Leakage of amniotic fluid is a dangerous complication of pregnancy, the consequences of which can be very tragic for both the mother and the child. Only with a normal amount of water and a sealed fetal bladder is the baby protected from external hazards. But water leakage is not such a rare occurrence in obstetrics, and therefore every pregnant woman should know by what signs she can recognize this pathology and what to do in this case.
Definition
Leakage of amniotic fluid is called partial outflow of amniotic fluid due to the high rupture of the membranes or the formation of microscopic cracks in them. This pathology differs from the outpouring of waters by a gradual decrease in the amount of fluid surrounding the fetus, nourishing and protecting it from negative external influences. Outpouring occurs at a time, in full or almost in full, and this phenomenon cannot go unnoticed by a woman. It is always accompanied by rupture of the shells. Leakage is more difficult to determine as fluid loss can be minimal.
Waters surround the baby throughout pregnancy. They nourish it, as they are rich in proteins, enzymes, hormones, glucose and lipids, and protect it by containing antibodies. The baby swallows water and pees with it, taking an active part in the production of liquid. Water is produced by the amniotic fetal membrane and is renewed every three hours to keep the environment inside the fetal bladder sterile.
Water acts as a shock absorber - softening shocks, as well as a sound absorber - reducing noise from the outside. Thanks to the waters inside the fetal bladder, a constant and optimal temperature for the growth and development of the baby is maintained - 37 degrees.
Fruit membranes are airtight. This protects the baby from outside viruses, fungi and bacteria. Normally, they become thinner and torn already in childbirth - at the peak of labor before the end of the first birth period. The discharge of water at any other time is considered a complication of childbirth.
However, a number of factors can lead to incomplete lateral high tear or cracks in the membranes, which will cause the constant release of amniotic fluid in small quantities. This condition is very dangerous but in a number of cases, doctors manage to successfully maintain a pregnancy until the period during which the child will not be threatened at birth. It is the matter of time.
The sooner a woman pays attention to the fact that her water is leaking, the sooner an objective diagnosis is carried out, the more chances of saving the child, mother and their health.
According to medical statistics, water leakage occurs in about 5% of pregnant women. It is this pathology that causes perinatal mortality in 10% of cases. The lack of adequate and high-precision diagnostics does not always allow detecting leaks in time, and this tenfold increases the likelihood of infections, premature birth, and the birth of an immature baby.
Causes of violation of the integrity of the membranes
The reason for the flow of water outward into the genital tract during pregnancy is always the same - a violation of the tightness and integrity of the membranes. If, with a rupture, almost always a rupture occurs in the lower part of the fetal sac, then leakage is usually the result of cracks or tears in the upper part of the fetal membranes. There are several causes of amniotic fluid leakage both in the early stages and before childbirth.
- Infection - the strength of the membranes decreases if a woman has infectious and inflammatory processes. Most often, the presence of endometritis, colpitis, inflammation of the cervical canal, and inflammation of the appendages leads to pathology. The likelihood of tearing increases significantly if a woman has an inflammation of the membranes themselves - chorioamnionitis.
- Disorders in the uterus and placenta - pathology is often found with a two-legged uterus, with isthmic-cervical insufficiency, when the cervix does not provide reliable closure of the uterine cavity. Tears of the fetal bladder can result from small placental abruptions in the early stages.
- External influences - inaccurate and, most importantly, multiple gynecological two-handed examinations, especially in late pregnancy, can cause thinning of the membranes. Also, women are not recommended to often do ultrasound with an intravaginal sensor, and not at all because ultrasound can affect the fetus, but because the procedure of vaginal examination itself increases the likelihood of violation of the integrity of the membranes. The reason for the tear and leakage of amniotic fluid can be hidden in previous invasive diagnostic procedures - amniocentesis, chorionic villus sampling, as well as when an obstetric pessary is installed on the cervix.
- Fetal causes - the walls of the fetal sac are more susceptible to pressure if a woman is carrying not one baby, but two or three. The pressure, in turn, leads to premature thinning and increased vulnerability. A tear can lead to dropsy of the fetal brain, its abnormal location in the uterine cavity, for example, with a transverse or oblique presentation.
