How to tell if amniotic fluid is leaking. How to detect water leakage during pregnancy. How infections damage the amniotic sac

08.18.2017 / Category: / Mari no comments

Water is important for all life on Earth. Amniotic fluid is also vital for the baby in the womb. The more complex and perfect the process, the more severe the consequences of deviations from the norm. It turns out that the number of pregnancies accompanied by such complications is growing every year. Questions remain open for mothers:

• how to see or how to determine leakage of amniotic fluid?
• how to behave correctly?
• Is it possible to prevent complications and save the baby?

How not to miss symptoms

POPV refers to the leakage of amniotic fluid as a result of damage to the membranes. In a standard situation, the rupture of amniotic fluid occurs before childbirth. Until this point, the liquid provides:

• metabolism between the fetus and the maternal body;
• sterility of the environment for the growth and development of the fetus;
• protection from shock, noise, compression by uterine muscles;
• cushioning sudden movements when mom moves.

For a normal pregnancy, the volume of amniotic fluid should be 1.5-2 liters. The fluid level is monitored using ultrasound. Pregnant women often encounter the concept of oligohydramnios - a lack of amniotic fluid. Its cause can be both the physiological characteristics of the mother’s body and microcracks in the membrane around the child. When neglected, leakage provokes premature birth, and early stages- miscarriages. For a child, complications of this kind are fraught with oxygen starvation. A baby can go without liquid for 12 hours to a day.

Important! Amniotic fluid leakage can occur at any stage of pregnancy.

There is a classification of ruptures according to the timing and location of the damage.

By location:

• cervical rupture - the membrane is damaged in the cervical area, resulting in a significant amount of fluid being lost;
• high lateral or upper tear of the bubble - liquid comes out in small portions, drop by drop.

Heavy discharge and urinary incontinence are common in later stages. This makes the diagnosis of pathology much more difficult.

Exceptional attentiveness makes it possible to recognize leakage of amniotic fluid. First calls:

• the nature of the discharge has changed: frequent, abundant, watery with less mucus;
• sudden movements, coughing, even hiccups and laughter are accompanied by discharge;
• due to the loss of some volume of water, the tummy decreases in size and may drop slightly;
• After emptying the bladder, fluid from the vagina continues to be released.

Even minor signs should not be ignored. The sooner measures are taken, the easier the mother and child will endure the consequences of POPV.

Common Causes

The leakage of amniotic fluid in the first stages goes unnoticed by the pregnant woman, since the doses are very small. A few drops can easily be confused with the usual discharge during pregnancy. The reasons for leakage lie both in deviations during pregnancy and in the structural features of the mother’s body, and the state of health at the planning stage.

Experts include the following main provoking factors:

• bacterial infections and inflammatory processes;
• “female” inflammation;
• incorrect position of the baby;
• narrow pelvis expectant mother;
• abnormal structure of the uterus;
• cervical insufficiency;
• placental abruption;
• amnicentesis, chorionic villus biopsy;
• pregnancy with two or more children;
• tears as a result of a fall.

Important! Alcohol and drug abuse and smoking automatically classify a pregnant woman as a risk group.

How infections damage the amniotic sac

Infections are the most insidious phenomena, since they can harm the body of mother and child unnoticed. Hormonal changes, a large load on the body, and general weakness create a favorable climate for harmful bacteria that are present in a woman’s body in small quantities and previously did not pose a danger. Even vaginal dysbiosis can lead to serious consequences.

Chronic diseases and forgotten “women’s” problems remind us of themselves with renewed vigor.

According to statistics, 10% of women whose childbirth ended with premature effusion of amniotic fluid are diagnosed with various inflammations of the respiratory or gastrointestinal tract. Inflammation of the genital organs leads to similar complications in 25% of cases. The danger of this situation is that bacteria penetrate inside through holes in the shell, bypassing all protective mechanisms.

Important! Even a slight suspicion should serve as a guide to action. There are several ways to determine leakage of amniotic fluid at home, as well as by laboratory methods.

When to be more careful

Erosion or other diseases of the cervix, abortions and operations in this area lead to damage to the amniotic sac in 50% of cases. Anomalies in the structure of the cervix are also dangerous. Insufficiency of the cervix, when the walls do not close, leads to protrusion of the bladder. Minor physical exertion is enough to damage the bladder.

Incorrect positioning of the fetus creates additional stress on the membranes. In late pregnancy, when the belly drops and the baby is inserted into the birth canal, a contact belt is formed around the baby's head. Thus, the amniotic fluid is divided into anterior and posterior waters. This mechanism allows you to distribute the load on the walls of the shell. When the fetus is positioned across or head up, all the liquid rushes down, pressing on the lower wall with double force and the risk of damage to the shell increases.

For the same reasons, a functionally narrow pelvis of the expectant mother can lead to bladder rupture. The head cannot be inserted into the birth canal, since it is larger in diameter and the entire volume of liquid ends up in the lower part of the bladder.

Perinatal diagnosis is aimed at identifying malformations, chromosomal disorders, hereditary diseases and, in rare cases, can cause leakage of fluid from the amniotic sac. Chorionic villus biopsy is performed at 11-13 weeks by cutting off a fragment of the placenta. Amniocentesis is the examination of amniotic fluid.

