How to stop the leakage of amniotic fluid. How to understand what kind of discharge

Leakage amniotic fluid or premature effusion amniotic fluid (PIV or PIOV in different sources) is a rupture of the fetal membranes, an outpouring of amniotic fluid before the onset of regular labor 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 birth process is accelerating.

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 methods diagnosis (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.

Approximately 1% of cases this procedure complicated by termination of pregnancy, 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 research, 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, wrong positions fetus (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) Drawing pains in the lower abdomen bloody issues(they don't always happen)

3) Change in fetal movements

Complications of premature water leakage

- termination of pregnancy (most often we are talking O 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)

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

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 the newborn ( inflammatory diseases skin, 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 (formed amniotic bands 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 developed during childbirth, then in 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 noted unclear abundant watery discharge, then you should urinate, take a shower, wipe yourself dry (dry the crotch thoroughly) and put a clean, dry white pad (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 in maternity hospital and call an ambulance (or contact the emergency room of the maternity hospital on your own).

- 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), on this moment it is produced under only one brand name Amnisure ROM Test (Amnishur).

This test is a system designed to self use, all indicated necessary items are included.

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 yellow on blue - green when in contact with liquids with a high pH. 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 it is possible false positive.

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 ( pronounced oligohydramnios) combined 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 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. General analysis blood at admission and in the future at least 1 time in 2-3 days;

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

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. Subject to availability uterine contractions with a frequency of more than 3-4 in 10 minutes - tocolysis (introduction medicines, filming contractile activity 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 at any stage of pregnancy. We wish you happy pregnancy and easy delivery at term. Look after yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

Amniotic fluid becomes the natural habitat of the fetus for the entire period of its intrauterine development. Under normal conditions, this biologically active liquid medium departs shortly before childbirth.

If there is different kind pathologies and diseases, amniotic fluid may leave earlier normal term. It is important to be able to timely establish the fact of amniotic fluid discharge and know how to behave in such situations.

Functions of amniotic fluid

Amniotic fluid provides the vital activity of the fetus as a whole. Among their main functions are the following provisions:

1. Nutrition developing child. Amniotic fluid contains a number of nutrients necessary for the normal development of the fetus.

2. Maintaining the required pressure and temperature indicators at a stable level.

3. Protecting the child from adverse influences. Thanks to the amniotic fluid, the intensity of various external pressures, shocks, etc., decreases.

4. Protection from infectious processes.

5. Creation of conditions for the free movement of the baby.

6. Protection against excessive noise.

Normally, intrauterine waters depart when regular labor activity is established and the cervix is ​​​​somely dilated.

Leakage of amniotic fluid during different periods of pregnancy

The sooner the water breaks, the more dangerous it is for the developing child.

Up to 20 weeks

The main reasons for the discharge of water on early stages pregnancies are:

• infection of the fetus;
• the development of the inflammatory process - chorionamnionitis.

There is no single algorithm of actions for the discharge of water at this stage of pregnancy. In most cases, doctors recommend termination of pregnancy. If the child can be saved, with a high degree of probability he will be born with many pathologies, including:

• blindness;
• cerebral paralysis;
• lack of hearing;
• severe respiratory failure.

In such situations, doctors prescribe a detailed examination, the results of which make a conclusion about the possibility of prolonging the pregnancy and existing risks for the fetus.

At 25-27 weeks

Also unfavorable and very dangerous situation. The most common cause of water leakage during this period of pregnancy is urogenital infections.

There is no single algorithm of actions. In most situations, there is no need to think about a favorable outcome for the child. Such children, if they survive, grow up as severely disabled. The doctor informs parents about possible scenarios individually based on the results of the examination.

At 38-40 weeks

The situation is not as dangerous as in earlier dates, but also very unpleasant. Most often, expectant tactics are used to maintain pregnancy. The doctor's task is to set the maximum allowable duration of waiting and find the safest way of delivery.

Thus, the sooner the water begins to break, the higher the likelihood of complications.

Causes of water leakage

Early discharge of intrauterine water is associated with a variety of damaging factors that affect the body of the fetus and woman.

The most common cause is a urinary tract infection. Under its influence, many pathological changes occur.

Also, fluid leakage may be associated with:

• inflammatory processes and infections in the uterus, vagina, cervix, and also the fetal bladder;
• isthmic-cervical insufficiency;
• failures hormonal background including hyperandrogenism. Because of it, many other pathologies can develop.

