If amniotic fluid leaks at 20 weeks. What to do if amniotic fluid leaks
Amniotic fluid leakage - is it there or not? This question often arises among expectant mothers, and not only those who are carrying their first child. After all, other phenomena that are completely natural and safe for mother and child can be confused with this phenomenon. How to determine in time that amniotic fluid is leaking, is it necessary and how to urgently consult a doctor?
If you notice that there has been a sharp increase in vaginal discharge, it appears in a trickle, and wets your underwear - try the following experiment. Wash yourself thoroughly, then dry yourself, put a piece of thin white cloth in your underwear. If symptoms of amniotic fluid leakage are visible to the naked eye in the form of a growing wet spot on a cloth pad, you need to go to the doctor.
What can the doctor do? First of all, he will conduct a gynecological examination. If the cervix is not shortened, closed, and no discharge is visible from it, most likely it is not water. Any more or less experienced gynecologist knows that mistakes are unlikely. In addition, the doctor may refer the woman for an unscheduled ultrasound. But it would be even better and more reliable to conduct a test for leakage of amniotic fluid, but, unfortunately, such diagnostic tools are not available in every antenatal clinic. But there is one in almost every maternity hospital. Within 10 minutes you will know for sure whether it is water or not. If you don’t want to go to the maternity hospital, you can buy a test (amniotest) yourself at a pharmacy, it costs about 400 rubles, and come to the doctor’s appointment right away with it. To make a diagnosis, your doctor will take a swab from your vagina.
Remember that plays a big role in the development of a child. Only integrity amniotic sac guarantees the sterile conditions in which the fetus develops. Already after 12 hours from the moment of rupture of the membranes, the risk of infection of the membranes increases sharply, and this threatens sepsis for the mother and death for the child. It is clear that it is best to give birth as quickly as possible after a bladder bursts, but this is only if the pregnancy is full-term or close to it. What to do if amniotic fluid leaks in early pregnancy? Doctors always try to save the child’s life whenever possible. A woman with amniotic fluid leakage is admitted to the pregnancy pathology department and is constantly given antibiotics for prevention. various infections. That is, pregnancy is prolonged as long as possible, and then stimulated labor. At a minimum, it is advisable to extend the pregnancy to 32 weeks - at this period the fetus is already quite viable.
What to do if water leaks prematurely?
It would seem a simple question, and the answer suggests itself - go to the maternity hospital urgently!
And if the water does not flow like a river, but leaks drop by drop, this happens with a high lateral tear of the amniotic sac, how can this be determined?
All these questions did not interest me at all, until premature leakage of amniotic fluid occurred to me, and I almost lost the long-awaited child, whose appearance my husband and I had been waiting for for 4 long years.
Everything happened unexpectedly, at 36 weeks and 3 days the transparent discharge no smell, the first thing I thought was that it was pregnant discharge, I went to see a doctor, the doctor said that the uterus was in good shape, and told me not to be active. Then I sank and my stomach began to ache. I went back to the doctor and was sent for an ultrasound, which showed moderate oligohydramnios.
They put me in storage; I really don’t like to lie down, but I had to. The discharge increased, I complained to the doctor about discomfort and the desire to wear a diaper, they examined me, did a water test and it turned out that they were leaking.
They immediately took a blood test, which determined that the infection had penetrated into the amniotic sac. It was decided that I urgently needed to give birth, then stimulation, birth, a barely alive child (5 points on the Apgar scale).
I can’t even describe how scared I was for my son, he was taken to the department intensive care, I didn’t see him until I was discharged from the hospital. Later they explained to me that the child was born with sepsis due to leakage of amniotic fluid, that this happens and the doctors will do everything in their power to save him.
After discharge, we went straight to the neonatal unit, straight into the ambulance. The month of treatment was very difficult for me and my son, with difficulty, but he pulled through, for which I am infinitely grateful to the doctors. Now he is five years old, but I still remember with horror the beginning of his life.
I prepared thoroughly for my second pregnancy; before getting pregnant, my husband and I were checked for hidden infections, which can thin the bladder and trigger premature labor.
During pregnancy, I carefully monitored even the slightest discharge, you think it’s paranoia, maybe so, but I didn’t want a repeat of the leakage. Throughout my pregnancy, I tormented the doctors with my suspicion, I was tested for water 3 times, and I myself was tested more than once, but fortunately the results were always negative.
