Few women can boast of pregnancy without “surprises.” Exacerbation of chronic diseases, overweight, toxicosis, threat premature birth– all these and other difficulties await the expectant mother at every step. Feeling anxious about themselves and their belly baby, pregnant women are distrustful of any barely noticeable changes in the body. It is thanks to the increased alertness of expectant mothers that it is possible to recognize such a symptom as leakage in time amniotic fluid.

In obstetric practice, timely diagnosis of amniotic fluid leakage plays an important role in the further course of pregnancy and childbirth. Much depends on the woman’s understanding of how amniotic fluid leaks.

What is amniotic fluid and why does it leak?

Throughout pregnancy, the baby is in the amniotic sac, an amniotic sac filled with amniotic fluid, which is essential for its full development.

Amniotic fluid provides the following functions:

• barrier (prevents infection of the fetus);
• protective (acts as a “safety cushion” in case of injuries and falls);
• prevents disruption of blood flow (prevents the walls of the uterus from compressing the umbilical cord);
• takes part in the formation of the digestive system (the fetus swallows amniotic fluid, training the swallowing reflex and intestinal motility).

By quantity amniotic fluid one can judge the condition of the fetus, the presence of intrauterine infection, malformations, etc.

IMPORTANT! Normally, amniotic fluid is a colorless, odorless liquid in an amount of 1-1.5 liters.

As a rule, amniotic fluid leaks as a result of one of the following factors:

• injuries in the abdominal area (in this situation, the admixture of blood in the amniotic fluid may indicate premature placental abruption);
• intrauterine infection (in this case, thinning of the wall of the fetal bladder occurs, followed by the formation of a crack or rupture);
• carrying out intrauterine diagnostics (fetal puncture - amniocentesis, chorionic villus biopsy, etc.);
• overstretching of the amnion (observed with polyhydramnios or multiple pregnancies).

IMPORTANT! Normally, amniotic fluid is released during childbirth. If amniotic fluid leaks before 37 weeks of pregnancy, we're talking about about premature rupture of the membranes, in which the woman needs to be hospitalized.

How do amniotic fluid leak? Changes in the amount and nature of discharge.

In the third trimester of pregnancy, it is sometimes quite difficult to understand whether amniotic fluid is leaking or whether there is simply more vaginal discharge, which is quite physiological. Unlike how amniotic fluid leaks, vaginal discharge most often increases in the morning, when getting out of bed after a night's rest.

If amniotic fluid leaks, then:

• when moving, for example, walking, the volume of discharge will increase;
• the nature of the discharge will change (liquid, odorless, transparent);
• a pregnant woman will not be able to control this process (the fluid flows out spontaneously).

IMPORTANT! The amniotic fluid may turn yellow, indicating an infection. The red tint of the water is a sign of intrauterine bleeding, green is due to the presence of meconium in the amniotic fluid, which is one of the signs of intrauterine fetal hypoxia.

How do amniotic fluid leak? Determine at home.

Test "White sheet".

In this case, no special devices are required to determine the leakage of amniotic fluid, except clean bed linen.

In order not to confuse the leakage of water with urine and vaginal discharge, before lying on a white sheet, you need to empty the bladder, toilet the external genitalia, blotting off excess moisture with a towel. Since amniotic fluid leaks almost imperceptibly, you should lie motionless on a folded sheet for 40-60 minutes. The presence of a wet, colorless spot on the underwear indicates premature release of amniotic fluid.

Test pad.

In large pharmacies you can now buy almost everything, including a test pad to determine the leakage of amniotic fluid. It's very simple and convenient way determine leakage of water, which is relevant if a woman cannot see a doctor in the near future, but suspects leakage of amniotic fluid.

What to do if amniotic fluid leaks? Visit your doctor.

You must inform your doctor about changes in the nature of discharge during pregnancy. Therefore, at the slightest suspicion of rupture of water, the expectant mother should contact the attending obstetrician-gynecologist, who will take all the necessary measures to make an accurate diagnosis.

