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 with the following symptoms: abdominal pain, severe edema, shortness of breath. With such a pathology, a woman needs hospitalization. While in hospital, the pregnant woman adheres to bed rest, which makes it possible to reduce the risk of premature birth. If acute polyhydramnios is characterized by the incessant flow of water and threatens the health of a woman and her baby, abdominal amniocentesis can be used as a remedy for the problem. In the process of such an operation, the placenta is pierced and excess fluid is removed.

Among the causes of pathology are the following:

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

Leakage of amniotic fluid during pregnancy

Another pathology of amniotic fluid is leakage. This condition is characterized by the appearance of abundant liquid discharge from the female genital tract. The amniotic fluid is distinguished from ordinary secretions by transparency, colorlessness, a very liquid consistency, and no odor. Often, leakage of amniotic fluid during pregnancy does not manifest itself with any symptoms, except for 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 get an appointment with 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 consult a doctor for some reason. In addition, if the test gives a positive result, the pregnant woman will somehow have to go to the hospital for inpatient treatment.

If a similar phenomenon makes itself felt after 36 weeks 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. Strict bed rest should be observed during hospitalization. In some cases, when the term is too short and it is not possible to maintain the pregnancy for a long time, the situation is fraught with abortion.

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

Amniotic fluid is green

Clarity, colorlessness, odorlessness and liquid consistency are characteristics of normal amniotic fluid. Slightly cloudy amniotic fluid during pregnancy can be observed at the very end of the term and is also considered the norm, since their appearance is due to the presence of epidermal scales and flakes of lubricant entering the fluid 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 caused by particles of original feces, which the baby secretes if he does not have enough 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 becomes the cause of irreparable consequences.

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

If during the entire pregnancy the waters were normal and turned greenish already during childbirth, very often this can be the cause of 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 sometimes caused by over-term pregnancy. If the baby is in the womb for too long, the amniotic fluid becomes old and does not function properly. Because of this, the baby is experiencing a lack of oxygen.
Sometimes a greenish tint to the amniotic fluid indicates infection. This happens if the expectant mother has had a cold, flu, bronchitis, has had an infection of the genitourinary system or any other inflammatory disease.
Very rarely, genetic diseases of the fetus can be the cause of the abnormal shade of amniotic fluid.

Green waters can be hazardous to babies if they swallow contaminated fluids. If such a phenomenon was found late in pregnancy, the woman may be prescribed a caesarean section. If such a pathology is detected in the early stages, you should first identify the causes of the condition and take measures to eliminate them. Since the amniotic fluid is often updated, it will be enough to eliminate the causes of the appearance of the pathology in order to correct the situation.

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

Tests of amniotic fluid during pregnancy

There are several ways to assess the state of amniotic fluid during pregnancy, the simplest of which is 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 establish its amount. For more detailed information, other studies are being carried out, which we will consider in more detail:

Amniocentesis is a complex procedure in which fluid is drawn directly from the amniotic fluid. To do this, a woman's belly is pierced with a special tool and a small amount of amniotic fluid is pulled out. The procedure is performed under local anesthesia. Then this material is sent to research, where immunological, biochemical, cytological and hormonal analyzes are performed. Depending on the location of the amniotic fluid, doctors determine the puncture site, and during the procedure, an ultrasound device is used. Amniocentesis is performed if there is a conflict between the blood rhesus 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, as well as 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 a 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. With the help of the procedure, you can establish the amount of amniotic fluid, examine its color and identify the presence of hypoxia in the fetus.

Amniotic fluid during pregnancy. Video

The discharge of water is one of the signs of the onset of labor. But many pregnant women are afraid of this moment and do not know how to behave correctly. Therefore, we want to tell you what they are, how they look and how water flows from pregnant women before childbirth, as well as how to behave in such a situation so as not to harm yourself and the baby. In addition, an informative video about this topic will be presented, which will answer frequently asked questions of expectant mothers.

Amniotic fluid is a colorless transparent liquid that consists of water, enzymes, glucose, carbohydrates, proteins and hormones.

The temperature of the amniotic fluid corresponds to the body temperature of the pregnant woman - 37 ° C.