Risk factors for fetal fluid leakage

Leakage of amniotic fluid can provoke different factors. Among the most common are the following:

• Infectious diseases.
• Injuries.
• Much and little water.
• Hormonal disruptions.
• Careless sexual intercourse.
• Falls and other external injuries of the abdomen.

What is dangerous leakage of amniotic fluid?

The main thing is to detect the problem in time and take measures to eliminate it.

The danger of fluid leakage directly depends on the period at which it happened. After 36 weeks, although this phenomenon is not considered normal, it does not pose an excessive danger to the child.

The main thing here is to detect the problem in a timely manner and take the necessary measures. Usually, doctors simply artificially induce labor or use other methods of delivery.

If the patient goes to the hospital on time, and the cavity of her uterus, at the same time, is not infected, doctors try to prolong the pregnancy as much as possible, using the expectant tactics mentioned earlier.

Much more dangerous is fluid leakage in the early stages, around 20-25 weeks. But even under such circumstances, this deviation is not a mandatory indicator for an immediate termination of pregnancy.

With timely seeking medical help, the use of tocolytic therapy, antibiotics and bed rest help to significantly improve the situation.

The problem is that many patients do not go to the doctor in time with fluid leakage in the early stages. Usually they come to the hospital with already developed infections and other complications, and sometimes even with a dead fetus.

In such situations, the pregnancy is terminated, and the woman is prescribed a course of treatment.

Thus, even if the waters did not begin to depart during the established period, the possibility of maintaining the pregnancy is present.

The main thing is to detect the problem in time and take measures to eliminate it.

Symptoms and signs of leakage

It is quite difficult to independently determine the leakage of fluid. The main signs are the following:

• an increase in the volume of fluid released from the vagina when changing the position of the body or making movements;
• in the presence of a significant rupture of the amniotic sac, the fluid begins to literally flow. A pregnant woman cannot hold back the flow even with strong tension in the pelvic muscles;
• with a small rupture of the bubble, it is possible to confirm the leakage of water only by passing the appropriate tests. There are also home tests.

Familiarize yourself with the available methods of medical and self-determination the presence of amniotic fluid leakage, described below.

Methods for detecting leakage of amniotic fluid

The expediency of using one or another medical method is determined by a specialist in accordance with the conditions of a particular situation.

Gynecological examination

An extremely uninformative, but still widely used method. During the examination, the doctor discovers a clear liquid in the area of ​​​​the posterior fornix of the vagina. The patient is asked to cough. If the detected fluid is amniotic fluid, it will begin to leak from the cervical canal.

Main disadvantage- with such an examination, amniotic fluid can be confused with sperm, urine, natural secretions and other liquids.

smear microscopy

Also not the best reliable method. A swab of fluid is taken and placed on a glass slide. When dried, the liquid crystallizes and a pattern is created on the glass that resembles fern leaves.

The main drawback is that a similar pattern appears in the presence of sperm impurities in the smear.

Aminotest

Used most frequently. Considered one of the most effective methods determination of rupture of the amniotic membranes.

A puncture is made on the surface of the patient's abdomen to inject a solution of indigo carmine. Half an hour later, a cotton swab is inserted into the vagina. If it stains, there is leakage.

The method is accurate, but expensive and painful. The main disadvantage is the possibility of infection, bleeding and other problems that can affect the normal course of pregnancy and even lead to its termination. Severe complications occur in about 1 in 250-300 cases.

Cytological examination

One of the simplest diagnostic methods. A swab is taken from the region of the posterior fornix of the vagina. If the integrity of the amniotic membranes is violated, water elements will be detected in the smear.

There are ways to detect leakage of intrauterine water on your own.

Dry sheet test

The simplest and most common test. Allows you to distinguish amniotic fluid from simple secretions, the volume of which increases closer to the end of pregnancy.

The sequence of actions is as follows:

• the pregnant woman goes to the toilet;
• is washed and wiped;
• lies on a dry sheet (a diaper or a piece of other clean and dry cloth is also suitable);
• waiting for about 15 minutes.

If during the specified time wet marks appear on the sheet, there is water leakage.

In such a situation, you must immediately call ambulance.

FRAUTEST amnio

A modern method of home determination of intrauterine water leakage. With this test, intrauterine fluids can be distinguished from urine and vaginal secretions.