- Violation of the state of the shells themselves - hyperextension of the membranes can occur with polyhydramnios, which is caused by a violation of the production of water by the amnion. Sometimes the premature aging of the membranes and their degeneration leads to pathology.
- Injuries sustained by a woman - this mainly includes blunt abdominal injuries that a woman can receive when falling, hitting the stomach. Penetrating type injuries to the abdominal cavity can also cause subsequent water leakage.
It is believed that women who have had a similar occurrence in previous pregnancies are more at risk of amniotic fluid leakage - the likelihood of recurrence is more than 30%.
Women who have scars on the uterus and cervix, as well as inflammatory ailments of the genital area, are more likely to face a problem.
More often, water leakage occurs in pregnant women with severe anemia, as well as in expectant mothers who smoke who did not want to part with their bad habit even after pregnancy.
Water during a tear comes out gradually, not only because the area of the tear is smaller, but also because the place of damage is adjacent to the uterine wall, which reduces the rate and volume of water discharge. Such gaps do not heal on their own, and the broken tightness increases the risk of infection from the outside to the fetus. Prolonged leakage due to the content of enzymes in the waters can lead to placental abruption. Often, it all ends with a miscarriage, if it happened early, or premature birth, if the leak started at the end of the 2nd and the beginning of the 3rd trimester.
Classification and types
The types of leakage are rather arbitrary and the main criterion is which allows doctors to figure out what to do next, is the time - the time of the appearance of waters.
- Premature - occurs up to 37 weeks, when the baby is considered premature by all obstetric and pediatric standards.
- Prenatal - occurs from 37 weeks, when the baby is full-term and in general may already be born, he is ready for this.
- Earlier lateral - occurs already during childbirth, but still with a closed cervix or with an open, but up to 4 centimeters.
If a woman has a suspicion of a leak at 39-40 weeks, it is considered prenatal water leakage and is less dangerous than a leak up to 37 weeks.
Symptoms and signs
If the water departed at once, then there are a lot of them, and it is very easy to distinguish them from vaginal discharge - a large amount of clear or turbid fluid flows out, not associated with urination. But a gradual leak is not easy to recognize. And many, especially in the later stages, when incontinence with laughing or coughing is an almost normal phenomenon, may simply not pay attention to the increase in liquid discharge in the perineum.
A tear or the formation of a microscopic crack in the fetal bladder is not associated with the occurrence of any unusual sensations, the fetal membranes do not contain nerve endings, and therefore there will be no pain for sure.
The dimensions of the abdomen, which visually change if the water comes out in full or in significant volume, usually remain habitual when leaking, the tummy looks as usual.
Water leaks in a different volume, and therefore some women can almost immediately understand that a new sensation of moisture in the perineum has appeared, while others may not be aware of this for a long time, not going too deeply - this is water or urine that is released involuntarily due to the significant pressure of the uterus on the bladder of the expectant mother.
The amount of vaginal liquidish discharge during leakage increases if a woman spends some time alone, lying down. The home test is based on this, with which, in general terms, you can check whether there is a leak or not. This method is called "diaper" or "dry diaper method". To do this, you need to lay a clean diaper in the crotch and lie quietly on your back for a while. If, after the woman returns to the original upright position, a wet spot forms on the diaper, you should immediately seek medical help.
Important! The diaper method can be uninformative if the woman has a low outflow rate, there are only microcracks.
During physical activity, tension of the press, when changing the position of the body in space, when yawning, coughing or sneezing, the amount of discharge usually increases slightly. When leaking, water is usually odorless and colorless, or has a slight yellowish color, and therefore, again, they are often confused with urine.
If the tear of the shell happened more than a day ago, then the first signs of infection may appear. At the same time, it is very difficult to understand exactly where the infection occurred - the membranes, the fetus or the uterus were affected. But such accuracy is not required from a woman in home diagnostics, this is the task of specialists. All types of infection are manifested by an increase in the woman's body temperature, a feeling of chills, and pain in the lower abdomen. The discharge can change its character - with a general wateriness, they can be accompanied by impurities with blood or pus.
What is the danger?
The danger of amniotic fluid leakage lies, again, in the time of pathology. The longer a woman could not understand what exactly was happening to her, the higher the likelihood that the consequences would be very dire.
Medical studies have shown that the presence of water leakage in a pregnant woman's history almost 15 times increases the risk of having a still baby, mortality increases 4 times, and the risk of neonatal complications and ailments in a newborn increases 3 times.