Normal amniotic fluid is colorless or pinkish.

Before childbirth, particles of the epidermis and fetal hairs may be present in the waters, which form white flakes, due to which their transparency is somewhat reduced.

If the departed amniotic fluid before childbirth is green, then this indicates the presence of original feces (meconium) in them and is a sign of fetal hypoxia. The appearance of red amniotic fluid is an equally dangerous symptom that speaks of bleeding. Both conditions are urgent, so the pregnant woman should urgently call an ambulance.

The normal volume of amniotic fluid by the end of pregnancy is 800 ml.

The main functions of amniotic fluid are to create optimal conditions for the normal intrauterine development of the fetus, namely:

the amniotic fluid performs a protective function in relation to the fetus, since it protects it from mechanical damage;
participation in metabolic processes, since the amniotic fluid contains substances that are necessary for the development and growth of the fetus;
all waste products of the child are released into the amniotic fluid.

How to understand that amniotic fluid is leaving before childbirth?

Normally, the rupture of amniotic fluid should occur in parallel with the onset of contractions and the beginning of the opening of the cervix. Also, early discharge of amniotic fluid is distinguished, when the cervix has not yet opened, but contractions are present, which is also considered the norm. But it is best of all, both for the child and for the mother, when the water leaves when the cervix opens more than 4 cm.

In every tenth pregnant woman, amniotic fluid leaves prematurely, even before the onset of labor.

Very often there is a situation when the cervix is completely open, and the amniotic fluid does not flow out, so the amniotic bladder is pierced, which is called amniotomy.

Normally, with the onset of contractions, the water is not completely poured out, since only that part of the fluid that is in the uterine cavity in front of the head is leaving.

It so happens that the water leaves completely when the amniotic bladder bursts from below. Most often, a similar situation is observed when lifting weights or changing body position.

In cases where the amniotic bladder ruptures in the upper and lateral parts, labor will be accompanied by partial and sometimes drip discharge of water. In such situations, it is difficult for a woman to determine whether the amniotic fluid has departed or whether the amount of vaginal discharge has simply increased.

In addition, a woman needs to pay attention to the smell of amniotic fluid, since they are normally odorless. A fetid odor of amniotic fluid is a sign of an intrauterine infection that threatens the life of both the fetus and the woman herself.

Before and during the outpouring of amniotic fluid, pregnant women do not have any painful sensations. The woman only feels the moisture in the crotch, as if she were a little described. On rare occasions, pregnant women in childbirth reported hearing amniotic sac bursting sounds that resembled a popping, popping, or popping sound.

Sometimes, after the outpouring of water, pregnant women may feel cramping pain and heaviness in the lower abdomen, which extends to the lower back.

If you notice the discharge of amniotic fluid before the onset of labor, you need to urgently inform the obstetrician-gynecologist in whom you are being observed. It is also important to indicate what color and smell the water was, in what quantity, and describe in detail your feelings.

How to behave during the discharge of amniotic fluid?

In a situation where the water leaves in small quantities, a woman should warn her obstetrician-gynecologist about this. If the outpouring of water occurred before 38 weeks, then it will be necessary to undergo a study that will allow to determine or exclude the leakage of water.

Normally, the amniotic fluid will be, as we have already said, colorless or slightly pinkish, transparent, odorless and pathological impurities. Also, a sign of water leakage will be that it cannot be delayed or stopped, unlike urine excretion.

A woman should urgently inform the treating doctor about the discharge of amniotic fluid.
Take the things you collected in advance, call an ambulance or go to the maternity ward on your own. Basically, women give birth in 6-12 hours after the passage of water.

The rupture of the amniotic bladder creates favorable conditions for the penetration of infection into the environment where the fetus is located. The maximum permissible anhydrous period for the fetus is 12 hours. A longer anhydrous period threatens the development of intrauterine infection and fetal hypoxia, so doctors resort to artificial stimulation of labor or even surgical delivery, and the child is prescribed antibiotic therapy after birth.

In the case when water leaks in the early stages, all possible measures are taken to preserve the pregnancy.

Why can water drain early in pregnancy?