During a gynecological examination, it is not always possible to determine whether amniotic fluid is leaking or not. Therefore, one of the simplest and most informative methods is the cytological research method, in which the discharge is analyzed (sampling is carried out in the posterior vaginal vault). If there is a rupture of the amnion, then elements of amniotic fluid will be detected in the smear.

Using an ultrasound examination, it is quite difficult to determine a crack or rupture of the amniotic sac. If you have ultrasound results over the last two weeks, you can compare the amount of amniotic fluid, which normally should remain unchanged until the birth itself.

Oligohydramnios on ultrasound – diagnostic sign, in some cases confirming premature rupture of amniotic fluid.

Premature rupture of amniotic fluid is a complication of pregnancy that can lead to dire consequences. Lack of treatment for leakage of amniotic fluid can lead to premature birth, the development of intrauterine infection, and pathological labor, which significantly reduces the baby’s chances of survival. You should not take amniotic fluid leakage lightly; at the first symptoms, you should immediately seek qualified help from a medical facility.

The composition and volume of amniotic fluid is one of the main components of a normal pregnancy. Being in this liquid, the fetus is protected from many negative factors: from noise, from infections, from mechanical influences. In addition to protection, amniotic fluid provides the unborn child with nutrients and comfortable conditions. Therefore, throughout pregnancy, its constant balance is so important. If changes occur in the volume of fluid (oligohydramnios, polyhydramnios), then both mother and child suffer, and various complications arise.

Normally, amniotic fluid should leak only before the onset of labor after the rupture of the amniotic sac. If a slow or copious outpouring of fluid occurs during gestation and long before the onset of labor, then various complications for the health of the fetus and the woman are possible. This is a situation in which nothing depends on a woman’s desires and actions. An examination and further recommendations from specialists are necessary on how the pregnancy will proceed in the future.

Signs of amniotic fluid leakage

If the amniotic sac has a small rupture or crack in the fundus or side of the uterus, fluid will leak slowly. This process can continue for a long time and will remain unnoticeable, since the liquid is constantly renewed and restored. It is difficult for a woman to notice the beginning of the problem and is easily confused with vaginal discharge or urinary incontinence. But over time, she can pay attention to the following changes in her body:

the discharge became liquid and constant;

aching pain appeared in the lower abdomen;

The fetal movements have changed - they have become slow and irregular.

Amniotic fluid is colorless, and its smell has nothing in common with the smell of urine. With incontinence, urine leaks from small physical efforts: coughing, laughing, straining. Amniotic fluid seeps out spontaneously, without outside influence.

If there is excessive leakage of water, it is difficult to confuse the problem with other ailments:

discharge of a light liquid (may have a brownish, greenish tint) heavily wets the laundry and can flow down the legs;

the stomach decreased in size and became denser;

fetal movement has almost stopped;

contractions began.

In the first and second cases, the instructions are the same: consult a doctor immediately.

Test for leakage of amniotic fluid

Most women prefer to independently verify the presence of a problem and only then contact a doctor with a complaint. What can a woman do at home if she suspects a water leak? First, make sure that the fluid being released is not urine or vaginal discharge. If you regularly use light-colored knitted underwear and pads, it will be easier to detect unusual discharge. Urine has a specific odor that is difficult to mistake for anything else. Dark underwear will help identify vaginal discharge. There will be a light leucorrhoea residue left on it. If the laundry is damp, odorless and has mucous whitish residue, it is most likely amniotic fluid.

Another recommendation to test leakage at home is to empty your bladder as much as possible, wash your genitals and wipe dry. After this, use a light, clean napkin as a pad. If after half an hour a wet spot remains on it, there is every reason to suspect leakage of amniotic fluid. Also, after a shower, you can lie down on a clean sheet and turn on your side. In a lying position, amniotic fluid leaks out faster. If you find a wet spot, you need to go to the hospital for help.

More accurate information can be provided by special tests that can be purchased at the pharmacy. Test pads are impregnated with a special reagent that detects high levelspH. Normally, a pregnant woman's vaginal discharge should be acidic. If water leaks, the levelpHwill be neutral or alkaline. If there is a problem, the gasket indicator will turn blue-green.