The test is equipped with a special yellow colorimetric indicator. When interacting with a high pH environment, the indicator becomes green-bluish. Under normal conditions, the pH of the vagina does not exceed 4.5. A similar indicator for amniotic fluid is about 7. The indicator changes color when in contact with liquids whose pH exceeds 5.5.

The test was found to be fairly accurate. At the same time, it is extremely easy to use. The check is performed as follows:

1. The test is removed from the foil bag. It is important that your hands are clean and dry.

2. The gasket is glued to underwear so that the yellow indicator is located opposite the entrance to the vagina. The test can be left on for 12 hours, just like a regular pad. It can also be removed earlier, at the first sensation of water leakage.

3. After the appearance of a feeling of leakage or after 12 hours, the test is removed from the underwear.

4. The color of the indicator is checked. If it changed to bluish green need to seek medical attention.

The test is not only easy to use and accurate, but also relatively inexpensive. The average cost is about 350-400 rubles. The tool is popular, so you can buy it in almost every pharmacy.

How to distinguish intrauterine water from urine and secretions

Often, pregnant women mistakenly identify fluid leakage, confusing it with urine and simple vaginal discharge, the volume of which can increase significantly closer to the end of pregnancy.

Methods for self-determination of leakage were given in previous section. In general, distinguish amniotic fluid from vaginal discharge and urine without medical assistance extremely difficult. Therefore, if you suspect a problem in question, immediately contact the hospital and follow the doctor's instructions.

What to do if premature leakage of fetal water is detected?

The outflow of liquid indicates damage to the fruit membranes. This, as already noted, can lead to extremely adverse consequences.

If the problem is found at home, you should immediately consult a doctor, or even better, call an ambulance.

If a problem is detected by a doctor, he will prescribe treatment and give recommendations in accordance with the characteristics of a particular situation.

Treatment of leakage of fetal water

The order of treatment is appointed in accordance with the term and the characteristics of the situation.

Pregnancies lasting less than 20-22 weeks cannot be saved in most situations.

If the fluid began to drain after 20-22 weeks, doctors make every effort to maintain the pregnancy. The main method, as noted, is it's a waiting tactic. It is aimed at prolonging pregnancy so that the child gets the maximum chance of being born full-term and healthy.

To prevent preterm labor, doctors usually give the patient tocolytics.

The volume and quality of the released waters are checked regularly. Every four hours the nurse changes the diaper. With a frequency of 5 days, sowing of vaginal discharge is done. The condition of the fetus is checked using cardiotocography.

If the problem appeared before 34 weeks of pregnancy, additional glucocorticoids may be prescribed. They are used to prevent the development distress syndrome The child has.

If it was not possible to prevent the occurrence of chorianamnionitis, or if a deterioration in the condition of the fetus was detected, the doctor may prescribe antibiotics. There will also be a choice of the method of delivery that is appropriate in a particular situation.

In case of fluid discharge during a full-term pregnancy with no contractions, the doctor may prescribe labor induction or recommend expectant management until natural childbirth. The most common stimulation is oxytocin. It allows the pregnant woman to go into labor faster.

Prevention of leakage of amniotic fluid

In order to prevent premature outpouring of amniotic fluid, doctors recommend:

• eliminate any foci of infection. These include diseases genitourinary system, pyelonephritis, dental diseases, tonsillitis and other problems;
• treat in a timely manner isthmic-cervical failure;
• take measures to eliminate the risk of abortion. For this, the pregnant woman is prescribed conserving therapy.

In any case, if there is a suspicion of water leakage, you should immediately seek medical help.

The sooner you do this, the greater the chances of maintaining the pregnancy and the birth of a full-term baby.

Pregnancy is a joyful and exciting period for future parents, which is associated with many experiences and anxieties. The health of the baby directly depends on the conditions of its existence in the mother's womb. There it is surrounded by amniotic fluid, which is called amniotic fluid. They are playing important role in the development of the unborn baby, their complete discharge occurs during full-term pregnancy during childbirth. Leakage of amniotic fluid ahead of time is considered a pathology and requires medical attention.

Causes

Each stage of pregnancy has its own causes of pathology.

Up to 24 weeks, the provoking factors are:

• infection of the fetus;
• development of the inflammatory process.

Even a slight leakage of amniotic fluid before 25 weeks is considered the beginning of a miscarriage.

