Leakage of amniotic fluid or premature rupture of amniotic fluid (PIV or PIOV in different sources) is a rupture of the membranes, an outpouring of amniotic fluid before the onset of regular labor activity with cervical dilatation up to 7-8 cm.

Normally, the outflow of amniotic fluid occurs spontaneously in the first stage of labor, upon reaching the opening of the cervix by 7-8 cm, in the next contraction, the woman notes an abundant outflow of fluid that is not associated with urination. After the outflow of waters, contractions, as a rule, intensify and the birth process accelerates.

Premature rupture of water can occur at any stage of pregnancy, as there are many factors that provoke this condition.

Predisposing factors for amniotic fluid leakage:

1. Invasive diagnostic methods (amniocentesis)

Amniocentesis is a diagnostic method that consists in puncturing the fetal bladder through the anterior abdominal wall under anesthesia and ultrasound control and taking amniotic fluid for biochemical and chromosomal analysis.

In about 1% of cases, this procedure is complicated by an abortion, you will be warned about this in advance and the patient always makes the final decision.

2. Untreated colpitis of various etiologies

Inflammation of the genital tract progresses without treatment, bacteria (most often it is a mixed infection) have an invasive ability and dissolve the fetal membranes with the help of their enzymes. The connection between infection and premature rupture of amniotic fluid has been proven by many clinical studies, in about a third of cases of water leakage this is the main cause.

3. Intra-amniotic infection

Intra-amniotic infection acts in the same way (damages the membranes) only from the inside. Infection in the fetal bladder is introduced in different ways, both through the blood and ascending from the genital tract (infection from the vagina penetrates into the amniotic fluid without damaging the fetal bladder and already massively develops inside).

4. Clinically narrow pelvis, abnormal fetal positions (oblique, transverse, pelvic), multiple pregnancy, polyhydramnios

Normally, the head of the fetus at full term is pressed against the bone ring of the entrance to the small pelvis, and thereby divides the amniotic fluid into anterior (in front of the fetal head) and posterior (all the rest). Under these conditions, the head of the fetus / first fetus from twins / triplets is high and there is a lot of water in the lower pole of the fetal bladder, which mechanically presses on the membranes and the risk of amniotic fluid leakage increases significantly.

ICI - shortening of the cervix and expansion of the internal uterine os, not corresponding to the gestational age (early term). The expansion of the internal os of the uterus can lead to prolapse (protrusion) of the fetal bladder outward, which leads to infection and rupture of the membranes.

Symptoms of amniotic fluid leakage

I. Rupture of the fetal bladder(this is a clear condition that is accompanied by the outflow of anterior amniotic fluid)

1) Abundant painless discharge of light (cloudy / greenish / straw, etc.) fluid not associated with urination

2) Reducing the height of the fundus of the uterus (the outflow of water reduces the intrauterine volume and the stomach becomes smaller and denser)

3) The development of labor activity after the outflow of water (it does not always occur, the outflow of amniotic fluid in the early stages, as a rule, does not provoke the immediate development of labor activity)

4) Change in fetal movements (slowing of movements, as the volume of the uterus has decreased and its tone has increased)

II. High / lateral opening of the amniotic sac(this condition may go unnoticed, as it proceeds with implicit symptoms and is extended in time)

1) Increased vaginal discharge, which becomes thinner, watery, soaks underwear and does not stop. They are also aggravated by coughing and lying down (in most).

2) Pulling pains in the lower abdomen, spotting (there are not always)

3) Change in fetal movements

Complications of premature water leakage

- termination of pregnancy (most often we are talking about a late miscarriage up to 22 weeks)

- premature birth. Premature birth occurs between 22 weeks and 36 weeks and 5 days of gestation and entails many complications for the mother and fetus, the severity of the condition depends on the duration of pregnancy.

Anomalies of labor activity (weakness of labor activity, discoordination of labor activity and others)

- fetal hypoxia and asphyxia (a long anhydrous period and anomalies of labor activity lead to impaired blood supply to the fetus through the umbilical cord and oxygen starvation of the fetus of varying severity develops)

Respiratory distress syndrome in a newborn (surfactant in the baby's lungs matures closer to 35-36 weeks, earlier outflow of water and childbirth entail inferior functioning of the lungs)

Infectious and inflammatory complications in a newborn (inflammatory skin diseases, congenital pneumonia)

Intraventricular hemorrhages, cerebral (cerebral) ischemia in a child

Deformation of the skeleton and self-amputation of limbs in a child with a long anhydrous period (amniotic cords are formed that injure the fetus)

Chorioamnionitis (inflammation of the membranes during a long anhydrous period)

Postpartum endometritis. Endometritis (or metroendometritis) is an inflammation of the inner uterine wall, more often it develops in women with premature outflow of water and the longer the anhydrous period (without antibiotic prophylaxis), the higher the risk of the disease. If chorionamnionitis has developed during childbirth, then in the postpartum period, the likelihood of developing endometritis is extremely high.

obstetric sepsis. Obstetric sepsis is the most formidable infectious and inflammatory complication in the postpartum period with high mortality.