The disadvantage of such tests is false positive results if a woman has vaginal dysbiosis, inflammation of the mucous membrane, or shortly before diagnosis, douching or sexual intercourse took place. In all such situations the level changespH.

Tests for the detection of protein-1 and placental microglobulin will be more reliable, since they are based on the identification of components that are contained only in amniotic fluid.

Only a doctor can definitively make a diagnosis. He will also conduct testing, examine the woman using mirrors, and send her for an ultrasound. Based on all the data obtained, tactics for further pregnancy management will be chosen.

Causes of amniotic fluid leakage

Loss of amniotic fluid occurs through cracks in the amniotic sac. Damage to its shells can occur for many reasons:

inflammation of the vaginal mucosa, which is based on infection. The most common pathogens are mycoplasmas, chlamydia, trichomonas, streptococci. Many women hope that the body will cope with the disease on its own and do not seek treatment. Bacteria continue to develop, penetrate the area of ​​the amniotic sac and dissolve its membrane. In 30% of cases of amniotic fluid leakage, the culprit is infection;

infections that enter the fetal membrane through the blood or from the genital tract without damaging the bladder. Continuing to develop inside, the pathogens violate the integrity of the shell and provoke leakage;

falls, injuries, blows to the abdominal area. Any mechanical impact can cause a shell rupture;

Pregnancy is not only a joyful time, but also a very hectic one for the expectant mother. After all, it is very important to be attentive to your condition and promptly monitor changes that can lead to dire consequences and require immediate medical intervention. One of the most alarming symptoms Leakage of amniotic fluid is considered.

Functions of amniotic fluid

The baby in the mother's belly is in the amniotic sac, filled with a special liquid - amniotic fluid. This fluid creates for the developing baby comfortable environment. It protects the baby from physical influences: even if the expectant mother falls, thanks to the liquid, the fetus will not be harmed. The waters protect the mother from strong pushes of the baby, forming a shock absorber. The child regularly swallows small amounts of liquid, which contributes to the proper formation of the digestive and excretory systems.

At the beginning of pregnancy, amniotic fluid is absolutely clear, but gradually it begins to become cloudy due to dying epidermal cells, the baby's vellus hair and fatty secretions.

Amniotic fluid should normally be sterile: it does not allow dangerous microorganisms to infect the fetus.

Shortly before the baby is born, the volume of amniotic fluid is approximately 1.5 liters. If the pregnancy proceeds without complications, the membranes rupture only before labor begins. At the same time, they say that the expectant mother’s water has broken. But sometimes, due to pathological processes, slow leakage of amniotic fluid occurs, which is extremely dangerous not only for the baby, but also for the woman.

Symptoms of amniotic fluid leakage

Amniotic fluid begins to leak only before birth. This process is impossible not to notice: in short terms approximately 500 ml of liquid is released, which has a very specific odor. After the water breaks, contractions begin.

Leakage of amniotic fluid is much more difficult to notice: the liquid may be released in small drops. First of all, a pregnant woman should be wary of transparent or yellowish discharge without odor, arising without the ability to stop this process by conscious effort. The discharge may increase with changes in body position, coughing or physical activity.

It is not always possible to detect leakage of amniotic fluid even during a medical examination. To make sure that amniotic fluid is leaking, it is necessary to do a special amniotest to determine the presence in the vagina of a protein contained only in amniotic fluid. The test is done very quickly: just blot the vaginal discharge. If leakage occurs, the test will instantly change color. To confirm the diagnosis, cytological and ultrasound examinations are prescribed.

Tests to detect amniotic fluid leakage

You can determine whether amniotic fluid is leaking at home. To do this, you need to first empty your bladder and wash yourself. After this, you should lie down on the bed, placing a clean sheet or disposable absorbent diaper under you, relax and lie there for about a quarter of an hour. If after this there is a noticeable damp spot on the sheet, you should go to the hospital as soon as possible.

You can detect a dangerous symptom at home: special express tests are sold in pharmacies. The tests are available in the form of strips and pads. The principle of operation of both tests is the same: it is based on determining the level of acidity of the vaginal environment. Normally it should be acidic. Amniotic fluid has a neutral pH and its leakage changes the acidity level of vaginal discharge.