The reasons for water leakage in the early stages may be the following:

exacerbation of chronic gynecological diseases;
infection of amniotic fluid;
failure of the closing function of the cervix;
conducting vaginal instrumental examinations during pregnancy;
chronic diseases of internal organs;
drinking alcohol, drug addiction and smoking during pregnancy;
congenital defects of the genitals, in particular the uterus and its cervix;
multiple pregnancy;
trauma to the abdomen and pelvis.

Early rupture of the amniotic sac threatens such a complication as choriamnionitis, which is characterized by an increase in body temperature to high numbers, abdominal pain, and discharge of pus from the uterus.

How is premature leakage of amniotic fluid treated?

The therapeutic tactics in this case depends on the degree of rupture of the amniotic sac, the duration of pregnancy, the presence of labor and the general condition of the woman and the fetus.

With the outpouring of water up to 22 weeks, artificial childbirth is shown.
When the water is poured out in the period from 22 to 24 weeks, therapeutic measures are prescribed, aimed at maintaining pregnancy, do not always bring success.
When the water is poured out up to 34 weeks, the woman is hospitalized in the gynecological department for the "preservation" of pregnancy, which consists in strict bed rest, monitoring the state of the expectant mother and the fetus. If during this period the lungs of the fetus are functionally capable, then delivery can be carried out.

Indications for emergency childbirth are a fetal weight of more than 2500 grams, fetal hypoxia, the presence of signs of intrauterine infection of the fetus and a gestational age of more than 37 weeks.

As a result, we can conclude that when the amniotic fluid is released, regardless of the gestational age, you urgently need to inform the gynecologist with whom you are being observed. The doctor will clarify with you the nature, color and volume of the released water and decide what to do next. In any case, you need to remain calm and listen to the recommendations of a specialist.

Watch a video on amniotic fluid.

Knowing that in the near future a woman will become a mother, she tries to minimize all existing risks that may turn out to be dangerous for the health and development of the baby in the womb. Unfortunately, not always everything depends solely on the woman herself.

The thing is that often a real threat lurks in harmless situations. The most common of these is minor water leakage during pregnancy. As a rule, this problem is diagnosed out of time, which leads to very serious complications.

general information

The embryo inside the mother's womb develops in its own "world" for all nine months, which is actually a small fetal bladder (amnion). It is filled with a special nutritious substance. This is the so-called amniotic fluid (otherwise - amniotic fluid). They are constantly renewed, thanks to which the atmosphere inside the womb is created as comfortable as possible for the baby. In the case of the normal course of pregnancy, the amnion membrane ruptures on its own at the first stage of labor, when the cervix begins to open gradually. However, very often the integrity of the bladder is violated much earlier. Leakage of water during pregnancy, according to experts, can occur even in the first trimester.

The role of amniotic fluid

Protecting the umbilical cord from compression between the walls of the vagina and the baby's body.
Providing immune protection.
Protection of the fetus from various kinds of mechanical stress.
Hermetic isolation from the influence of infections.
Thermoregulation.
Prevention of bleeding.

Nature has made sure that all shells remain airtight until the baby is born. However, often, due to some factors, the bladder itself ruptures, which entails water leakage during pregnancy.

Why does the membranes rupture?

Various kinds of infectious / inflammatory diseases in the genital area. The toxins released by bacteria consistently lead to a thinning of the walls of the fetal bladder itself, microcracks appear. Quite often, pregnant women are unaware of the presence of such ailments, but even the most common dysbiosis can cause this problem.
Bad habits. In women who smoke and abuse alcoholic beverages, leakage of amniotic fluid is diagnosed several times more often.
Insufficiency of the cervix. In the case of this pathology, the cervix itself is not fully closed. After a while, the fetal bladder begins to protrude directly into the cervical canal. As a result, it can easily become infected and rupture, even with little exercise.

Possible dangers

As noted above, the amniotic fluid plays the role of comprehensive protection, that is, it protects the baby from most of the dangers. If it is not enough, very serious complications can arise. Below are just a few of them.