How to identify water leakage

1. How can you determine the premature outflow of water at home?

If you notice vague profuse watery discharge, then you should urinate, take a shower, dry yourself (dry the perineum thoroughly) and put a clean, dry white pad (a white cotton diaper is best) between your legs, after 15 minutes you should check the pad. Or lie down on a dry sheet without underwear. A wet spot on the sheet, wetting of the lining indicates a possible leakage of amniotic fluid. In this case, you should collect a minimum of things to the maternity hospital and call an ambulance (or contact the emergency room of the maternity hospital yourself).

- if you suspect water leakage, but the discharge is not abundant, does not soak the laundry, does not have a special smell and color, then at home you can perform placental microglobulin test(PAMG - 1), at the moment it is produced only under one brand name Amnisure ROM Test (Amnishur).

This test is a system designed for self-use, all the required items are included in the kit.

How to do a water leak test:

Insert a tampon into the vagina to a depth of 5 - 7 cm for a period of one minute
Immerse the swab in the solvent vial for 1 minute and swirl well
Place the test strip in the test tube for 15-20 seconds
Place the strip on a clean, dry surface and after 5-10 minutes you can evaluate the result
One stripe - no water leakage, two stripes - amniotic fluid leakage
Test reliability 98.7%
Do not read the result if more than 15 minutes have passed

Test pads for amniotic fluid leakage (Frautestamnio, Al-sense) are a pad with a reagent-soaked area (indicator) or an insert. The indicator contains a colorimetric indicator that changes from yellow to blue-green upon contact with high pH liquids. Normally, the pH in the vagina is 3.8-4.5, the pH of the amniotic fluid is 6.5-7. The test pad changes color when it comes into contact with a liquid with a pH level greater than 5.5.

The pad should be attached to the underwear, as usual, the yellow indicator should be facing the vagina. The pad is used for about half an hour, or until sufficient moisture can be used up to 12 hours, and then the color is evaluated and compared with the color chart on the package. Blue - green color may indicate the outflow of amniotic fluid. The indicator color is stable for up to 48 hours. If, after drying, the color turns yellow again, then this most likely means that there was a reaction with urine ammonia. But the final conclusion will be given to you only by a doctor.

There are also gaskets on sale with a removable indicator insert (Al - Rekah), after applying the gasket as described above, the insert is removed by pulling the protruding tip, placed in a bag and waiting for the result for about 30 minutes. The color will also change to blue-green.

Gaskets are easy to use and affordable, but their information content is somewhat lower than test systems.

A false positive result can be caused by:

Colpitis of any etiology
- bacterial vaginosis
- recent intercourse
- douching

In all these cases, the pH of the vaginal secretion changes and a false positive result is possible.

2. Obstetric diagnosis of water leakage

Gynecological examination in the mirrors with a cough test

When viewed in the mirrors, the cervix is ​​exposed, and the doctor asks the patient to cough, if the fetal bladder ruptures, the amniotic fluid will leak in portions during a cough shock. Sometimes, when viewed in the mirrors, a clear outflow of water is visible, the liquid is in the posterior fornix, then a cough test may not be performed.

The nitrazine test (amniotest) shows the most reliable result within 1 hour after the outflow of water. The amniotest is a cotton-tipped stick soaked in a reagent that must be placed in the posterior fornix of the vagina and the color change assessed. However, a false positive result can be caused by the same factors as when using test pads.

Ultrasound (an ultrasound doctor measures the level of amniotic fluid, also known as the amniotic fluid index - IAF and compares it with the data of the previous ultrasound; after the outflow of water, it decreases sharply).

Oligohydramnios (severe oligohydramnios) in combination with fluid leakage confirmed by gynecological examination confirms the diagnosis of PIV.

Treatment for leakage of amniotic fluid

Tactics in the expiration of amniotic fluid at different times.

Up to 22 weeks

Prolongation of pregnancy is impractical due to the minimal chance of fetal survival and the frequency of purulent-septic complications on the part of the mother. The patient is subject to hospitalization in the gynecological department, where pregnancy is terminated for medical reasons.

22–24 weeks

Hospitalization of the patient in the department of pathology of pregnancy and explanation of the risks and consequences for the mother and fetus.

The prognosis for the fetus at this time is still extremely unfavorable. Parents are warned that children born at this time are unlikely to survive, and those that survive will not be healthy (there is a high risk of cerebral palsy, blindness, deafness and other neurological disorders). With the categorical insistence of the patient on the prolongation of pregnancy, despite these risks, antibiotic prophylaxis is carried out as indicated below.

25 - 32 weeks

In the period up to 34 weeks, in the absence of contraindications, expectant management is indicated, taking into account the duration of pregnancy. Expectant tactics in the period of 25 - 32 weeks no more than 11 days.

32 - 34 weeks

Expectant tactics are shown no more than 7 days.