Due to my interest in this topic, I was able to find clear answers to all the questions that worried me about the topic of water leakage. I want to post the main material below so that expectant mothers have the opportunity to recognize the “enemy of pregnancy” (i.e., premature leakage of water) by sight.
What leads to rupture of the membranes and, as a result, leakage or rupture of amniotic fluid?
PROM is premature rupture of the membranes
Inflammatory diseases maternal genitalia and intra-amniotic infection
Most often observed during premature pregnancy. In this case it happens premature ripening cervix, enzymes are secreted that exfoliate the placenta and soften the membranes ovum. The condition is extremely dangerous and life-threatening mother and fetus. It has been proven that 4–12% premature birth with PROM are accompanied by premature placental abruption, and this is fraught with profuse bleeding and severe fetal hypoxia.
Clinically narrow pelvis and anomalies of presentation and fetal position
In this case, PROM is typical for full-term pregnancy and leads to early rupture of amniotic fluid (when labor has already begun, but the dilatation of the cervix has not reached 7–8 cm). Normally, the presenting part of the fetus fits tightly to the pelvic bones of the mother and forms a belt of contact, conditionally dividing the amniotic fluid into anterior and posterior. At narrow pelvis and anomalies of presentation, this belt does not form, and most of the amniotic fluid ends up in the lower part of the bladder, leading to rupture of its membranes. Malicious influence on the health of mother and fetus is minimal.
Isthmic-cervical insufficiency
PROM as a result of cervical insufficiency is more typical for premature pregnancy, although it also occurs in more later. Incompetence of the cervix leads to protrusion of the membranes, and therefore it Bottom part easily becomes infected and ruptures even with small physical activity.
Instrumental medical intervention
It should be noted that only procedures associated with instrumental research amniotic fluid or chorion, and speculum examination or sexual intercourse can in no way lead to PROM.
Bad habits and diseases of the mother
It has been noted that women suffering systemic diseases connective tissue, underweight, anemia, vitamin deficiency, as well as long-term use hormonal drugs Those who abuse nicotine and narcotic substances are at greater risk of developing PPROM.
Abnormalities of the uterus and multiple pregnancies
This includes the presence of a uterine septum, conization of the cervix, shortening of the cervix, isthmic-cervical insufficiency, placental abruption, polyhydramnios and multiple pregnancies.
How to recognize leakage of amniotic fluid?
The clinical picture of PROM depends on the degree of damage to the membranes. If there has been a rupture of the membranes, the woman notes the release of a large amount of fluid not associated with urination.
The height of the uterine fundus may decrease due to the loss of a significant amount of amniotic fluid. Labor begins very quickly.
It is more difficult when there are microscopic cracks and amniotic fluid leaks literally drop by drop. Against the background of increased vaginal secretion during pregnancy excess liquid often goes unnoticed.
A woman may notice that there is more discharge when lying down. This is one of the signs of PROM. The addition of infection leads to the development of chorioamniotitis and is characterized by increased body temperature, chills, tachycardia in the mother and fetus, tenderness of the uterus on palpation and purulent discharge from the cervix during examination.
The onset of labor and latent period after PROM depend on the gestational age at the time of rupture.
How long will it take for labor to begin if there is a rupture and water is leaking?
It all depends on how long the membranes ruptured.
At 24–28 weeks. Longest latent period. In some cases it can last up to 1 month. But without medical intervention, it inevitably leads to the development of infectious complications.
Until 37 weeks. Labor begins within the next 24–48 hours in only 50% of cases. Most (70–95%) have a longer latent period – up to 7 days.
During full-term pregnancy. The shortest latent period. Without obstetric intervention, contractions begin on their own through:
12 hours – in 50% of cases;
24 hours – 70%;
48 hours – 85%.
How to diagnose leakage of amniotic fluid?
We are not talking about a massive outpouring, when a clear decrease in the amount of water is visible both on ultrasound, but about those conditions when water leaks drop by drop.
The most common today are 4 types of tests
Smear microscopy
When dried, the amniotic fluid crystallizes to form a characteristic pattern in the form of fern leaves on a glass slide. But the same pattern may appear if there are impurities of sperm in the vaginal discharge. That's why this method cannot be considered absolutely reliable.