Detachment of the placenta. In the absence of emergency hospitalization, the likelihood of preserving the fetus is extremely small.
In the first trimester, leakage of amniotic fluid can provoke intrauterine fetal death.
Suffocation of the fetus. In the future, due to a violation of metabolic processes in a child, ischemic encephalitis may occur.
Premature babies are very likely to develop distress syndrome. This problem arises due to the fact that the lungs are underdeveloped, and surfactant is not produced in them.

Based on the foregoing, it becomes clear that seeking qualified help is simply necessary for such a problem as water leakage during pregnancy.

Symptoms

According to experts, the easiest way is to diagnose the presence of pathology in the latter
months. The thing is that by this time the volume of amniotic fluid is approximately 1.5 liters. In this case, it is difficult not to notice the leakage, since the nature of the vaginal discharge changes. They become more abundant and even liquid in consistency, a woman begins to regularly feel moisture on her underwear.

To identify the leakage of amniotic fluid in the early stages, a pregnant woman needs to carefully monitor the amount and appearance of vaginal discharge. It is important to note that amniotic fluid does not differ in color or characteristic odor.

At home, you can detect water leakage during pregnancy by using the most common fabric pad, which must be placed in your underwear. If a damp, colorless spot appears on it regularly, this is most likely a problem. Conventional sanitary panty liners are not suitable for this home check, as they are relatively quick to absorb.

How to identify leakage yourself?

Modern medicine does not stand still. Today, in almost every pharmacy, you can purchase a special test that will determine the presence or absence of this problem in a few minutes. Its cost is low, and a wide variety of brands allows you to buy the most suitable option. The amniotic fluid leak test usually consists of an indicator strip, a reagent bottle and a swab. Initially, a tampon is used to collect vaginal discharge. Then it should be placed in a bottle and shaken slightly. At the final stage, an indicator strip is lowered into it. Two lines indicate that there is a gap, one that there is no gap. If one of the stripes has a faint pink tint, there is still slight leakage.

Standard diagnostic methods

Gynecological examination. In this case, the specialist asks the patient to cough in order to create pressure on the fetal bladder itself. In the event of a breakthrough, the doctor will be able to visually determine the presence of water in the vagina.
A swab also helps to confirm amniotic fluid leakage during pregnancy. The doctor applies a sample of the discharge to a glass slide. So, if there is amniotic fluid in it, then later, during crystallization, it will create a special pattern on the glass, which outwardly resembles a fern leaf.
Ultrasound procedure. This method allows you to determine the presence of a problem, but only in late pregnancy.
Injection of a safe dye during the amniocentesis procedure. The specialist injects a safe dye into the amnion, which directly stains the amniotic fluid itself. Then, about 30 minutes later, a tampon is inserted into the vagina. If there is water leakage during pregnancy, the signs will be visible immediately (the tampon will stain). This method is one of the most informative, but not always safe for the fetus.

Pregnancy management

Currently, there are two options for the management of pregnant women with this
problem.

Pregnancy up to 37 weeks

In this case, they try to keep the pregnancy as long as possible. The woman is hospitalized without fail and placed in a sterile delivery unit, where the condition of the fetus is constantly monitored. The future woman in labor is prescribed antibiotics and tocolytic drugs, which prevent the spontaneous contraction of the uterus. If the condition of the baby in the womb worsens, infection is observed, delivery is urgently carried out.

Pregnancy 37 weeks or more

If, for example, water leakage was detected at 39 weeks of pregnancy, then the woman is also hospitalized and monitored. Stimulation of labor is recommended only if the condition of the fetus has deteriorated sharply for some reason.

Possible consequences

If the leakage of amniotic fluid occurred for a short time, then damage to the bladder can lead to infection of the baby and even his death. In the process of diagnostic examination in different trimesters, doctors must take water analysis to determine the degree of maturity of the child's internal organs. If their development is normal, and the baby can independently exist outside the uterus, doctors, as a rule, decide to stimulate labor. This measure is necessary to avoid subsequent infection of the fetus.

In addition, for the treatment of this problem, experts recommend bed rest and constant rest. The woman is given antibiotics to prevent the spread of the infection, and other drugs, the main purpose of which is to stop labor if the fetus is not yet ready for birth.