34 - 36 weeks

Expectant tactics are shown no more than 24 hours.

37 weeks or more

Expectant tactics are shown for no more than 12 hours, then the onset of labor induction is shown. In this case, antibiotic prophylaxis begins after 18 hours of the anhydrous period.

Contraindications to expectant management:

Chorioamnionitis
- preeclampsia/eclampsia
- premature detachment of a normally located placenta
- bleeding with placenta previa
- decompensated condition of the mother
- decompensated condition of the fetus

If there is a contraindication to expectant management, the method of delivery is chosen on an individual basis.

Expectant tactics

1. Examination of the cervix in the mirrors, vaginal examination is carried out only upon admission, then it is not carried out

2. During the initial examination in the mirrors - sowing on the flora and sensitivity to antibiotics

When establishing the fact of outflowing waters - the immediate start of antibiotic prophylaxis of purulent - septic complications of the mother and fetus (chorioamnionitis, neonatal sepsis, obstetric sepsis)

Erythromycin peros 0.5 g every 6 hours to 10 days;

Ampicillin peros 0.5 g every 6 hours up to 10 days;

or if beta-hemolytic streptococcus is detected in microbiological crops

Penicillin 1.5 g IM every 4 hours

3. Prophylaxis of respiratory distress syndrome (SDR) with dexamethasone (8 mg IM No. 3 under the supervision of a doctor with control of fetal movements and heartbeat), it should take about two days to obtain the effect. Dexamethasone is a glucocorticoid hormone that accelerates the maturation of surfactant in the baby's lungs. Prevention of SDR is carried out in terms of 24 - 34 weeks.

4. Thermometry every 4 hours

5. Control of the fetal heart rate, secretions from the genital tract, uterine contractions at least 2 times a day

6. Complete blood count upon admission and in the future at least 1 time in 2-3 days;

7. Ultrasound examination 1 time in 7 days with the determination of the amniotic fluid index and Doppler blood flow in the uterine arteries and umbilical artery

8. Cardiotocography with assessment of a non-stress test (reaction of the fetal heartbeat to its own movements) at least 1 time per day

9. In the presence of uterine contractions with a frequency of more than 3-4 in 10 minutes - tocolysis (the introduction of drugs that relieve the contractile activity of the uterus, the drug hexoprenaline is most often used, the dose and rate of administration is chosen by the attending physician)

10. With the development of labor activity not less than 48-72 hours after the first injection of dexamethasone, tocolysis is not performed.

After the maximum waiting period has elapsed, a consultation of doctors is carried out to select the method of delivery. Preparation of the cervix and labor induction or caesarean section are possible. Both methods have their own advantages and risks, so in each case the issue is decided strictly individually.

Pregnant women with HIV infection

1. With PIV after 32 weeks - immediate labor induction.

2. With PIV up to 32 weeks, expectant management is indicated aimed at preventing fetal SDR and chorionamnionitis (antibiotic prophylaxis, as indicated above).

3. Prevention of vertical transmission of the virus.

4. Labor induction is indicated 48 hours after the start of the prevention of fetal SDR.

5. With premature rupture of amniotic fluid, caesarean section does not reduce the risk of transmission of the virus from mother to fetus.

Despite the simplicity and availability of home diagnostic methods, do not neglect an extraordinary visit to your doctor in case of suspected amniotic fluid leakage. The earlier the diagnosis is made, the more favorable the result in any period of pregnancy. We wish you a safe pregnancy and easy delivery at term. Look after yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

Often, the leakage of amniotic fluid becomes a cause for concern for the expectant mother. However, not all pregnant women understand what it is and how to distinguish amniotic fluid from vaginal discharge. Let us consider the situation in more detail, name the causes, ways to eliminate the violation.

Amniotic fluid - what is it?

Amniotic fluid is a vital environment for the fetus. Filling the fetal bladder, it prevents trauma to the fetus, creating favorable conditions for it. So directly thanks to her, the baby's body temperature is maintained at the same level. Equally important is the protection that the amniotic fluid provides to the unborn baby.

Its volume is unstable, increases with the growth of the gestational age. This process is noted throughout the entire gestation period, however, water is produced unevenly. The volume is increasing every week. The maximum is reached around gestation. At this time, the volume of amniotic fluid is 1000-1500 ml. At the same time, immediately before the process of childbirth, its quantity decreases.

What is dangerous leakage of amniotic fluid?

Amniotic fluid during pregnancy is vital for the unborn baby. Reducing its volume can lead to irreversible consequences. Among these, physicians distinguish:

• infection of the baby inside the womb;
• development of complications of an infectious nature in a future mother: chorioamniotonitis (inflammation of the membranes of the fetus),;
• premature delivery;
• weak labor activity.