Doing the test is very simple. First, a smear is made using a special swab and placed in a test tube. After a few minutes, an indicator is lowered into the test tube. If two stripes appear on the indicator, amniotic fluid is leaking.

However, tests are not absolutely reliable: sometimes changes in pH levels occur for other reasons. Therefore, only a doctor can determine whether amniotic fluid is leaking.

Of course, if the amniotic sac is damaged sufficiently, leakage can be noticed without special tests: the expectant mother can feel her stomach decreasing in size, sometimes liquid even begins to flow down her legs. Such cases require immediate medical intervention, otherwise there is a high risk of premature birth or even fetal death.

Causes of amniotic fluid leakage

The main reasons leading to leakage of amniotic fluid are as follows:

• the woman has any infections. Infectious diseases can lead to thinning of the membranes, which increases the risk of damage or even rupture;
• cervical insufficiency. If the cervix dilates under pressure from the growing fetus, the bladder sags slightly and may burst;
• careless examination by a gynecologist;
• multiple pregnancy;
• injuries;
• the appearance of neoplasms in the uterus (both malignant and benign).

Why is amniotic fluid leaking dangerous?

If the expectant mother detects leakage of amniotic fluid, she should consult a doctor without wasting time. After all, leakage poses a danger to the child’s life.

It was said above that amniotic fluid serves as a kind of barrier for the baby, protecting against infectious agents. If the water is released too early, the risk of infection of the fetus increases.

Leakage can trigger premature labor or.

Usually when amniotic fluid leaks to the expectant mother antibacterial therapy is carried out. The earlier treatment is started, the more success will be achieved. If you miss time, dangerous septic complications will arise, which can lead to the death of both the baby and the woman.

If leakage is detected at later, a decision can be made.

Treatment of amniotic fluid leakage

Unfortunately, there is no way to stop the process of amniotic fluid leaking. The actions of doctors depend on how long the symptoms are detected.

If the pregnancy is full-term, then labor begins two to three hours after the leakage of amniotic fluid. In the absence of doctors will stimulate labor or undergo surgery.

In case of a premature pregnancy, the term of which does not reach, and there are no symptoms of infection of the fetus, the woman is hospitalized and expectant management is used, because every day spent in the mother’s womb is very important for the baby. At the same time, the pregnant woman is given special medications that stimulate the development of the child’s respiratory system.

The closer to the expected date of birth the leakage begins, the more favorable the prognosis. If the amniotic sac is damaged early stages carrying a child, the woman will be advised to have an abortion.

Prevention

It is very important for the expectant mother to take all measures to avoid leakage of amniotic fluid:

1. At this stage, all existing infectious diseases;
2. If the gynecologist detects cervical insufficiency, it is recommended to apply sutures to the cervix or introduce a relief ring;
3. Before pregnancy occurs, it is very important to healthy image life, give up bad habits and avoid stress;
4. It is necessary to visit a doctor regularly so that they can notice the symptoms of leakage. Women who are carrying two or more children should be especially careful: with multiple pregnancies, the risk of leakage greatly increases;
5. A pregnant woman should exercise caution: injuries, excessive physical exertion and falls can lead to cracks and ruptures in the amniotic sac.
6. It is also very important to carefully monitor your condition: the earlier a leak is detected, the more likely it is that doctors will be able to save the baby.

Leakage of amniotic fluid is one of the most dangerous obstetric pathologies that requires immediate intervention. Purchase some rapid tests to check your suspicions at the first sign of leakage, and monitor any changes that occur in your body. Remember: the sooner you notice leakage, the greater the chance that doctors will be able to save your baby’s life!

Pregnancy is not only a joyful period, but also a restless one; it does not always pass serenely. Expectant mothers often face a wide variety of complications. Some of them cause only minor discomfort and go away on their own, while others can lead to serious consequences and require immediate medical attention. One of these complications is leakage of amniotic fluid.

Photo by Shutterstock

Gynecology

obstetrician-gynecologist at the Nova Clinic network of reproductive and genetics centers

The reasons for leakage of amniotic fluid can be very different. Most often, the release of amniotic fluid is caused by some kind of inflammatory process in the body.