These are very high risks, and the more time the pathology goes unnoticed, the more likely they become.
The premature birth of a child is dangerous by the development of respiratory failure, in which his immature lung tissue will not be able to cope with the task of ensuring spontaneous breathing after birth. For this reason, many children die even with timely resuscitation assistance.
If, 12 hours or a day after the rupture, the woman does not receive help, infection, inflammation of the amnion, and necrotic changes in the uterus may begin. For a baby, intrauterine infection is fraught with severe cerebral hemorrhages, disruption of all organs and systems, sepsis, and death.
Almost always, with a premature violation of the integrity of the fetal sac, symptoms of oxygen starvation appear. Hypoxia can lead to numerous and varied disorders of the fetus; in severe cases, it leads to the death of the baby.
A baby whose fetal bladder is perforated and allowed to enter the infection may be born with retinopathy, self-amputation of the limbs. For a woman, the condition is dangerous with the risk of placental abruption, and this can happen at any moment. In this case, massive bleeding often occurs, which can lead to the death of the woman in labor.
Labor pains in women after leakage of water are usually weaker, inconsistent, labor weakness often appears and there is a need for stimulation or emergency caesarean section. The postpartum period usually proceeds with complications.
Determination methods
It is difficult even for specialists in the field of obstetrics to find out exactly if water is leaking. This is a very difficult obstetric diagnosis, since even the most modern and accurate methods have the likelihood of getting false results, and most of the quick methods that are in service with gynecologists are completely powerless in this case.
- Gynecological examination - in case of suspicion of leakage, it is not recommended, since it increases the risk of faster penetration of the infection to the fetus, if there is indeed a tear. In addition, the information content is low and this risk is clearly not worth it - with the help of mirrors, the doctor can see the fluid in the posterior fornix of the vagina, but it will be difficult to understand that it is sperm or water. Previously, experts asked a pregnant woman to cough - while the amount of fluid in the posterior fornix had to increase. Today there are other methods that are used by doctors.
- Ultrasound examination - the method will help to notice the onset of placental abruption or signs of fetal hypoxia, in general, to assess the amount of water and their transparency, but it will not be able to detect cracks or tears in the membranes, and therefore the method is not considered reliable for diagnosing leakage directly.
- Vaginal smear examination - microscopy is based on a special pattern of water on a glass slide after drying. It resembles fern leaves. But the method is considered not only unreliable, but also nonspecific, because when dried, the sperm also gives exactly the same "fern" image in the microscope.
- Water tests. There are home pads and more complex systems, and there are amniotests that are done in a maternity hospital or antenatal clinic. The simplest ones are based on determining the change in the acidity of the vaginal environment - it becomes more alkaline due to mixing with waters. More complex and accurate tests are based on the determination of specific proteins that are present only in waters - microglobulin-1 and placental growth factor. Tests that are based on the determination of microglobulin are the most accurate - their effectiveness is above 97%. The rest are less accurate. The most common mistakes are simple test strips.
- Amniocentesis with indigo. This method is quite traumatic and dangerous. Its essence boils down to puncturing the wall of the uterus through the abdominal wall and injecting a dye solution into the fetal bladder. A tampon is inserted into the vagina, if after half an hour the dye gets on the tampon, this means that water is leaking. The method is quite accurate, but it is fraught with additional risks - infection, injury to the fetus, early labor, termination of pregnancy. Therefore, with the invention of amniotests, this method has become less and less used.
As you can see, there is not a single method that could give an answer to the question of whether there is actually leakage with one hundred percent accuracy.
Therefore, much depends on the professionalism and experience of the doctor. You should not rely on accuracy at home, even if you use the most accurate test, because even a positive or negative result is not a guarantee that there is no pathology.
It is important to consult a doctor on time, who better understands how and why a pathological condition manifests itself. If the crack in the membranes is small and the water is successfully replenished during the course, there is no infection, it is quite possible to preserve the pregnancy until the period when the birth will not pose a danger to the baby.
What to do if a woman suspects a leak?