Causes of amniotic fluid leakage

When amniotic fluid leaks during pregnancy, a woman needs to see a doctor. The main task for physicians is to determine and eliminate the cause of the violation. At the same time, a comprehensive assessment of the situation is carried out. Possible reasons include:

1. Inflammatory and infectious diseases in the reproductive system. As a result of such pathogenic processes, thinning of the membranes of the bladder, in which the fetus is located, occurs. Due to the loss of elasticity, integrity is violated. This is possible with colpitis, endocervicitis.
2. Isthmicocervical insufficiency. With this type of violation, incomplete closure of the cervix is ​​​​noted. Due to excess pressure, which is caused by an increase in the size of the fetus, the fetal bladder protrudes into the cervical canal. This leads to a violation of its integrity.
3. Multiple pregnancy. This phenomenon is considered as a contributing factor to the development of the disorder. Due to the increased load on the walls of the fetal bladder, they do not withstand and are damaged, causing leakage of amniotic fluid.
4. Developmental anomalies, benign or malignant tumors in the uterus. Incorrect sizes of the reproductive organ, the presence of cysts and tumors in it interfere with the normal growth of the baby, amniotic membranes. As a result, injury to the walls may occur.
can cause the release of amniotic fluid to the outside.

Leakage of amniotic fluid in the early stages

Leakage of amniotic fluid during pregnancy, at its short terms, is fraught with interruption of the process of carrying a baby. If the violation develops for up to 20 weeks, then the baby cannot be saved. In this case, infection of the fetal membranes occurs, vital processes are disrupted, as a result of which the baby dies. The woman is cleaned of the uterine cavity to prevent infection and life-threatening complications.

Leakage of amniotic fluid in the second trimester

Leakage of amniotic fluid is often fixed for a long time. It is provoked by increased pressure on the membranes of the fetus, the mass of which increases several times. When a complication of this kind developed in the first half of the 2nd trimester (up to 22 weeks), doctors are forced to interrupt the gestational process. This helps to avoid complications that adversely affect a woman's health.

If the leakage of amniotic fluid begins after, then in most cases it has a favorable outcome. The pregnant woman is sent to the hospital, where she is monitored. Doctors conduct dynamic monitoring, by conducting ultrasound, examining the condition of the bladder shell in the gynecological chair. There is no specific treatment for this. The efforts of doctors are aimed at improving the condition of the pregnant woman. It all depends on how much time has passed since the start of leakage caused by a violation of the shell.

How to determine the leakage of amniotic fluid?

To protect herself and the unborn baby, a pregnant woman should be aware of the signs of this violation. Leakage of amniotic fluid, the symptoms of which may be mild, has an increasing character - as it progresses, the volume of fluid increases. If the membranes are broken in a place located high from the neck, the water flows poorly. In such cases, pregnant women may not pay attention to this phenomenon, taking it for vaginal discharge. Among the obvious symptoms of leakage, it is worth highlighting:

• sudden, profuse discharge from the vagina;
• change in the nature of the discharge - they became watery, increased in volume;
• reduction in the volume of the abdomen;
• appearance .

How to distinguish discharge from leakage of amniotic fluid?

In order to be able to distinguish a violation from the norm, each pregnant woman must clearly understand what the leakage of amniotic fluid looks like. Among the main manifestations:

• an increase in the amount of fluid released during physical activity, movement, change of position;
• tension of the pelvic muscles does not lead to the cessation of discharge (unlike spontaneous urination).

When the bladder rupture is very small, pathology can only be determined using a special test or a smear. Women can diagnose larger tears on their own, at home. For this:

1. Go to the toilet and empty your bladder completely.
2. Rinse thoroughly and wipe everything dry.
3. Lay a sheet on the sofa, dry and clean, and lie down on it without underwear.
4. If after 15-20 minutes wet spots appear on the sheet, there is a high probability of leakage. The efficiency of such a simple test exceeds 80%.

What color is amniotic fluid when it leaks?

The color of amniotic fluid during leakage may be different. This makes it difficult to diagnose the disorder. In most cases, the waters are clear and colorless, so it is difficult to identify them by the marks on the sanitary napkin. Occasionally, the amniotic fluid acquires a pinkish tint. When the amniotic fluid becomes infected, it can become greenish, yellow, cloudy. However, in such cases, another clinic is also noted, which helps to diagnose pathology.

Amniotic fluid leak test

A pregnant woman can diagnose a pathological condition with the help of special tools. There are pads to determine the leakage of amniotic fluid. Their action is based on a change in the color of the indicator, depending on the medium with which contact has occurred. Initially, it has a yellow color (corresponding to a vaginal pH of 4.5). Other liquids give it a greenish-blue color. Amniotic fluid has the highest pH. This allows you to diagnose the leakage of meager amniotic fluid.

Tests for amniotic fluid leakage

Talking about how to recognize the leakage of amniotic fluid, doctors note that it is difficult to do this with a small volume. In such cases, a violation is diagnosed by laboratory methods, including:

• a smear of vaginal discharge - the “fern effect” (drying liquid on a glass slide forms a pattern similar to the named plant);
• a smear from the posterior fornix of the vagina is a reliable method of diagnosis;
• amniotest - is based on the intramuscular injection of a dye into the abdomen, which stains the amniotic fluid released to the outside (it is rarely used due to the high risks and cost of the reagent).