From 25 to 35 weeks, pathology is also dangerous. The most common cause of leakage during this period is urogenital infections (inflammation of the urinary tract).

At 39-40 weeks, the situation is not dangerous and doctors often choose expectant tactics and find a safe way of delivery.

The main causes of water leakage include:

• Injuries, falls.
• Careless (rough) sexual intercourse.
• Bad habits of the mother.
• Diabetes.
• Hormonal disbalance.
• Multiple pregnancy. Due to the excessive load on the body of a woman carrying 2 or more babies, the risk increases premature birth. With such a pregnancy, "steal syndrome" can occur.
• Rhesus conflict. If the blood type of the mother and child is incompatible, then the body of the pregnant woman is "cleansed", resulting in an outpouring.
• Inflammatory processes and infections in the cervix, vagina, fetal bladder.
• Pathologies of the cervix, anomalies of its structure, manipulations, diagnostic procedures (punctures and sampling of cells for analysis), fibroids. These reasons provoke the rupture of the fetal bladder.

Symptoms

The physiology of a woman is arranged in such a way that the amniotic waters are constantly updated and in the 3rd trimester of pregnancy, the discharge is more abundant, which is the norm. It is quite difficult to independently determine whether they are flowing and within the power of a specialized specialist leading a pregnancy. However, it is important for expectant mothers to be able to recognize the onset of premature discharge of fluid.

What should be of concern:

• The gasket gets wet quickly, you have to change it often (a lot of water flows out).
• After lying on your back for a long time (30-60 minutes), a wet spot forms on the fabric.
• When changing the position of the body, an outpouring of fluid (leakage) is felt.
• Water can move away during urination, incontinence.
• Sticky discharge smells fetid, unpleasant.
• If there is a significant rupture of the amniotic sac, fluid flows down the legs. Even strongly squeezing the intimate muscles, copious discharge don't stop.
• With ruptures lasting more than a day, a woman has a temperature increase of up to 38 degrees, chills, pain in the lower abdomen, which are aggravated by palpation. In the discharge, an admixture of pus, ichor may appear.

What they look like: external signs of discharge

To distinguish the leakage of amniotic fluid from urine, it is advisable to pay attention to their appearance.

Amniotic fluid is characterized by shades:

• Yellow color. There is no need to worry though, this is acceptable.
• Yellow with red veins. In 98%, this is a consequence of the fact that the uterus began to open, and the body is preparing for the birth process.
• Green. In this case, you need to sound the alarm. This color of the amniotic fluid is typical for intrauterine defecation or a small amount of amniotic fluid. In this case, the baby suffers from intrauterine starvation.

  A woman who notices such signs in herself should immediately consult a doctor in order to save the life and health of the child.

• Brown. Here we are talking about intrauterine death baby and saving a woman's life. Such cases are rare.
• Red. scarlet or pink color speaks of a serious danger to the life of the baby and mother. Caught in similar situation it is necessary to take a prone position, do not move until the ambulance arrives.

It is important to evaluate the smell of amniotic fluid. If it is fetid, sour, unpleasant, this indicates the presence of infection of the membranes.

The watery consistency of the discharge indicates various diseases or pathologies. Therefore, pregnant women who have such discharge should immediately consult a gynecologist for diagnosis.

How to determine

Only a doctor will reliably determine the likelihood of amniotic fluid discharge. For this, a set of diagnostic measures is carried out:

• Examination on a gynecological chair. A pregnant woman should cough, thereby increasing pressure on the intra-abdominal zone, which determines the pathology. If there is a rupture, a new portion of amniotic fluid will be thrown out.
• Study in mirrors. In most cases, when examining the mucous membrane of the vagina and cervix, the gynecologist manages to understand whether this is an outpouring or just a discharge.
• Uzifetus. The method can indicate the symptoms of oligohydramnios, but it is not always provoked by prolonged leakage of water. Many women after passing the ultrasound are interested in if the pharynx is closed, whether water can flow. The answer is yes, they can, because we are talking about the integrity of the bladder, while the neck is in any state.

Analyzes

Laboratory studies include:

• Vaginal swab. Microscopy shows characteristic symptom leaks: placed on a glass slide, the amniotic fluid dries up in the form of fern leaves. However, if there is sperm in the smear, the pattern will be the same.
• cytological method- taking a smear from the posterior fornix of the vagina, protrudes simple method diagnostics. As a result, cells of the skin, urinary and genital organs of the child are found, which reliably indicates the leakage of water.