It is very important to diagnose the leak yourself at home within the first 12 hours.... After this time has elapsed, the accuracy of all existing amniotests is further reduced, and the likelihood of infection increases. If a simple diaper test, which you can carry out on your own by putting a clean dry diaper into the crotch, gives a positive result, you need to call the ambulance immediately, informing the dispatcher about the color of the outgoing waters, if there is - the smell and the presence or absence of impurities. This is very important, because with green or red waters, leaks with blood, not an ordinary, but an intensive care team will be sent to your call, since changes in the color of the amniotic fluid can indicate a serious condition of the fetus.
If there are no wet stains on the linen, the diaper is dry, and there is a suspicion of leakage, you should use tests for self-diagnosis.
Simple test strips that can measure the acidity of vaginal discharge include Frautest amnio, AL-sense. These are gaskets with a special matrix. You need to attach the pad to the underwear and, after a few hours, evaluate whether the test strip on the pad is yellow or has changed color to greenish. A change in color indicates that the normal acidic vaginal environment has become alkaline and water is likely to enter it.
Be prepared for false results - a discoloration on the pad can occur with bacterial infections of the vagina, such as vaginosis. It is not recommended to use vaginal suppositories, have sex and do douching.
The cost of such gaskets starts at 550 rubles.
To get more accurate results, it is better to make a test that is based on determining not the acidity of the genital tract, but the presence of microglobulin-1 in them. To date, there is only one such test in pharmacies. - AmniSure ROM Test or simply "Amnishur". This is a kit that includes a container of diluent, a sterile swab, and a test strip. A tampon is inserted into the vagina for a minute, following the rules specified in the instructions.
Then it is placed in a container with a solvent for another one and a half minutes, after which a test strip is placed in it, which, after a ten-minute wait, will show either one or two strips. One strip indicates that the membranes are intact, there is no leakage. Two red bars indicate leakage with an accuracy of better than 97%.
Neither the presence of urine, nor the presence of sperm in the genital tract can distort the result of the Amnishur test, and therefore it is considered the most reliable. Its cost is high - more than 2 thousand rubles. Slightly cheaper is the AmnioQuick system, which is used in exactly the same way, but detects not microglobulin-1 in the secretions, but insulin-like placental growth factor. This test is less sensitive and more likely to fail. It costs from 1 thousand rubles.
It is very important to know that if leakage is suspected, a woman should not take a bath, insert fingers or other foreign objects into the vagina, or have sex... All this increases the risk of infection. Regardless of the results of home testing, it is important to see a doctor as soon as possible - both with early withdrawal and with late leakage, the risks and complications can be equally dangerous.
What do doctors do?
What to do if a woman starts to leak, doctors decide. First of all, they take into account the gestational age, the condition of the fetus. If a woman is admitted to the hospital without contractions, it is still too early for the child to be born, doctors most often decide to wait. But this is not a passive wait, but a whole range of measures to save the mother and child.
If the leak begins before 22 weeks, usually the pregnancy is not maintained, it is recommended to interrupt it, since it will be almost impossible to deliver the baby, and the risk of severe and even lethal complications for the woman and the fetus is too great.
From 22 weeks, the approach to treatment is different.
The woman is placed in a sterile ward, where she is in full bed rest. Her sterile pads are changed every 2 hours, antibiotics can be used to eliminate even potential risks of infection. How long it will be possible to continue carrying, no one will say in advance - everything will depend on the condition of the fetus and its future mother.
They do not preserve the pregnancy, but decide on a premature birth if the woman has already started inflammation of the membranes - chorioamnionitis, if the child has hypoxia, if contractions begin, placental abruption. The rest are recommended to administer drugs for accelerated maturation of the fetal lung tissue, as well as antispasmodics, which will help reduce the tension of the uterine muscles and prolong pregnancy.
If a woman's leakage began after 34-36 weeks, then doctors can use both wait-and-see tactics and active ones if the child is ready for birth. For this, a survey is carried out during the day, all risks are identified and only then a decision is made. If the period is more than 37 weeks, then there is no need to maintain the pregnancy, the baby is full-term. Doctors stimulate labor if contractions do not start on their own.
In any case, it is estimated in what amount of water, what color they are. This is important for assessing neonatal risks.
Prevention
To prevent water leakage, you should limit physical activity during pregnancy. Do not smoke while waiting for a child, especially for women who have at least one risk factor. A woman should register for a consultation on time.