Nitrazine test (determining vaginal pH)
The amniotic fluid has a neutral or slightly alkaline environment, and the vagina is acidic. When amniotic fluid appears in the vagina, its acidity shifts towards neutral. However, changes in pH are also observed with genital tract infection and the presence of sperm in the vagina.
Both methods do not give reliable results, and their information content decreases as the time elapses since the rupture of the membranes increases.
Insulin-like growth factor binding protein-1 (IGF-1) test
The test is 4 times less sensitive than PAMG-1. Does not react to traces of amniotic fluid, i.e. for subclinical ruptures with a minimal amount of impurities is uninformative. Has its own characteristics and is carried out only medical personnel.
Test for the determination of a-microglobullin-1 PAMG-1 (Amnishur)
A-microglobulin-1b large quantities is located in the amniotic fluid, so the test is sensitive even on early stages pregnancy.
Diagnostics takes only 5–10 minutes, the technique is very simple and can be used by any woman at home. Using a sterile swab, vaginal contents are collected and placed in a bottle with a solvent for several minutes. Then a test strip is lowered into the bottle, which has a control zone and a test area.
If PAMG-1 is present, a visible line will appear in the test area (PROM present - 2 stripes, PRPO absent - 1 strip). Numerous studies have proven that the reliability of the PAMG-1 test is equal to the reliability of the amniocentesis method using indigo carmine dye and is superior in effectiveness to combined methods. traditional methods diagnostics
The last two methods are based on the detection of certain proteins in vaginal discharge, which are normally present only in amniotic fluid. Certain monoclonal antibodies have been developed that do not react to components of semen, urine and vaginal discharge.
The principle of operation of both tests is the same, but differs in sensitivity. It is not recommended to use the test after 12 hours after rupture.
Complications
The frequency of complications and their severity depend on the stage of pregnancy when the amniotic fluid ruptured, and on the tactics of managing the pregnant woman by medical personnel. For example, early pregnancy loss increases the mortality rate of newborns by 4 times.
Respiratory distress syndrome.
Increases neonatal mortality to 70%. One of the most dangerous complications. It develops during premature birth, when the baby’s organs, in particular the lungs, are not yet fully formed. They do not contain surfactant, a substance that prevents the lungs from collapsing. In this case, expectant management and the use of glucorticoids to stimulate surfactant production are extremely important.
Infectious and inflammatory complications in the child and the postpartum mother.
15-30% of women in labor develop intra-amniotic infection. About 13% of women with PROM suffer from postpartum endometritis. For a child this threatens generalized infectious process, often with fatal.
Hypoxia and fetal asphyxia.
In the future, this manifests itself as ischemic encephalitis and pancreatitis, requiring long-term and complex treatment.
Anomalies of labor.
There is a weakness of the labor forces or, on the contrary, rapid labor, which further aggravates the situation.
Premature detachment placenta.
Accompanied heavy bleeding and severe fetal hypoxia. For a woman, this is fraught with ischemia of the pituitary gland and amputation of the uterus. This complication has a high mortality rate for both the mother and the fetus.
Wikipedia article on water leakage -
The work of an American company to study the problem of water leakage
Amniotic (or amniotic) fluid is the first habitat of a little person and, I must say, a very pleasant one. Inside the amniotic sac (one of the tasks of which is the production of amniotic fluid) is kept constant temperature(37°C), no extraneous noise or even microorganisms from the outside world penetrate there, since the waters have a bactericidal effect.
The biochemical composition is so unique that even smart machines could not replicate it. Interestingly, it changes as the fetus grows. Initially, this is an effusion of blood plasma from the maternal vessels, and in the later stages their composition and quantity are regulated by the baby’s kidneys and lungs. The volume of water depends on the timing of pregnancy. Until the 32nd week, the amount of fluid increases by approximately 40-45 ml daily, and then, as the fetus grows, it also gradually decreases to 500-1500 ml.
Amniotic fluid is 97% water, and the remaining 3% is minerals, enzymes, carbon dioxide, hormones, proteins, oxygen, immunoglobulins and even skin cells and baby vellus hairs. There is a constant exchange of substances between the fetus, the maternal body and the amniotic fluid. Every three hours, amniotic fluid is renewed.