Test

Pregnant women at home apply methods of what to do before a visit to the doctor and how to understand whether water is leaking or not. Tests that are sold freely available will help to find out and determine the pathology.

The tools are accompanied by instructions on how to use and what the result will show:

At home

To quickly determine the presence of pathology will allow a test carried out at home.

Pregnant woman empty completely bladder, then perform thorough hygiene procedures genitals, wipe the perineal area until it feels dry. Lie on the bed with a piece of cloth, preferably white, under you, check for wet spots after 25-30 minutes. If they are present, then it is likely that the amniotic fluid is leaking.

Management of pregnant women with leakage

After being discovered by a gynecologist in a pregnant woman prenatal leakage amniotic fluid, an appropriate management strategy is established. In many ways, it depends on the gestation period.

In the 1st trimester

The term is considered early: from the first day of the final menstruation to the 13th week. If at this time profuse bleeding occurs, then doctors prescribe medication or surgical interruption pregnancy.

When there is an opportunity to fight for healthy life the baby, to bring the fetus, the expectant mother is placed in the hospital "for preservation", which increases the likelihood of a positive outcome.

In civilized countries, this is done extremely rarely, since pregnancy up to 12 weeks is considered to be untenable.

In the 2nd trimester

From the 14th to the 27th week, everything is much more complicated: if the waters have broken, doctors equate this with the onset of a miscarriage. In the second trimester, the gynecologist makes a decision, based on the individual case of the patient, to maintain and carry out treatment against the background of regular monitoring of the condition of the fetus and the pregnant woman, or to stimulate a miscarriage followed by curettage. Women with multiple pregnancy a pessary is installed, an obstetric ring that allows you to save the baby and avoid premature birth.

In the 3rd trimester

From the 28th week immediately before the birth of a child, doctors use expectant and active tactics. In the third trimester, doctors resort to techniques to prevent leakage of amniotic fluid, which helps to grow the baby in utero. The patient is in a special sterile unit, taking a number of drugs, it is important to prevent infection. With detachment, inflammation, delivery can be immediate. Antibacterial therapy applied after the diagnosis of chorioamnionitis.

In all cases, the gynecologist makes a decision using individual approach to every pregnant woman to save her life and health.

What threatens: consequences

Amniotic fluid fills the fetal bladder, creating a comfortable and safe environment for the development of the baby throughout pregnancy. Thanks to this, the fetus can move freely and actively, without sudden shocks. Additional function fetal bladder - assistance provided to the cervix during childbirth, when internal pressure increases due to contractions. Eventually amniotic fluid V lower section bubble presses on the uterine neck, accelerating its disclosure.

What threatens water leakage:

• Prolapseamniotic sac. The diagnosis is difficult and requires medical attention. Isthmic-cervical insufficiency, when the bladder prolapses, creates high risk termination of pregnancy.
• Premature rupture- 4% increase in child mortality.
• Infection and respiratory distress syndrome. The lungs of a child stick together from the inside, not allowing air to circulate. These children need expensive treatment and artificial ventilation air.
• Infectious complications in mother and child. However, it is not always possible to save a child's life.

How long can a baby be without amniotic fluid

It is believed that 10-12 hours is the maximum allowable period, which can be an anhydrous period before childbirth.

In such cases, antibiotics are considered to avoid the development of intrauterine infection, while the woman should drink more fluids. If there are problems with the pressure of the mother and the heartbeat of the child, emergency delivery is indicated.

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

The outpouring of amniotic fluid (amniotic fluid) is one of the stages normal delivery. The rupture of the membranes of the fetal bladder occurs during contractions during the opening of the cervix. Leakage of amniotic fluid before 37 weeks of gestation can cause preterm labor and other complications. serious complications pregnancy.

Possible options for outflow of water

Leakage and outflow of amniotic fluid are distinguished by the time of occurrence. Normally, the fetal bladder opens at the term of full-term pregnancy (after 37 weeks) with partial or complete disclosure of the cervix. At this moment, women goes active labor activity. The uterus contracts regularly, the body prepares for the birth of the baby. Such an outpouring of water is called timely and does not pose a danger to the woman and the fetus.

A belated outflow of amniotic fluid is said if the membranes of the fetal bladder are torn in attempts, in the second stage of labor. Often, a baby is born in a whole fetal bladder ("in a shirt"). This phenomenon occurs with very dense fetal membranes and is also considered the norm.

