How to understand that amniotic fluid leaks? The main symptoms and signs

It’s normal to be aware of any physical changes during pregnancy, particularly as the due date draws near. Leakage of amniotic fluid is one of the important things to be aware of. It’s critical for both your health and the health of the unborn child to recognize the warning signs of a leak in the fluid that envelops and shields them in the womb.

It can be difficult to distinguish between a minor amniotic fluid leak and more common conditions like discharge or urine. There are a few distinct symptoms, though, that can assist you in determining the cause. Knowing about these early on can have a significant impact on how soon you seek medical assistance.

This article will guide you through the primary symptoms and indicators of amniotic fluid leakage, assisting you in determining when action is necessary and the best course of action.

Symptom	Description
Unusual wetness	A constant feeling of wetness in your underwear that doesn"t stop, unlike normal discharge.
Clear or pale fluid	The fluid is typically clear, pale, and watery, unlike thicker vaginal discharge.
No odor	Amniotic fluid usually has no strong smell, unlike urine, which has a distinct odor.
Continuous leaking	The fluid keeps leaking, unlike a sudden, one-time release of urine.

Definition

The leakage of amniotic fluid is called partial outflow of amniotic fluid due to a high rupture of the fetal membranes or the formation of microscopic cracks in them. This pathology is distinguished by a gradual decrease in the amount of fluid surrounding the fruit that feeds and protects it from negative external influences. Pouring occurs at a time, in full or almost complete, and this phenomenon cannot remain an unnoticed woman. It is always accompanied by a rupture of the shells. Leakage to determine much more difficult, since the loss of fluid can be minimal. Water surround the baby throughout pregnancy. They nourish it because they are rich in proteins, enzymes, hormones, glucose and lipids, protect it due to the content of antibodies. The baby swallows water and pees it, taking an active part in the production of liquid. The waters are produced by the amniotic membrane and are renewed every three hours to keep the environment inside the amniotic sac sterile. The waters act as a shock absorber — they soften shocks, and also as a sound absorber — they reduce external noise. Thanks to the waters, a constant and optimal temperature for the growth and development of the baby is maintained inside the amniotic sac — 37 degrees.

The fetal membranes are hermetic. This protects the baby from the penetration of viruses, fungi and bacteria from the outside. Normally, they become thinner and rupture already during labor — at the peak of contractions before the end of the first labor period. The discharge of waters at any other time is considered a complication of labor. However, a number of factors can lead to an incomplete lateral high rupture or cracks in the membranes, which will cause a constant release of amniotic fluid in small quantities. This condition is very dangerous, but in some cases, doctors manage to successfully maintain the pregnancy until the term at which the child will not be in any danger at birth. It"s a matter of time.

The sooner a woman discovers that her water is leaking and the sooner an unbiased diagnosis is made, the better the mother’s and child’s health will be preserved.

Medical statistics indicate that about 5% of pregnant women experience water leakage. In 10% of cases, this pathology is the reason for perinatal death. It is not always possible to detect leakage in a timely manner due to a lack of sufficient and highly accurate diagnostics, which tenfold increases the risk of infections, premature birth, and premature baby birth.

Causes of violation of the integrity of the fetal membranes

• Infection — ​​the strength of the fetal membranes decreases if a woman has infectious and inflammatory processes. Most often, pathology is caused by the presence of endometritis, colpitis, inflammation of the cervical canal, as well as inflammation of the appendages. The likelihood of a rupture increases significantly if a woman has inflammation of the fetal membranes themselves – chorioamnionitis.
• Disorders of the uterus and placenta — pathology often occurs with a bicornuate uterus, with isthmic-cervical insufficiency, when the cervix does not provide reliable closure of the uterine cavity. Ruptures of the fetal bladder can be a consequence of small placental abruptions in the early stages.
• External influences — careless and, most importantly, repeated gynecological bimanual examinations, especially in the late stages of pregnancy, can cause thinning of the fetal membranes. Also, women are not recommended to frequently do ultrasound with an intravaginal sensor, and not at all because ultrasound can affect the fetus, but because the vaginal examination procedure itself increases the likelihood of damage to the integrity of the membranes. The cause of rupture and leakage of amniotic fluid may be hidden in previously performed invasive diagnostic procedures – amniocentesis, chorionic villus biopsy.
• Fetal reasons — 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 their premature thinning and increased vulnerability. A rupture can be caused by hydrocele of the fetal brain, its abnormal location in the uterine cavity, for example, with a transverse or oblique presentation.
• Violation of the condition of the membranes themselves — overstretching of the fetal membranes can occur with polyhydramnios, which is caused by a violation of the production of water by the amnion. Sometimes pathology is caused by premature aging of the membranes and their degeneration.
• Injuries received by a woman — this mainly includes blunt abdominal trauma, which a woman can receive from a fall, a blow to the stomach. A penetrating abdominal wound can also cause subsequent leakage of water.