Does ultrasound detect amniotic fluid leakage?

Leakage of amniotic fluid, the signs of which are mentioned above, can also be diagnosed using ultrasound. In such cases, on the monitor screen, the doctor assesses the extent of the violation, the localization of the rupture of the amniotic membrane. With a mild violation, this technique is ineffective due to the impossible visualization and the difficulty of detecting a defect in the amniotic sac.

Often during pregnancy, there are situations when a pregnant woman may notice signs of leakage of amniotic fluid on her underwear.

Amniotic fluid is the liquid in which the baby is located during all 9 months of pregnancy.

Amniotic fluid is a nutrient medium for the baby, thanks to which he can fully develop and is protected from external noise, shock and temperature changes.

Normally, amniotic fluid leaves during the birth of a child at a cervical dilatation of 8-10 cm. This is called the timely departure of amniotic fluid.

However, there are situations when the water begins to depart much earlier than the due date - this is called premature discharge of amniotic fluid.

Most pregnant women, starting from the gestational age of 33-34 weeks, begin to suspect amniotic fluid leakage.

Often this turns out to be completely wrong, because at this time the body actively begins to prepare for childbirth and an absolutely normal phenomenon occurs - an increase in vaginal discharge. This situation has nothing to do with amniotic fluid.

1. The gasket gets wet very quickly and you have to change it often.
2. When changing position, for example, when bending over, squatting, you feel a slight outflow of fluid.
3. After a night's sleep, you notice a small stain on the bed.

All these situations are quite subjective, and on the one hand it can be abundant vaginal discharge, or slight urinary incontinence, or indeed amniotic fluid.

In order to determine the leakage of water, you can use the following methods:

• Diaper test.

Take a shower, wash yourself, dry your genitals and put a piece of white cotton diaper in your panties instead of a pad.

If the diaper gets wet for 15 minutes, and the liquid is not mucous in nature (which is more like vaginal discharge), it is most likely a water leak.

• Do an amniotic fluid test.

Such tests are sold in pharmacies, and the Amnishuer test is the most common at the moment. The price of tests ranges from 690 rubles. up to 1200. However, the test can be carried out at home, and you will receive the result within 5-10 minutes.

• Vaginal smear.

If the second point is not available to you, then it is best to contact the antenatal clinic and tell the doctor about your suspicions. The doctor will take a swab from the vagina and place a swab with the contents of the vagina in a special solution. You will receive the result within 15 minutes.

With signs of amniotic fluid leakage, there is no need to be afraid and wait, losing precious time. The best course of action is to make sure whether you have reasons to be afraid or not.

Causes, signs and consequences of amniotic fluid leakage in different periods of pregnancy. Modern methods for diagnosing amniotic fluid leakage. What to do if water starts to leak?

Amniotic fluid or amniotic fluid is an integral part of the fetal development process. Leakage or premature discharge of amniotic fluid is considered a pathology and requires urgent correction of the situation. But how to understand that the amniotic fluid is leaking or has departed at different periods of pregnancy? What to do if amniotic fluid leaks out? What are the methods for diagnosing amniotic fluid leakage?

What do amniotic fluid look like, what color, smell?

Functions of amniotic fluid

Amniotic fluid performs a whole list of useful functions:

• Protect the fetus from external mechanical damage (shocks, bruises).
• At first, they provide the embryo with all the necessary substances and microelements (proteins, lipids, carbohydrates, hormones, enzymes, etc.).
• Allow the baby to move freely inside the placenta.
• They protect it from infections and bacteria due to the immunoglobulins contained in them.
• Provide sound blockade of the fetus from the outside world.
• Prevent spontaneous clamping of the umbilical cord.
• They take over all the life processes of the baby.

Normally, amniotic fluid should be from 0.6 to 1.5 liters, depending on the stage of fetal development and the timing of pregnancy. Any deviations from these indicators are already considered a serious problem. In this regard, women can be diagnosed with polyhydramnios and oligohydramnios. Oligohydramnios is much less common than polyhydramnios and is a more complex condition.

As for the color of the amniotic fluid, they are transparent in appearance, since they are 97% water. Even with careful consideration, they can detect lanugo (small hairs from the baby's skin), as well as particles of the skin of the crumbs.

However, sometimes the amniotic fluid has a completely different color, which indicates the presence of any changes and disturbances in the process of fetal development:

• Pink amniotic fluid may indicate the presence of blood particles in it. Often this is a sign of placental abruption.
• If the amniotic fluid is colored green or yellow, then this state of affairs may indicate fetal hypoxia or intrauterine infection.
• Dark brown or black fetal waters are considered the most dangerous. In such situations, emergency help is needed for the baby and his mother.

If we talk about the smell of amniotic fluid, then many doctors claim that it is somewhat similar to the aroma of breast milk. Perhaps that is why, having barely been born, the baby is looking for a painfully familiar smell on his mother's chest.