The most main function amniotic fluid – nutrition of the fetus. It's interesting that at first nutrients absorbed through the skin of the fetus. But gradually future baby learns to make swallowing movements and can actually swallow a little liquid. Even later, the baby learns to “inhale” air to prepare the lungs for childbirth, and some water gets in there. During birth, the baby's lungs will compress as they enter the birth canal, and then all the amniotic fluid will be released so that the baby can take its first breath.
Hard to see, hard to detect
Amniotic fluid even affects the birth process. The amniotic sac presses on the cervix, helping it to open as quickly as possible, and after the amniotic sac ruptures, water washes the baby, as if lubricating it, to make it easier to come out. Normally, this happens at the beginning of labor, after which we can say that this process has started. Sometimes it happens that the amniotic sac ruptures prematurely, and the waters break all at once. Expectant mothers notice this immediately - in such a situation, you need to immediately go to the maternity hospital, because with a damaged amniotic sac, the baby experiences a lack of oxygen and can become prey to infections.
If, then, the membranes of the amniotic sac have become thinner and its integrity is compromised. The fetus is left unprotected and may become infected; moreover, this increases the risk of premature onset of labor. A more insidious situation occurs when water leaks in small quantities and from time to time. It is difficult to notice this, but it is easy to confuse it with urinary incontinence, which sometimes occurs in later stages, or mistake it for an increase in the amount of vaginal discharge.
Unlike urine, amniotic fluid is clear liquid colorless and odorless. Therefore, if at any stage of pregnancy the mother notices watery discharge, which have not existed before, you need to consult a doctor as soon as possible.
Causes and Effects
There are many reasons for leakage of amniotic fluid. Most often they are associated with the woman’s previous or existing this moment and infections of the genital organs, neoplasms of the uterus, insufficient locking ability of the cervix (isthmic-cervical insufficiency. The integrity of the bladder can also be affected invasive methods prenatal diagnostics (cordocenesis, amniocentesis, chorionic villus biopsy).
There are several ways to determine water leakage. First, you need to examine the woman in a gynecological chair. During the examination, she is asked to cough (this increases intra-abdominal pressure and, if the integrity of the bladder is compromised, amniotic fluid will be released). In addition to the examination, you need to do a smear to determine the elements of amniotic fluid and perform a special test for water leakage. By the way, it can be done at home.
The expectant mother takes a sample of vaginal discharge using a tampon and places it in a special tube. After a minute, put the test strip there. Now you need to wait 5-10 minutes. The test reagent recognizes only placental microglobulin, which is present in the waters. If there is water leakage, the strip changes color, which means you need to consult a doctor. The test is informative and reliable, just keep in mind that it does not work with heavy bloody discharge, and if you use disinfectants or medications, you must wait at least 6 hours after using them.
There is damage
Now it all depends on how much time is left before the birth. If the due date is already close, it is possible to stimulate labor. Of course, to make such a decision, the doctor will first do an ultrasound and determine the degree of fetal maturity. It is necessary that the child’s lungs and kidneys can work independently - only in this case will the woman undergo an unscheduled caesarean section.
If the due date is still far away, it is necessary. The expectant mother will be treated to help her carry her baby to the required period, because every day is important in this. Since when the membranes rupture, the child can easily become infected with bacteria and viruses from the vagina and cervix, urgent hospitalization and treatment are necessary. Alas, if you wait only 32 hours, intrauterine infection of the fetus is guaranteed.
In the hospital to the expectant mother antibiotic therapy, drugs that block labor and drugs that accelerate the maturation of the fetal lungs are prescribed. This is done in order not only to gain time, but also to “prepare” the baby for life outside the mother’s body. When giving birth, it is better for the expectant mother to go to a maternity hospital, which is equipped with a neonatal intensive care unit.
Because special prevention there is no leakage of water, it is necessary to promptly treat all vaginal infections (and this is the most common reason), refuse bad habits, observe sexual hygiene and go through regularly gynecological examinations. I never tire of repeating to my patients that they need to carefully prepare for pregnancy, and for this you need to sanitize all areas chronic infection, give up alcohol (any kind!) and nicotine in advance. And do not hesitate to consult a doctor at the slightest suspicion of even the slightest leakage of amniotic fluid - the stakes are too high.
Tatyana Ustinova