Leakage can also be caused by isthmic-cervical insufficiency, anatomical abnormalities in the structure of the uterus, abdominal trauma and many other factors. Sometimes the exact cause cannot be determined.”

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

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

The role of amniotic fluid

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

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

Photo: JGI/Jamie Grill/Getty Images

In addition, sterile amniotic fluid participates in the child’s nutritional processes and does not allow pathogenic organisms from the external environment to penetrate into the fetal bladder. The waters are renewed every few hours, while constantly maintaining an optimal chemical composition.

By the end of pregnancy, the volume of amniotic fluid reaches 1.5 liters. Normally, the membranes rupture and waters are released during the first stage of labor at least 38 weeks into the pregnancy. In 10–15 percent of pregnant women, the integrity of the amniotic sac is disrupted long before the due date, which can lead to serious consequences for the mother and the child.

Signs and diagnosis

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

The main sign of leakage of amniotic fluid is watery discharge, which increases with physical stress and changes in body position.

Sometimes, especially in late pregnancy, leakage of water can be easily confused with normal vaginal discharge, which towards the end of pregnancy may become more abundant and thinner than usual. It is also not uncommon for water leakage to be confused with urinary incontinence - the enlarged uterus puts pressure on the bladder, and during physical stress, laughter or sudden movements, urine can be involuntarily released in small quantities.

Photo by AntonioGuillem/iStock/Getty Images PlusGetty Images

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

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

If there is excessive leakage, diagnostic methods such as a routine vaginal examination and a cough test can be informative (physical stress when coughing causes increased leakage).

If other methods fail exact result, in cases where the condition of a pregnant woman gives rise to fears for her and the fetus’s life and health, the method of amniocentesis is used - in this case, a safe, non-toxic dye is introduced into the cavity of the amniotic sac, and a clean tampon is placed in the patient’s vagina.

The staining of the tampon is 100% likely to indicate water leakage, but the amniocentesis method is dangerous in itself, since during its implementation the integrity of the membrane of the amniotic sac must be broken.

Photo Tetra Images - Jamie Grill/Brand X Pictures/Getty Images

It is rare for a woman to independently determine whether amniotic fluid is leaking. If you have any suspicions, the most in a simple way the “clean diaper” method becomes a confirmation or refutation of them. To do this, the pregnant woman needs, after completely emptying her bladder and thoroughly washing herself, to simply wipe herself dry and lie down on a clean, dry diaper for 30–60 minutes. If after this a wet spot is found on the diaper, you must immediately contact medical care.

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

One strip means the absence of a gap, two confirm its fact

Causes and consequences of amniotic fluid leakage

The causes of ruptured membranes are usually the following:

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

Leakage of amniotic fluid is a serious complication of pregnancy, requiring immediate medical attention and hospitalization. The fact is that violation of the integrity of the bladder threatens premature onset of labor and infection of the fetus - the baby, not protected by a sealed bladder and the barrier of amniotic fluid, is defenseless against infections.

Amniotic fluid is not just a layer of water that protects the fetus from trauma and allows the baby to move freely. Without amniotic fluid (and even if it is present, its quantity less than normal) the child cannot fully develop. Therefore, a woman should know how to determine leakage of amniotic fluid by simple symptoms and with the help of home tests.

Amniotic fluid is formed from the moment of conception. Their number gradually increases, reaching a peak in the second trimester. By the time of birth, amniotic fluid is not formed as intensively. Water leakage during pregnancy can occur at any stage. Before 22 weeks this is a sign of an incipient miscarriage, after which it is a sign of the onset of labor.

Why does amniotic fluid leak?

Causes of leakage of amniotic fluid in different dates are different. Depending on this, the tactics for managing a pregnant woman are built.

At the beginning of gestation

At this time, isolated leakage of amniotic fluid is rarely observed. More often, a miscarriage begins with bloody discharge and only then, as the uterus contracts and the fertilized egg is expelled, amniotic fluid is released. It mixes with blood and is difficult to isolate separately.

