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Leaking Amniotic Fluid: Signs, Causes And Treatment

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Leaking Amniotic Fluid: Signs, Causes, And Treatment

The amniotic fluid is a clear yellowish fluid that contains nutrients, immune cells, hormones, and fetal urine. It plays a vital role during pregnancy and is known to surround and protect the fetus from injury, help the fetus move and grow, aid in the development of organs such as the kidneys, gastrointestinal tract, and lungs. It also prevents umbilical cord compression and infection in the amniotic sac. The fetus starts to swallow and excrete amniotic fluid around 20 weeks of gestation.

Some women may experience leakage of fluid during pregnancy, which could be amniotic fluid, urine, or vaginal discharge. In this MomJunction post, we tell you about amniotic fluid leakage, how to differentiate amniotic fluid leak from other fluid discharges, 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 (1).

Amniotic fluid levels during your pregnancy can be (2):

  • 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 (3):

  • 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.

 [Read: Water Break During Pregnancy]

Causes Of Premature Rupture Of Membranes

Usually, the premature rupture of membranes is unexpected. And it is not easy to figure out the cause. If the 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 (4):

  • 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 (5). If the fluid leaks before term, it could lead to the risks below (6):

  • 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  (7):

  • 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 (8):

  • 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 (9).
  • 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 (10).
  • Admission to a hospital for observation and transfer to a hospital where there are good neonatal intensive care facilities just in case the baby arrives early.

[Read: Low Amniotic Fluid: Can The Levels Be Increased?]

Does Leaking Amniotic Fluid Mean Miscarriage?

Leaking amniotic fluid is not one of the common reasons for a miscarriage. However, if it occurs in the second trimester and is accompanied by other symptoms such as abdominal pain, then it could be a sign of miscarriage. Nevertheless, you should get it checked by the doctor before concluding anything.

Can Amniotic Fluid Replenish Itself?

In a few cases, the amniotic sac may reseal itself and prevent leakage of the fluid. The fetus will continue to produce amniotic fluid even if there is a leak, but it may not be enough if there is a heavy leak (11). However, more studies are required to understand the resealing of the sac and replenishing of amniotic fluid after a leak.

Do you have any experiences to share with us? Do tell us about them in the comments section.

References:

1. Megan Lord and Martha Kole; Amniotic Fluid Index (AFI)
2. L. Fischer; Amniotic Fluid: Physiology and Assessment; The Global Library of Women’s Medicine (2008)
3. Prelabour rupture of membranes; The Mother and Child Health and Education Trust; World Health Organization; 2019
4. Shailja Dayal and Peter L. Hong; Premature Rupture Of Membranes
5. Overview of Labor; Stanford Children’s Health
6. Preterm Premature Rupture of Membranes (PPROM); University of Rochester Medical Center
7. Rupture of the Membranes; Michigan Medicine
8. Preterm Premature Rupture of Membranes: Diagnosis and Management; The American Academy of Family Physicians
9. Preterm (Premature) Labor and Birth; The American College of Obstetricians and Gynecologists
10. Use of magnesium sulfate for fetal protection from neurological complications; World Health Organization
11. R. Devlieger, et al.; Fetal membrane healing after spontaneous and iatrogenic membrane rupture: A review of current evidence

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