Signs, symptoms and causes of amniotic fluid leakage in the second trimester

Causes of amniotic fluid leakage in the second trimester

Causes of leakage of amniotic fluid in the second trimester can be:

1. Mechanical impact on the bladder (shocks, falls, bruises).
2. A different kind of infection that has penetrated through the genitals or through the placenta.
3. Tumors in the uterus.
4. Too intense or deep sexual contact (especially if there are contraindications).
5. Incorrect technically performed diagnosis of a pregnant woman, which led to damage to the fetal bladder.
6. Isthmic-cervical insufficiency.
7. Multiple pregnancy.
8. Presentation of the fetus.
9. Lack or excess of amniotic fluid.

Recognizing the leakage of amniotic fluid during pregnancy is quite difficult, since many women during this period of their lives very often suffer from urinary incontinence and involuntary urination. However, with a close examination of the released fluid and careful observation of herself, the pregnant woman will still be able to independently diagnose the leakage of amniotic fluid. In any case, even if there are slight signs of amniotic fluid leaking out, it is better to consult a doctor immediately.

• When viewed from the outside, the leaked amniotic fluid will have a transparent color and an unusual smell, while the urine is distinguished by its yellowness and the corresponding "aroma".
• As for the identification of amniotic fluid in comparison with other vaginal discharges, they often have a white, yellow, green or pink color and mucous impurities, which is uncharacteristic of fetal waters.
• Leakage of amniotic fluid can be observed with a sharp change in body position, as well as during physical exertion.

If the discharge of the amniotic fluid was not diagnosed in time, then in the later stages the woman may experience more pronounced symptoms of a dangerous condition:

• high body temperature
• nausea and vomiting
• weakness and body aches
• discharge with a sharp, unpleasant odor

It is also possible to detect leakage of amniotic fluid at home using special pharmacy testing agents.

Signs, symptoms and causes of amniotic fluid leakage in the third trimester

If a woman, after 37 weeks of pregnancy, suddenly has a clear liquid flowing down her legs, then she should take a bag with her and go to the hospital. This situation suggests that her fetal bladder burst, and labor began.
If the pregnant woman began to notice that wet transparent marks remain on her underwear, then it is advisable for her to observe herself - perhaps amniotic fluid is leaking from her. This state of affairs in the third trimester is not considered dangerous, but it must be diagnosed in time. The reason for this is the harmful consequences for the fetus - the lack of amniotic fluid can lead to oxygen starvation of the baby and other deplorable conditions.
To understand what exactly is leaking, you need to conduct a series of tests:

• Try to contain the discharge with the help of the muscles of the vagina - if nothing works, then there is leakage of water.
• Empty the bladder as much as possible, wipe dry and lie down on a clean, dry bed for half an hour or an hour - if the sheet gets wet in a calm position or with a sudden movement, then this is also a sign of amniotic fluid release.
• Buy an express test at the pharmacy and do everything according to the instructions.

What is the danger of leakage of amniotic fluid in the second and third semester of pregnancy?

Leakage of amniotic fluid in the second and third trimester of pregnancy is dangerous with the following conditions and consequences:

1. Increase the likelihood of infection to the baby.
2. Mechanical effect on the fetus.
3. Penetration of harmful microflora to the baby.
4. Placental abruption.
5. Fetal hypoxia.
6. Fetal distress syndrome.
7. premature birth.
8. Bleeding due to placental abruption.
9. Hemorrhage in the baby's brain in the first days of life.
10. Physical deformities of the fetus due to the pressure of the uterus on it.
11. Maternal infection.

Amnishur test for the determination of amniotic fluid leakage

Amnishur - a test to determine the leakage of amniotic fluid

• The AmniSure test is a rapid test that can confirm or refute the fact of amniotic fluid leakage.
• You can buy Amnishur at any pharmacy.
• The principle of operation of this remedy is based on the identification of placental alpha globulin in secretions, which can only be found in amniotic fluid - no other human secret contains this substance.
• The test is so sensitive that it can recognize this alpha globulin even with its minimum amount.
• AmniSure is 98.7% accurate.

Instructions for Amnishur test

Instructions for using the Amnishur test:

• We open the box and find inside a test tube with reagents, a swab, a test strip and a test tube stand.
• We take a closed test tube with reagents in our hands and shake it thoroughly.
• When all the substance in the test tube sinks to the bottom, remove the lid from it and place it in a vertical position in a special tripod.
• We take a tampon in our hands and carefully unpack it so as not to touch its tip.
• We take a tampon in the middle of the handle and insert it into the vagina to a depth of no more than 7 cm.
• Keep the tampon in the vagina for about a minute.
• We take out the tampon from the vagina and lower its tip into the test tube.
• With rotational movements, rinse the swab in the reagent for about a minute.
• After the specified time has elapsed, remove the swab from the test tube and dispose of it.
• We take the sealed test strip in our hands and carefully print it out.
• We lower the white tip of the test with drawn arrows into the reagents.
• If there is an abundant leakage of amniotic fluid, then the test will immediately show two strips.
• If the leakage was small, then you will have to wait about 10 minutes.
• If there was no leakage, only one strip will remain on the strip.