It is thought that women who have experienced this in past pregnancies are more likely to experience amniotic fluid leakage; the likelihood of a recurrence is higher than 30%.

In addition, women with inflammatory diseases of the genital tract and scars on their uterus and cervix are at an increased risk of experiencing the issue.

Pregnant women with severe anemia and smokers who are determined to continue their bad habit after pregnancy are more likely to experience water leakage.

Because the area of the rupture is smaller and the injury site is close to the uterine wall, which lowers the rate and volume of water discharge, the water leaks out gradually when it bursts. These tears don’t go away on their own, and the weakened seal makes the fetus more vulnerable to external infections. Placental abruption may result from a prolonged leak caused by the water’s enzymes. If this occurs early, it usually results in a miscarriage; if it occurs at the end of the second or early third trimester, it often results in a premature birth.

Classification and types

The main factor that helps doctors determine what to do next is time—the moment the water first appears. The types of leaks are rather arbitrary.

• Premature – occurs before 37 weeks, when the child is considered premature by all obstetric and pediatric standards.
• Antenatal – occurs from 37 weeks, when the child is full-term and in general can already be born, he is ready for this.
• Early lateral – occurs already during childbirth, but still with a closed cervix or with an open one, but up to 4 centimeters.

Water leaks that occur between 39 and 40 weeks of pregnancy are referred to as antenatal leaks, and they are less dangerous than leaks that occur before 37 weeks.

Symptoms and signs

When the waters suddenly burst, there’s a lot of it and it’s easy to tell them apart from vaginal discharge because a lot of clear or hazy fluid comes out and isn’t connected to urination. However, gradual leakage is more difficult to identify. Additionally, a lot of people might not even notice the increase in liquid discharge in the perineum, particularly in the later stages when it’s practically normal to experience urine incontinence when laughing or coughing.

Since there are no nerve endings in the fetal membranes, there won’t be any pain if the amniotic sac ruptures or forms a microscopic crack. Nor are there any other odd sensations linked to this condition.

When leaking, the size of the abdomen, which changes visually if water leaks out completely or in a sizable volume, usually stays the same and the tummy appears normal.

Because water leaks in different volumes, some women may notice a change in the perineum almost immediately, while others may take some time to figure out whether the moisture is actually urine or water that was released involuntarily as a result of the expectant mother’s uterus exerting significant pressure on her bladder.

If the woman lies down for a while while at rest, she will release more vaginal liquid during leakage. This serves as the foundation for a simple at-home test that allows you to determine whether or not there is a leak in general. The "diaper" or "dry diaper method" is the name given to this technique. You must first insert a clean diaper into the perineum and spend some time lying quietly on your back. You should get medical assistance right away if a wet spot appears on the diaper after the woman has reverted to her original vertical posture.

Crucial! If the woman has only microcracks and a low outflow rate, the diaper method might not be very helpful.

The amount of discharge typically increases slightly during physical activity, abdominal tension, when shifting one’s posture in space, when yawning, and when coughing or sneezing. Again, leaky waters are often mistaken for urine because they typically smell, appear colorless, or have a faint yellowish tint.

First signs of infection may manifest if the rupture of the membrane happened more than a day ago. Determining whether the infection affected the uterus, the fetus, or the membranes is extremely challenging in this situation. However, a woman is not needed to perform such accuracy in home diagnostics; this is the responsibility of specialists. A woman experiencing chills, a rise in body temperature, and lower abdominal pain are all signs of infection. Discharge can vary in type; in addition to being generally watery, it may contain blood or pus-filled impurities.

What is the danger?

The risk of amniotic fluid leakage is contingent upon the pathology’s duration. The longer a woman is unable to comprehend what is exactly happening to her, the more likely it is that the results will be disastrous.