Premature rupture of amniotic fluid is a condition in which the fetal bladder opens before the onset of labor. After 37 weeks, this phenomenon is not too dangerous. In this case, a spontaneous start of labor activity will occur within the next few hours. If necessary, the doctor can stimulate the onset of labor with medications.

A certain danger to a woman and her baby is the outpouring of water for up to 37 weeks. In this case, there is a high probability of starting labor ahead of time and the birth premature baby. Prolonged exposure of the baby to an anhydrous space can lead to infection and the development of serious complications.

What is amniotic fluid leakage?

With the complete outflow of amniotic fluid, a significant rupture of the fetal bladder occurs. Keep the pregnancy up due date in this case it is almost impossible. Water leakage looks a little different. In this situation, the fetal bladder does not burst completely, but only in one small area. Amniotic fluid comes out of the fetal bladder in small portions, drop by drop. The expectant mother may not even notice the leakage of water for the time being, attributing all the symptoms to increased natural secretions.

The most dangerous is the gradual leakage of water for up to 37 weeks. In this case, even a small defect in the fetal bladder can provoke infection of the fetus. In some cases intrauterine infection can lead to the death of the child. At term, the risk of infection is significantly reduced.

The value of amniotic fluid

Before talking about the problem and its possible consequences, you should figure out why amniotic fluid is needed.

The main functions of amniotic fluid:

• protecting the baby from infections;
• mechanical protection of the fetus and umbilical cord from any external influences;
• metabolism between mother and child;
• maintaining a constant pressure of the internal environment of the uterus;
• maintaining a constant temperature;
• creating favorable conditions for the existence of the fetus.

The composition of amniotic fluid changes throughout pregnancy. The study can detect various fractions of proteins, fats and carbohydrates, minerals and vitamins, oxygen and carbon dioxide. The amniotic fluid contains immunoglobulins that protect the baby from various infectious agents. And finally, particles of desquamated epithelium, vellus hair and elements of the original lubricant float freely in the amniotic fluid.

What happens if amniotic fluid breaks or starts to leak? The baby will lose its most important protective shell - a complete fetal bladder with amniotic fluid inside. Under such conditions, the child will not be able to exist long time. Further intrauterine development of the fetus will be a big question.

Causes

Leakage of water before the term of a full-term pregnancy can be triggered by such conditions:

• isthmic-cervical insufficiency;
• genital tract infections;
• trauma during pregnancy;
• polyhydramnios;
• multiple pregnancy;
• invasive interventions during pregnancy (amniocentesis, cordocentesis, chorionic biopsy).

Symptoms

To recognize a full-fledged rupture of amniotic fluid is not special work. In the III trimester of pregnancy, the volume of amniotic fluid is 1000-1500 ml. When most of the waters recede, it is simply impossible not to notice. In such a situation, you must immediately call an ambulance. Further tactics will depend on the duration of pregnancy and the condition of the fetus.

Leakage of amniotic fluid can go unnoticed for a long time. Outwardly, the waters are a clear, turbid or slightly yellowish liquid. Amniotic fluid has its own specific smell, but it can be quite difficult to recognize it. The smell is not too sharp and many women simply do not feel it.

The release of amniotic fluid, even with a slight rupture of the fetal bladder, occurs constantly. Drops of amniotic fluid remain on the lower and bed linen in the form of small round spots. When changing body position and physical activity the number of withdrawals increases. If the rupture of the bladder increases, the amniotic fluid begins to drain down the legs.

Water leakage or other problem?

Amniotic fluid leakage is often confused with symptoms of a urinary tract infection or urinary incontinence. Each of these states has its own distinctive features.

Vaginal discharge during infection:

• plentiful, thick, viscous;
• milky, yellow, green;
• have a characteristic unpleasant odor;
• accompanied by itching, burning and discomfort in the vagina.

Two simple methods are used to diagnose the cause of vaginal discharge:

• survey smear on flora;
• bacteriological culture.

If pathogenic bacteria are found in the vagina or on the cervix, specific therapy is performed. During pregnancy, priority is given to local antibacterial drugs in suppositories and gels. The course of therapy is 5-10 days. After treatment, vaginal discharge should decrease or disappear completely.

Discharge from urinary incontinence:

• liquid;
• yellowish;
• have a characteristic pungent odor;
• may be accompanied by burning and pain when urinating.