Amniotic fluid is not just a water membrane that protects the fetus from injury and allows the baby to move freely. Without amniotic fluid (and even if it is there, 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 using home tests.

Amniotic fluid is formed from the moment of conception. Their number gradually increases, reaching a peak by the second trimester. By the time of childbirth, amniotic fluid is not produced as 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 labor.

Why does amniotic fluid leak?

The reasons for the leakage of amniotic fluid at different times are different. Depending on this, the tactics of managing a pregnant woman are being built.

Early in 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 up to 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 the prescribed labor.

Leakage of amniotic fluid occurs for various reasons, which cannot always be established even after a thorough examination. The main ones include the following:

Infectious diseases... Sexual infections and the 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. With the localization of the focus of inflammation in the vagina and cervix, pathogens penetrate further into the cervical canal, uterine cavity, fetal membranes. Infection of the membranes is the cause of premature rupture of amniotic fluid.
Chronic processes... Serious chronic diseases, for example, pyelonephritis, autoimmune pathologies can also indirectly cause the outpouring of water.
Rhesus conflict. When the blood groups of the fetus and the mother are incompatible with the Rh factor, Rh sensitization occurs. In such a situation, the body is trying to "get rid" of the unwanted pregnancy, which is the reason for the leakage of water.
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 pregnancies are accompanied by cervical cervical insufficiency (ICI, opening of the cervix ahead of time). With monochorionic twins, triplets (one placenta for all), "steal syndrome" may occur. As a result, one baby develops polyhydramnios, the other - oligohydramnios. All this is often accompanied by leakage of amniotic fluid.
Cervical pathology... The ICN leads to the premature outpouring of water. In this case, the neck, as the gestation period increases, does not withstand the load and begins to open. As a result, the fetal bladder prolapses (descends) into the cervical canal and ruptures.
Neck manipulation... When an obstetric suture is applied in case of cervical incompetence, an accidental piercing of the fetal bladder may occur, followed by the outpouring of water.
Diagnostic procedures. Amniocentesis (puncture of the uterus through the anterior abdominal wall and sampling a small amount of amniotic fluid), cordocentesis (puncture of the umbilical cord for sampling or blood transfusion), chorionic villus sampling (the procedure is similar to amniocentesis, but chorionic cells are taken) due to their invasiveness are always accompanied by a risk water leakage.
Myoma of the uterus. In the presence of several myomatous 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, under pressure the integrity of the membranes is violated and water leaks.
Abnormalities in the structure of the uterus... In this case, a similar picture develops as in the case of knots. The septum of the uterus, one horn or saddle shape can lead to the outpouring of water.
Fetal pathology. If the baby has any malformations, the likelihood of the outpouring 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 fetal bladder and rupture of the membranes.
Thrombophilia. Changes in the properties of connective tissue and blood lead to destructive transformations of the cervix and membranes, which provoke rupture of the fetal bladder.
Diabetes . Changes in metabolism, especially with decompensation of sugar, increases the risk of premature birth and leakage of amniotic fluid.

Premature birth sometimes occurs against the background of specific circumstances, for example, infection, fetal abnormalities. But often there are no obvious reasons for the early onset of labor.

How it looks

The leakage of amniotic fluid can look differently. It all depends on the level of strain.

Abundant to moderate discharge... When the bulk of the amniotic fluid flows out, which is located in front of the presenting part of the fetus (as 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 flowing. In this case, the amount of water can 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 bloody (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 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 sourish one. Fetid, unpleasant is a sign of infection of the membranes and, most likely, of the baby.
With or without contractions... Water can leak with or without the onset of uterine contractions and contractions.

Leakage can occur both after physical activity and during well-being, such as during sleep or after a night's rest. When the position of the body changes, the amniotic fluid may flow out more abundantly.

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

an increase in the amount of vaginal discharge;
discharge is liquid;
appear periodically or constantly leak.