Attention! After a 15-minute stay of the test in the liquid, its result is considered invalid.

Pad test for amniotic fluid leakage

• Another method for detecting amniotic fluid leakage at home is special test pads.
• The main principle of action of this agent is the reaction to liquids with an elevated pH level.
• The fact is that in all female secrets, the pH often does not exceed 4.5, while the amniotic fluid has a high pH - from 6 to 7.
• Thus, when it hits a special indicator built into the pad, the amniotic fluid causes a change in its color.
• There is no need to worry about the indicator, since it is protected by two layers of special material and does not come into contact with the female body.
• On the inside of the gasket, its presence can only be determined by the yellow strip located in the middle.

The principle of operation of the test pad:

• Carefully unseal the gasket and remove it with clean, dry hands, being careful not to touch the yellow line.
• We fix the pad on the underwear in such a way that the yellow strip runs strictly along the center of the vagina.
• We put on clothes and go about our business.
• After 12 hours, or if you feel heavy discharge, remove the test pad from the laundry.
• We analyze the spots formed on the gasket.
• If there are green or blue spots on the pad, you can talk about the leakage of amniotic fluid.
• If no stains form on the test pad, then there is no leakage.

Note! Blue and green spots can also appear due to a woman having vaginal infections, so this result should be reported to the doctor in any case.

How to distinguish leakage of amniotic fluid from secretions, urine?

There are several ways to distinguish leakage of amniotic fluid from secretions and urine:

• By color - amniotic fluid has no color.
• By smell - fetal waters either do not smell at all or have an unobtrusive, special smell.
• With the help of the Amnishur test.
• With test pads.
• If possible, control the emission - leakage cannot be delayed.
• With the help of a change in body position - during physical exertion or a sharp change in body position, as a rule, water leaks.

Is amniotic fluid leaking visible on ultrasound?

Can amniotic fluid leakage be seen on ultrasound?

Ultrasound examination will not be able to fix a gap in the fetal bladder. However, this type of diagnosis is able to detect oligohydramnios, which is the result of leakage of amniotic fluid. It is also possible to identify the involuntary waste of fetal fluids in dynamics when the amount of amniotic fluid becomes less and less from examination to examination.

At what time and for how long can amniotic fluid leak?

• In the first trimester of pregnancy, the amount of amniotic fluid is so small and imperceptible in a woman's abdomen that it is almost impossible for it to leak.
• Leakage of amniotic fluid can begin in the first half of the second trimester. Such conditions are considered very complex and almost incorrigible.
• In the second half of the second and first half of the third trimester, with the timely detection of leakage of fetal water, doctors try to delay the moment of childbirth to the maximum.
• In late pregnancy, with leakage of amniotic fluid, a woman has no choice but to simply show her baby to the world.
• Leakage of amniotic fluid can last from half a day to two weeks.
• True, in some women, with minimal and rare cases of water leakage, their volume manages to recover, which is not a critical condition.
• However, even such women need to be constantly under the supervision of doctors.

Is it possible to stop the leakage of amniotic fluid?

• If amniotic fluid leaks were found from the 36th to the 40th week of pregnancy, then, as a rule, the woman begins to prepare for childbirth.
• If rupture or profuse leakage of amniotic fluid was detected before 22 weeks, then a miscarriage will most likely be diagnosed.
• If the water leaks between 22 and 36 weeks, then doctors will do everything possible to support the mother and fetus until the lungs are fully developed.

As a rule, in such cases it is assigned:

• Antibacterial therapy (to stop or prevent any inflammatory processes in the body of the mother and fetus).
• Hormone therapy (to contain labor).
• Bed rest.
• Constant monitoring of a pregnant woman.
• Control of fetal development parameters.

How amniotic fluid leaks before childbirth at 37, 38, 39, 40 weeks?

Immediately on the eve of childbirth, in the event of a rupture of the fetal bladder, a woman may have the impression that she could not restrain herself, and spontaneous urination occurred. In such cases, as a rule, about 150-250 g of liquid is poured out. The gradual leakage of amniotic fluid occurs almost imperceptibly:

• After sleep, when a woman wants to go to the toilet, she may mistake a wet spot on her underwear for her incontinence.
• During physical exertion or overexertion, laundry can also get wet.
• If a woman lies, and then suddenly changes her body position, then a little liquid may pour out of her.

Leakage of amniotic fluid: what to do?

• As soon as a woman detects a spontaneous premature release of amniotic fluid or a prerequisite for it, she should immediately inform the doctor about this.
• It is also advisable to independently conduct one of the pharmacy rapid tests.
• It is recommended to show the test results to the gynecologist.
• Leakage of amniotic fluid is a very serious condition, so you should not joke with it - only a doctor can provide qualified and timely assistance to a pregnant woman.