Urinary incontinence is a common problem in pregnant women. Sphincters of the bladder do not always cope with increased load which leads to intermittent urinary incontinence. The discharge is aggravated by coughing, sneezing, laughing, any physical activity. How longer term pregnancy, the more noticeable the problem becomes. If you suspect urinary incontinence, you should contact a urologist.

Water leaks:

• liquid;
• transparent, cloudy or slightly yellowish;
• have a slight specific odor;
• intensify with a change in body position;
• not accompanied by any discomfort in the vagina.

If you suspect water leakage, you should immediately consult a doctor.

Diagnostics

There are several ways to determine the leakage of amniotic fluid:

The diaper test

The easiest way to recognize dangerous pathology at home. Before testing, you must empty your bladder and take a shower. Take a shower after horizontal position by placing a clean and dry cotton diaper under the buttocks. The leakage of water is indicated by the gradual wetting of the diaper over the next two hours.

pharmacy test

A special test pad for determining amniotic fluid can be purchased at any pharmacy. This test makes it possible to distinguish amniotic fluid from normal vaginal discharge and urine. Read the instructions before using the test.

The study is based on the identification of certain ingredients in the amniotic fluid. These substances change the pH of the vaginal discharge. Normal vaginal secretion has a pH of 3.8-4.5. The test strip begins to react when it comes into contact with a medium with a higher pH (above 5.5).

The test is for single use only. Before use, make sure the packaging is intact. The test strip is attached directly to the underwear and remains there for up to 12 hours. If the pad becomes wet quickly, it must be removed from the underwear immediately.

It is necessary to evaluate the result in a well-lit place. When amniotic fluid leaks, spots of green or blue color. The spots may be various shapes, size and intensity. With normal vaginal discharge, the pad does not change color.

An important point: the appearance of blue or green spots is possible with some bacterial infections genital tract. If there is any change in the indicator of the test strip, you should consult a doctor.

Restrictions:

• it is not recommended to test less than 12 hours after sexual intercourse and the use of any vaginal suppositories;
• do not use the pad immediately after taking a shower;
• when itching, burning or other signs appear allergic reaction you need to remove the pad, change underwear and consult a doctor.

Cytological examination

Testing is done by a doctor. For research, discharge from the vagina is taken. The resulting material is applied to a glass slide and examined under a microscope. The detection of detached fetal skin cells and other specific elements in the smear indicates leakage of amniotic fluid.

Swab for arborization

The test is carried out in medical institution. For research, cervical mucus is taken and applied to a glass slide. After drying, the material is examined under a microscope. When amniotic fluid leaks, a pattern resembling fern leaves is clearly visible on the glass.

Amniotest

Testing consists in identifying a special substance - placental alpha-1-microglobulin in the vaginal secretion. The presence of this element clearly indicates the leakage of amniotic fluid. For research, a swab soaked in a special indicator is inserted into the woman's vagina. Next, the swab is lowered into a test tube with a solution. A test with an indicator is added to the same tube. When amniotic fluid leaks, a colored stripe appears on the test.

Complications

Leakage of amniotic fluid can lead to the start of labor at any time. How less term pregnancy, the harder premature baby will adapt to the new conditions of existence. It is far from always possible to suspend childbirth when water is poured out.

Rupture of the membranes of the fetal bladder and prolonged leakage of water can provoke infection of the fetus. In this case, the child is born with various developmental pathologies and lesions internal organs. Sudden fetal death from infection is possible at any stage of pregnancy.

What to do?

If amniotic fluid leakage is suspected future mom must be hospitalized. Further tactics will depend on the duration of pregnancy, the general condition of the woman and the fetus.

For a period after 37 weeks, with leakage of water, obstetricians stimulate labor. Prolonged stay of the baby in an anhydrous space can lead to infection. Wait in this case doesn't make sense. A baby born after 37 weeks is considered full-term and can exist outside the mother's womb.

At a gestational age of up to 37 weeks and there are no signs of infection of the fetus, expectant management is used. A therapy is prescribed aimed at maintaining pregnancy and reducing the tone of the uterus. Fetal lungs prepare for independent breathing with the help of hormonal drugs.

There is no specific treatment that can stop water leakage. To assess the condition of the baby, ultrasound, dopplerometry and CTG are regularly performed. With severe fetal suffering, early delivery is performed.