How to understand what kind of discharge

In premature pregnancies, it is extremely important to distinguish true leakage from normal vaginal leucorrhoea. It is not always easy to do this without additional examination and dynamic observation. It is especially difficult to make 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, as a result of which urinary incontinence occurs - with straining, sneezing, coughing. This is especially typical in the later stages, when the uterus creates additional pressure on the bladder and pelvic floor. If the pregnant woman does not notice this, the impression of water leakage may appear.
With the pessary installed... After the installation of the RAP (unloading obstetric pessary) - a foreign body - the amount of vaginal discharge increases due to constant inflammation. They collect in the posterior fornix and can flow more abundantly when the body turns. Sometimes one gets the impression that it is water.
With inflammation in the vagina... An 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 leaves... When the moment of childbirth approaches and the cervix opens, mucus comes out, which during pregnancy "like a plug" closes the cervical canal from infection. Sometimes it is quite liquid in consistency and can resemble water.

By what criteria it is possible to differentiate water inflow with other states, the following table shows.

Table - How to distinguish water from other secretions

Criterion	Water	Discharge with pessaries	Discharge during inflammation	Mucous plug
Quantity	Usually a lot		Suffering panty liners for personal hygiene	Immobile
Colour	Normally transparent, but may be bloody, green or yellow	Most often white or yellowish	Depending on the cause of the inflammation - from transparent (with vaginosis) to yellow, white, cheesy	Transparent, but there may be blotches of blood streaks, whiter than the vagina
Smell	Usually not, but with inflammation, an unpleasant putrefactive	Sour, often unpleasant	"Fishy" with vaginosis and purulent, putrid - with other types of inflammation	Does not have
Consistency	Watery	Creamy	Thickish	As egg white or thicker
Time of appearance	Suddenly	2-3 weeks after insertion of the pessary	There is no pattern	Before childbirth, including premature birth
Do they pass	Only with a high tear of the bladder	After removal of the pessary and debridement	After treatment	They do not go away before childbirth, but may decrease somewhat

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

Inspection 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 found - under magnification after drying, the picture on the 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 discharge when mixed with amniotic fluid. It is sold freely in the pharmacy, and a woman can do it herself at home.
Ultrasound of the fetus. Revealed oligohydramnios by ultrasound of the fetus is another symptom "for" if amniotic fluid is suspected. However, a normal amniotic fluid index does not exclude leakage, especially a high tear.
Laboratory methods... In some clinics, there are techniques for identifying certain substances in the vaginal secretions, which appear only after the amniotic fluid enters them. However, the method is expensive and not always informative, therefore it is rarely used.

In doubtful cases, a wait and see tactic is used. The woman is being monitored in a hospital setting. Careful monitoring of discharge is carried out, ultrasound is performed in dynamics, test and laboratory research.

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 respects, it depends on the period in which the water flowed.

1 trimester. Bloody discharge and water in this period begin together with a violation of the integrity of the fetal bladder and the progression of miscarriage. Medication or surgical termination of pregnancy is indicated.
2 trimester. Up to 22 weeks, any leakage of amniotic fluid is equivalent to the onset of a miscarriage. Its further stimulation and subsequent curettage of the uterine cavity is carried out.
3 trimester. The tactics are determined on the basis of the term, the condition of the mother and the fetus. With the outpouring of waters 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 fetal lungs. There are techniques to prevent further leakage of amniotic fluid, which helps to raise the baby in utero for some time. Since the waters are re-produced every four to eight hours, soon their volume increases to normal values. If there are signs of detachment, inflammation, or according to the woman's indications, delivery may be immediate. The outpouring of water after 37 weeks is equivalent to the onset of labor.

Is it dangerous for the fetus

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

The consequences of the start of water leakage for the child ahead of schedule are as follows:

the risk of infectious complications increases- chorioamnionitis, congenital pneumonia;
hypoxia occurs- the outpouring of water affects the uteroplacental blood flow, especially if it occurs against the background of any diseases of the woman;
there is a possibility of birth premature- when water is poured out in the early stages, it is difficult (up to 30-32 weeks) to keep a pregnant woman for more than a month;
parts of the fetus's body may fall out - in case of non-cephalic presentation, together with the waters through the opened neck, the loops of the umbilical cord or parts of the fetus (more often the arms, legs) can fall out, 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 a condition without amniotic fluid is dangerous for the fetus. It does not matter what is the gestational age with the outpouring of water, only a specialist can determine the most appropriate tactics in each case.