Research has indicated that a pregnant woman with a history of amniotic fluid leakage has a nearly 15-fold increased risk of stillbirth, a 4-fold increase in mortality, and a 3-fold increase in the risk of neonatal complications and illnesses for the unborn child.

These are extremely high risks, and they become more likely the longer the pathology goes undiagnosed.

A child born too soon runs the risk of developing respiratory failure because their developing lungs won’t be mature enough to support their own breathing after birth. Because of this, a lot of kids pass away despite prompt resuscitation.

A woman may develop an infection, amniotic inflammation, and necrotic alterations in her uterus if she does not receive medical attention within 12 hours or a day following the rupture. Intrauterine infection carries a high risk of death, sepsis, severe brain hemorrhages, and disruption of all organs and systems in the baby.

Symptoms of oxygen starvation almost always arise with early disruption of the fetal sac’s integrity. Hypoxia can cause a fetus to suffer from a wide range of disorders; in extreme situations, it can even result in the baby’s death.

A newborn with retinopathy, or self-amputation of limbs, may have a perforated amniotic sac that allowed infections to enter. The condition poses a risk of placental abruption, which can occur at any time and is dangerous for women. Massive bleeding frequently happens in this situation, and the laboring woman may not survive.

Following amniotic fluid leakage, women typically experience weaker, more erratic labor contractions; labor weakness frequently manifests itself, and either an emergency cesarean section or stimulation is required. The postpartum phase typically faces difficulties as it progresses.

Determination methods

It can be challenging to determine for sure whether amniotic fluid is leaking, even for obstetricians with extensive training. This is a very complex obstetric diagnosis because most of the fast methods available to gynecologists are completely ineffective in this situation, and even the most advanced and accurate methods have the potential to yield false results.

• Gynecological examination — ​​if leakage is suspected, it is not recommended, since it increases the risk of faster penetration of infection to the fetus if there is a rupture. In addition, the information content is low and such a 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 whether it is sperm or water. Previously, specialists asked the pregnant woman to cough — in this case, the amount of fluid in the posterior fornix should 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 its transparency, but will not be able to detect cracks or tears in the fetal 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 non-specific, since when dried, sperm also produces exactly the same “fern” picture under a microscope.
• Tests for determining amniotic fluid. There are home test pads and more complex systems, and there are amniotests that are done in a maternity hospital or antenatal clinic. The simplest are based on determining changes in the acidity of the vaginal environment – it becomes more alkaline due to mixing with amniotic fluid. More complex and accurate tests are based on determining special proteins that are present only in amniotic fluid – microglobulin-1 and placental growth factor. Tests that are based on determining microglobulin are the most accurate – their effectiveness is higher than 97%. The rest are less accurate. Simple test pads are considered the most frequently mistaken.

As you can see, no single technique could provide a 100% accurate response to the question of whether or not there is a leak.

Thus, a lot relies on the doctor’s qualifications and experience. Even with the most accurate test, you should not rely on accuracy at home because a positive or negative result does not rule out pathology.

Making early contact with a physician is crucial, as they possess a deeper understanding of the pathological condition and its manifestation. Pregnancy can be continued until the point at which giving birth won’t endanger the unborn child if the membrane crack is tiny, the waters are successfully replaced during the leak, and there is no infection.

What to do if a woman suspects leakage?

It is very important to diagnose leakage independently at home within the first 12 hours. After this time, the accuracy of all existing amniotests decreases even more, and the likelihood of infection increases. If a simple diaper test, which you can do yourself by placing a clean, dry diaper in the perineum, gives a positive result, you should immediately call an ambulance, telling the dispatcher the color of the outgoing water, if there is any — the smell and the presence or absence of impurities. This is very important, because if the waters are green or red, or if there is blood leakage, they will not send a regular team to your call, but a resuscitation team, since a change in the color of the amniotic fluid may indicate a serious condition of the fetus.

It is worthwhile to use self-diagnosis tests if the diaper is dry, there are no wet spots on the underwear, and there is a possibility of leakage.

Simple test pads like Frautest Amnio and AL-sense can measure the acidity of vaginal discharge. These pads have a unique matrix. The pad must be fastened to the underwear, and after a few hours, you must determine if the test strip on the pad has turned yellow or greenish. The typical acidic vaginal environment has changed to an alkaline state when the color changes, and the waters are most likely entering it.

