The fetus is surrounded by and cushioned in a clear, yellowish fluid in the womb known as amniotic fluid. Some women may experience amniotic fluid leakage during pregnancy, too much of which may be harmful.
The amniotic fluid comprises hormones, immune cells, nutrients, and urine produced by the fetus. The fetus starts swallowing and excreting this protective fluid at around 20 weeks. The amniotic fluid helps fetal movement and growth. In addition, it serves to prevent infections and injuries to the fetus, support organ development (e.g., kidneys, intestines, and lungs), and protect the umbilical cord from compressing.
Keep reading this post to learn more about amniotic fluid leakage, how to differentiate it from the leakage of other fluids such as urine or vaginal discharge, and what to do in such cases.
Normal Levels Of Amniotic Fluid
The normal levels of amniotic fluid vary according to the gestational age. The amniotic fluid is visible after 12 days of conception, reaching the highest volume at the 36th week of gestation and declines near to birth. Your doctor will measure the amount of amniotic fluid through ultrasound during your prenatal visits. A normal amniotic fluid index is between 5cm and 25cm .
Amniotic fluid levels during your pregnancy can be
60ml at 12 weeks of gestation
175ml at weeks of gestation
Around 400-1200ml between 34 and 38 weeks of gestation
The fluid level declines by around 125ml a week at 38 weeks of gestation and comes down to around 800ml by the 40th week.
Leakage could result in too little of the amniotic fluid in the sac, which could be problematic. Hence, it is important that you detect a possible amniotic fluid leak and seek medical help.
Signs And Symptoms Of Amniotic Fluid Leak
Amniotic fluid comes out in a gush when the membrane ruptures. This is also known as a water break, and it usually happens when you go into labor. If there is a small hole in the amniotic sac, it may lead to a slow fluid leak, which feels like the trickle of fluid down to the vagina. Women may find it difficult to determine between amniotic fluid, urine, or vaginal discharge.
The following qualities may help you distinguish amniotic fluid –
Clear or colorless
It can be with mucus or blood
No odor
Unlikely to stop leaking
Soaks pad or underwear often
It may not be amniotic fluid if there is:
Odor
Light- or pale-yellow color
Thick mucus or look milky
Urine and vaginal discharge have a peculiar odor and color. You may use a pad or panty liner to check these aspects. Another way to know this is to try holding your pelvic floor muscles for a few seconds. If it is urine, the leakage will stop. If it doesn’t stop, it is probably an amniotic fluid leak. These home tests to confirm amniotic fluid may not be useful for all women. It is advised to get medical help if you are not sure it is not amniotic fluid.
Causes Of Premature Rupture Of Membranes
Usually, the premature rupture of membranes is unexpected. And it is not easy to figure out the cause. water breaks early, i.e., before the start of labor, it is called premature rupture of membranes (PROM). And if it occurs before 37 weeks, it is called preterm premature rupture of membranes (PPROM). Causes of PROM include:
- Smoking
- Recreational drug use
- Alcohol use
- Uterine infection
- Accidental trauma
- Polyhydramnios or too much of amniotic fluid in the sac
- Oligohydramnios or too little amniotic fluid in the sac
- Overstretching of amniotic sac and uterus
- Improper prenatal care
- Cervical surgery or short cervical length
- Amniocentesis
- Previous preterm birth
- Sexually transmitted infections
- Less than six months after previous labor
- Twin or multiple pregnancies
- Second and third trimester vaginal bleeding
- Nutritional deficiencies and underweight
- Connective tissue disorders
Usually, the amniotic sac ruptures or water breaks during or at the beginning of labor after 37 weeks of pregnancy. The leakage of amniotic fluids before 37 weeks is, however, associated with certain risks.
What Happens When Amniotic Fluid Leaks?
Many women go into labor in about 24 hours of the rupture of membrane or leakage of amniotic fluid at term. If it doesn’t begin in 24 hours, labor is induced to prevent any complications . fluid leaks before term, it could lead to the risks below:
- Infections (both mother and baby)
- Placenta separating from the uterus
- Umbilical cord problems
- C-section delivery
An amniotic fluid leak in the first and second trimester may be associated with an increased risk for birth defects, miscarriage, stillbirth, or preterm labor, whereas in the third trimester, it may cause difficulties in delivery.
When To Call The Doctor?
When you find that the leaking fluid from your vagina is not discharge or urine, but is amniotic fluid, got to the doctor. You should also call the doctor immediately :
- When you find the fluid is green-tinged or brownish-yellow or has a foul smell
- When you have vaginal bleeding
- When you have a fever or flu-like symptoms such as feeling hot and shivery
- When your heart rate has increased
- If there is abdominal pain or contractions
- If you are uncertain and concerned
The doctor will diagnose your condition based on your gestation age and will also give you an internal examination before going ahead with the treatment. An amniotic fluid leak is diagnosed by a speculum examination, followed by a pH test and microscopic examination of fluid.
While you are waiting for the doctor, try to stay calm and do not insert anything, such as a tampon or cloth, into the vagina to stop the leakage. Just notice how much fluid has leaked and what the color of the fluid is to let the doctor know.
How Is Amniotic Fluid Leakage Or PROM Treated?
The treatment plan differs from one woman to another, as it is based on the gestational age, cause of fluid leakage, and maternal and fetal health status. If it occurs at term, it is managed with delivery, unless there is an indication to wait for spontaneous labor.
If fluid leaks or PROM occurs before term, after observation of maternal health and fetal monitoring, the next steps could be.
If it occurs between 24 to 34 weeks of gestation, Antenatal corticosteroids are given to speed up the maturity of the fetal lung.
Prescription of antibiotics to prevent infection
Tocolytic medicines to prevent preterm labor, if it benefits
Delivery is recommended to manage PROM unless there are benefits from delaying it without any risks .
Magnesium sulfate is given to protect the fetus from neurological complications such as cerebral palsy if delivery is expected within 24 hours before 32 weeks of gestation.
Admission to a hospital for observation and transfer to a hospital where there are good neonatal intensive care .
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