Dear women, if you suddenly doubt your discharge or feel something was wrong - do not delay, but urgently run to your leading specialist. Sometimes a few hours play a very important role in such a scrupulous and responsible business as carrying a baby.

Leakage of amniotic fluid: Video

Hello dear readers! We are accustomed to the fact that in the womb the baby is under reliable protection. Simply because it is surrounded on all sides by amniotic fluid, which is popularly called amniotic fluid.

And everything would be fine, only for various reasons the integrity of the fetal bladder can be broken, as a result of which their leakage begins. What does it threaten? At best, unpleasant consequences, and at worst, a tragedy. To prevent this from happening, you always need to know how to determine the leakage of amniotic fluid. This is what we will talk about today. Therefore, sit back and remember!

In order to realize the seriousness of the situation, it is necessary to understand the functions that the amniotic fluid performs. In fact, it is a unique filling of the fetal bladder, which for 9 months provides an optimal environment for the crumbs to live.

In addition, she:

• protects the baby from all kinds of infections that can penetrate to him through the mother's genitals;
• ensures normal blood flow to it, preventing squeezing of the umbilical cord;
• protects it from shocks and shocks, without restricting movement at the same time.

Thus, amniotic fluid is an indispensable substance, which at some point may begin to leak. And in order to prevent the possible consequences that such a condition entails, you need to know how to recognize it. Moreover, at the disposal of modern medicine there are several options for detecting leakage of amniotic fluid. But first things first.

2. Reasons

The most common causes of leakage include:

• external physical impact, for example, a fall of a pregnant woman or a mechanical injury;
• isthmic-cervical insufficiency - it is diagnosed when the cervix is ​​not closed enough, as a result of which it simply cannot cope with the pressure of the growing fetus;
• the appearance of neoplasms in the uterus, benign or malignant;
• inflammatory processes and infectious diseases of the cervix or vagina, for example, colpitis, endocervicitis;
• polyhydramnios and multiple pregnancy;
• careless carrying out of some diagnostic procedures, such as chorion biopsy, amniocentesis, cordocentesis.

3. Symptoms

Perhaps all women who have given birth in colors will be able to talk about how to understand that amniotic fluid is leaving. Meanwhile, in the case of their leakage, everything is not so simple.

The fact is that they can not always gush in the same stream that cannot be restrained even by the effort of the genital muscles. And it's good, agree!

If the damage to the fetal membrane was insignificant, the water flows out drop by drop. Mixing with the natural secretions of a woman, they may go unnoticed for some time.

Although sometimes some signs of leakage of amniotic fluid can still be distinguished:

• its loss increases with movement and a change in body position;
• the appearance of the discharge changes, as evidenced by traces on linen or personal hygiene products. In contrast to the usual thick consistency and a pronounced white tint, it appears transparent with pink, greenish or brownish. It is also worth noting that not only the traces themselves, but also their color should alert. Unfortunately, greenish or cloudy do not bode well.

4. How else to recognize a leak

External examination is not the only thing that can be done at home. The fact is that there is also a kind of test that will show whether there is a loss of amniotic fluid.

For this you need:

1. Empty the bladder and toilet the genitals;
2. Put a dry and clean diaper, preferably white, and sit over it for 1.5 - 2 hours. If the diagnosis is confirmed, she will constantly get wet.

In addition, you can always use a special test, which is designed for home verification. It is a pad that needs to be worn for a certain amount of time. Soaked in reagents, it allows you to determine even the minimum proportion of amniotic fluid leakage.

And now the most important thing. When to go to the hospital if at least one of the tests confirmed the fears? Immediately. After all, the life and health of the baby depends on the speed of response of the pregnant woman. In the end, already in the hospital, the doctor will be able to do an additional cytological examination and finally figure out whether there is a problem. Moreover, premature rupture of amniotic fluid is not the worst thing.

5. Complications

Due to premature leakage, there may be:

• premature birth;
• development of intrauterine infection;
• infectious-toxic shock or inflammatory processes in the mother;
• weak labor activity.

6. Treatment

It is worth noting that there is no such treatment for this condition. Depending on the gestational age, doctors decide what to do next. If the kidneys and respiratory system of the crumbs are sufficiently developed, even the outflow of amniotic fluid is no longer considered a big problem. In this case, they simply stimulate childbirth, thereby preventing infection of the baby.

Another thing is if he is not yet ready for life outside the mother's womb. Then various activities are carried out aimed at prolonging the pregnancy until the moment when it gets stronger.

First of all, it is:

• strict bed rest;
• regular examinations of the mother and fetus;
• the appointment of hormonal drugs to prepare immature airways for independent life;
• antibiotic therapy.

Of course, the leakage of amniotic fluid, especially in the early stages, is a direct threat to the life of the crumbs. But if it does happen, don't panic. You just need to follow all the recommendations of the doctor and believe in the best!

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