Be ready to receive misleading results; bacterial vaginal infections, such as vaginosis, can cause a change in color on the pad. Douching, having sex, and using vaginal candles are not advised.

It is preferable to conduct a test that measures the presence of microglobullin-1 in the genital tract rather than its acidity in order to obtain more accurate results. These days, pharmacies only offer one such test: the Amnisure Rom Test, also known as "amnishur." This set comes with a test strip, a sterile swab, and a solvent container. Following the guidelines in the instructions, the swab is inserted into the vagina for a minute.

After an additional 15 minutes in a solvent-filled container, it is expected to display one or two stripes on a test strip inserted into the container after ten minutes. According to one strip, there is no leakage and the fetal shells are intact. A pair of red stripes indicates a higher than 97% accuracy rate in the presence of leakage. However, it is not advised to take this test at home. A doctor can conduct this study more accurately, so it is best to consult with him.

The Amnisure test is thought to be the most accurate since it cannot be manipulated by the presence of sperm or urine in the genital tract. Another option is the AmnioQuick system, which functions in an identical manner but measures insulin-like placental growth factor in the discharge rather than microglobulin-1. The likelihood of error is higher and the test is less sensitive.

It is crucial to understand that a woman should refrain from bathing, having sex, or sticking fingers or other foreign objects into her vagina if leakage is suspected. The risk of infection is raised by all of this. No matter how the home test turns out, you should consult a doctor right away because there can be equally serious risks and complications from both early discharge and later leakage.

The unusual wetness in your underwear that doesn’t smell like urine and feels more like a steady trickle than a gush is indicative of amniotic fluid leakage. It’s critical to monitor the color, quantity, and any changes in sensation, such as a sudden fluid release after coughing or moving. To rule out any risks to you or your unborn child, it is best to speak with your healthcare provider if you suspect amniotic fluid leakage.

What do doctors do?

Doctors decide what to do when a woman begins to leak. First, consideration is given to the fetus’s condition and gestational age. Doctors typically choose to wait if a woman is admitted to the hospital without experiencing contractions because it is too early for the baby to be born. However, there are a number of steps being taken to save the mother and child, not just passive waiting.

It is usually not maintained and advised to end the pregnancy if leakage starts before 22 weeks because carrying the baby to term will be extremely difficult and there is an excessive risk of serious and potentially fatal complications for both the mother and the fetus.

After 22 weeks, the treatment strategy is altered.

After being admitted to a sterile ward, the woman is kept bedridden. Every two hours, sterile pads are changed for her, and antibiotics may be administered to rule out any possible infection risks. Nobody can predict how long a pregnancy will be able to last because it all depends on the health of the fetus and its future mother.

Instead of continuing the pregnancy, they choose to deliver the baby early if the mother exhibits chorioamnionitis, an inflammation of the fetal membranes, the child is hypoxic, or the placenta abruptly ruptures. It is advised that others give medications to hasten the development of the fetal lung tissue and antispasmodics to help ease uterine muscle tension and extend the pregnancy.

Doctors can take a wait-and-see approach or take proactive measures if the baby is ready for delivery if a woman starts leaking after 34 to 36 weeks of pregnancy. In order to accomplish this, they perform an analysis in less than a day, determine every risk, and only then decide. The baby is full-term if the period is already longer than 37 weeks; there is no need to continue the pregnancy. In the event that contractions do not start on their own, doctors induce labor.

In any event, they determine the color and amount of water that is vanishing. When evaluating the risks to newborns, this is crucial.

It’s crucial to follow your gut if you’re ever unsure whether you may be leaking amniotic fluid. Any unusual wetness should be closely monitored, especially if it’s clear and odorless as this could be a serious indicator. Never be afraid to keep an eye on the regularity and consistency of the leaks and contrast them with typical vaginal discharge.

Although it can be difficult to tell the difference between amniotic fluid and other forms of discharge, keep in mind that early detection is vital for both your health and the safety of your unborn child. It’s best to get in touch with your healthcare provider as soon as possible if you observe any of the symptoms mentioned, such as sudden gushes or a steady trickle of fluid.

Your physician will make sure everything is on schedule and walk you through the next steps. Never wait to take action if something seems off; it’s always better to err on the side of caution. You can act quickly and stay informed about your body during pregnancy if you are aware of these signs.

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