In the middle and end of gestation

Even the slightest leakage of amniotic fluid before 22 weeks is considered the beginning of a miscarriage. After this period and up to 37 weeks, the release of amniotic fluid is a signal of the imminent onset of premature 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 normal and indicates the beginning of labor.

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

• Infectious diseases. Sexual infections and the TORCH complex (recent rubella, cytomegalovirus, herpes) are the cause of premature leakage of amniotic fluid in the first and second trimesters in 95% of cases. When the source of inflammation is localized in the vagina and cervix, pathogens penetrate further into the cervical canal, uterine cavity, and fetal membranes. Infection of the membranes is the cause of premature rupture of amniotic fluid.
• Chronic processes. Serious chronic diseases, for example, pyelonephritis, autoimmune pathologies can also indirectly cause rupture of water.
• Rhesus conflict. When the blood groups of the fetus and mother are incompatible according to the Rh factor, Rh sensitization occurs. In such a situation, the body tries to “get rid” of an unwanted pregnancy, which causes water leakage.
• Multiple pregnancy. When carrying two or more fetuses, a woman has an increased risk of developing premature birth due to excessive stress on the body. Often multiple pregnancies are accompanied by isthmic-cervical insufficiency of the cervix (ICI, opening of the cervix prematurely). With monochorionic twins or triplets (one placenta for all), “steal syndrome” may occur. As a result, one baby develops polyhydramnios, while another develops oligohydramnios. All this is often accompanied by leakage of amniotic fluid.
• Pathology of the cervix. ICN leads to premature rupture of water. In this case, as the pregnancy period increases, the cervix cannot withstand the load and begins to open. The result is that the amniotic sac prolapses (sinks) into the cervical canal and ruptures.
• Cervical manipulation. When applying an obstetric suture for cervical incompetence, accidental puncture of the amniotic sac may occur, followed by rupture of water.
• Diagnostic procedures. Amniocentesis (puncture of the uterus through the anterior abdominal wall and collection of a small amount of amniotic fluid), cordocentesis (umbilical cord puncture for blood collection or transfusion), chorionic villus biopsy (the procedure is similar to amniocentesis, but chorionic cells are collected) due to their invasiveness are always accompanied by risks water leakage
• Uterine fibroids. 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, the pressure breaks the integrity of the membranes and water leaks.
• Anomalies of the structure of the uterus. In this case, a similar picture develops as with nodes. A uterine septum, one horn, or saddle can lead to rupture of water.
• Fetal pathology. If the baby has any developmental defects, the likelihood of water breaking before full-term pregnancy occurs is also higher.
• Injuries. Injuries in the abdominal area (blunt, sharp) can lead to compression of the amniotic sac 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 membranes.
• Diabetes mellitus. Changes in metabolism, especially with decompensation of sugar, increases the risk of premature birth and leakage of amniotic fluid.

Premature birth sometimes occurs due to specific circumstances, for example, infection, fetal pathology. But often no obvious reasons for the early onset of labor are found.

What does it look like

Amniotic fluid leakage can look different. It all depends on the level of tear.

• Heavy and medium discharge. When the bulk of the amniotic fluid flows out, which is located in front of the presenting part of the fetus (like a “wedge”), the woman notes that it “flows down the legs”; ordinary maxi pads cannot absorb all the amniotic fluid.
• Minor discharge. When there is a high tear in the membranes or when the layers of membranes are displaced relative to each other, the defect area may overlap and the amniotic fluid stops leaking. In this case, the amount of water may be insignificant - up to 200 ml or less. In such a situation, it is sometimes difficult to diagnose and confirm whether it was amniotic fluid or not.
• Color and presence of impurities. Amniotic fluid may contain blood (in this case it is necessary to exclude placental abruption), with an admixture of meconium - green or yellow (a sign of fetal hypoxia). Normally, the color of amniotic fluid when leaking should approach transparent, with a milky tint; it may contain fetal vellus hair and particles of its epithelium - all this provides a kind of suspension.
• Smell . Amniotic fluid does not have a pungent odor, perhaps a slight sour odor. Fetid, unpleasant - a sign of infection of the membranes and, most likely, the baby.
• With or without contractions. Water can leak with or without the onset of uterine contractions and contractions.

Leakage may appear after physical activity, and against a background of well-being, for example, during sleep or after a night's rest. When your body position changes, amniotic fluid may flow more abundantly.

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

• increased amount of vaginal discharge;
• liquid discharge;
• appear periodically or leak constantly.

How to understand what kind of discharge it is

In a premature pregnancy, it is extremely important to distinguish true leakage from normal vaginal leucorrhoea. This is not always easy to do without additional examination and follow-up. It is especially difficult to make a diagnosis in the following cases.

• For urinary incontinence. Even in young women, especially after repeated births, the tone of the pelvic floor muscles may decrease, resulting in urinary incontinence - when straining, sneezing, coughing. This is especially common in the later stages, when the uterus creates additional pressure on the bladder and pelvic floor. If the pregnant woman does not notice this, it may seem like water is leaking.
• With a pessary installed. After installing the RAP (unloading obstetric pessary) - foreign body– the amount of vaginal discharge increases due to constant inflammation. They collect in the posterior fornix and can flow more abundantly when turning the body. Sometimes it seems like it's water.
• For 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 may be transparent, white, yellow or green.
• When the mucus plug comes out. As the moment of birth approaches and the cervix opens, mucus comes out, which during pregnancy “like a plug” closes the cervical canal from infection. Sometimes it has a rather thin consistency and can resemble water.

The following table shows what signs can be used to differentiate water leakage from other conditions.

Table - How to distinguish water from other secretions

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

• Inspection in the 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 discharge, a “fern symptom” is detected - under magnification after drying, the picture on the slide resembles the leaves of this plant.
• Amniotest. There are special test strips to determine the presence of amniotic fluid. They are based on changes in the pH of vaginal discharge when mixed with amniotic fluid. It is freely sold in pharmacies, and a woman can perform it herself at home.
• Ultrasound of the fetus. If oligohydramnios is detected by fetal ultrasound, if rupture of amniotic fluid is suspected, this is another symptom “for”. However, a normal amniotic fluid index does not exclude leakage, especially a high tear.
• Laboratory methods. Some clinics have methods for identifying certain substances in vaginal secretions, which appear only after amniotic fluid enters them. However, the method is expensive and not always informative, so it is rarely used.

In doubtful cases, wait-and-see tactics are used. The woman is being monitored in a hospital setting. Careful monitoring of discharge is carried out, ultrasound is performed in dynamics, tests and laboratory studies are performed.

Tactics for managing 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. It largely depends on the period in which the waters began to flow.

• 1st trimester. Bloody discharge and water in this period begin together when the integrity of the amniotic sac is disrupted and the miscarriage progresses. Medical or surgical termination of pregnancy is indicated.
• 2nd trimester. Before 22 weeks, any leakage of amniotic fluid is considered the onset of a miscarriage. Further stimulation is carried out and subsequent curettage of the uterine cavity.
• 3rd trimester. Tactics are determined based on the period, condition of the mother and fetus. When the waters rupture before 37 weeks, it is possible to prolong pregnancy from several days to a month or even more with simultaneous antibiotic therapy and the administration of drugs for the maturation of the fetal lungs. There are techniques to prevent further leakage of amniotic fluid, which helps to grow the baby in utero for some more time. Since water is produced anew every four to eight hours, its volume soon increases to normal levels. If there are signs of detachment, inflammation, or according to the woman’s indications, delivery can be immediate. The rupture of water after 37 weeks is equivalent to the onset of labor.

Is it dangerous for the fetus?

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

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

• the risk of infectious complications increases– chorioamnionitis, congenital pneumonia;
• hypoxia occurs– rupture 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 being born prematurely– if water breaks 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 fetal body may fall out - with a non-cephalic presentation, along with the water, loops of the umbilical cord or parts of the fetus (usually arms, legs) may fall out through the opened cervix, which can threaten its life.

If a woman is able to suspect or even accurately determine 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 doesn’t matter what the gestational age is when water breaks, only a specialist can determine the most appropriate tactics in each specific case.