Material for analysis is collected using a puncture. A long needle is inserted into the uterus by piercing the abdomen in a place that is safe for the fetus. The optimal period is the second trimester. If necessary, amniocentesis is also performed in the third trimester. After such tests, a course of anti-inflammatory therapy is prescribed and the condition of the expectant mother is carefully monitored.

Important! The presence of the above features during pregnancy should not throw expectant mothers into panic. The information above only emphasizes the importance of paying close attention to your condition.

Diagnostics

Determination of leakage can be carried out both in laboratory conditions and independently.

If indicated, smears are taken from the pregnant woman and examined for the presence of amniotic fluid proteins.

There is another method that is not highly accurate, but is used quite often. The so-called fern symptom. The smear is applied to a glass slide, and after drying, the result is assessed visually. The mucus crystallizes when it dries. If the smear contains amniotic fluid, a pattern resembling fern leaves is formed. An admixture of urine or semen in a smear can have a similar effect.

The amniotest is characterized by absolute accuracy, high price, painful procedure and the risk of causing additional problems: infection, bleeding. Using a long needle, a special dye is injected into the amniotic fluid. The dye is not dangerous for the baby, since the amniotic fluid is completely renewed every 2-3 hours, which means that the dye is removed from the mother’s body. 30 minutes after the procedure, a tampon is placed in the patient’s vagina. Staining of the tampon indicates the presence of holes in the membrane. For every 300 such manipulations there is 1 case of severe complications.

If the ultrasound results are below normal, doctors must confirm or refute the leakage of amniotic fluid with additional studies, since the damage to the membrane itself is not visible on the monitor.

A very dubious diagnostic method that is also practiced is examination by a gynecologist. The expectant mother is asked to cough. At this time, the doctor carefully observes whether liquid appears.

Time-tested diagnostics

Laboratory tests and examinations are an inconvenient, often long and grueling way to detect leakage of amniotic fluid. They knew how to determine shell damage on their own long before the advent of modern tests.

For a home test, a clean cotton cloth is sufficient; you can use a white sheet. A woman should wash herself thoroughly and dry herself. You need to lie down on a sheet without underwear. You should relax as much as possible. After 20 minutes you need to evaluate the result. If the tissue is wet, then there is a reason for more accurate analyzes.

According to another method, white fabric folded several times and “worn” for 1.5-2 hours like a pad. You need to lie down and change your body position several times: lie for 10 minutes on your right side, then on your left and on your back. Carefully stand up and sit down, bend slightly to both sides. Movements are performed carefully without much enthusiasm. Afterwards the lining fabric is inspected. Amniotic fluid leakage appears as a wet spot when the fluid is completely absorbed into the tissue. When dry, the edges of the stain will be uneven with a brownish tint. If there is little discharge and they are not absorbed, but remain on the surface in the form of mucus, everything is fine.

Modern tests: pad test

The pad test is a simple and popular way to check for the presence of amniotic fluid in the discharge. Relatively affordable.

It works due to the fact that the acid-base balance in the human body is different. And the pH of the vagina is acidic and is 3.8-4.5. Acidity inhibits the development of “unfriendly” bacteria and helps maintain women’s health.

Amniotic water is the habitat of a new organism, rich in nutrients and biologically active components. The color of amniotic fluid in the initial stages of pregnancy is yellowish, then it becomes more transparent, similar to ordinary water. Towards the end of pregnancy it becomes cloudy. A greenish or brown color indicates infections. The pH of amniotic fluid is 6.98-7.23.

Thus, if leakage occurs, the acidity of the vagina will decrease and the pH value will correspondingly increase. The gasket is equipped with an indicator that turns turquoise upon contact with a neutral environment - pH 5.5 and above.

Important! During the test, it is important that no moisture gets on the gasket. Hands and crotch must be completely dry.

The test pad can be worn for 12 hours or until the woman feels moisture. Then the pad is removed from the underwear, the test strip is removed and placed in a special case (included in the kit). If after 30 minutes the strip has not changed color, everything is fine.

The disadvantage is that the acidity of the vagina can decrease for other reasons. The most common is thrush or other infections. Which also during pregnancy requires quick and adequate treatment. In any case, thanks to the test, a woman can promptly identify this or that problem.

Amniotic fluid protein test

Science does not stand still. Developed and more accurate tests. The marker in this case is placental α1microglobulin. The protein is found in large quantities in amniotic fluid and is absent in the vagina, urine and blood. Thus, the test accurately detects water leakage.

In addition to high accuracy, there are a number of other advantages:

• does not require special skills or tools;
• carried out in a home environment;
• quick results;
• the packaging contains everything you need.

The procedure is simple. Before starting the test, you must remove the container with the special solution from the package and shake it so that the contents sink to the bottom.

The kit includes a sterile swab. With its help, you need to take a sample of vaginal discharge. The tampon is inserted inside no more than 5-7 cm. It is recommended to keep the tampon in the vagina for about 1 minute.

Important! The tampon should not come into contact with other liquids or substances other than vaginal discharge. Hands must be dry.

The resulting sample is placed in a test tube with the solution for one minute. During the entire time it is necessary to stir the solution with a swab.

The swab is removed from the test tube. The box also contains a sealed test strip that resembles a rapid pregnancy test. Further actions are the same: lower the strip into the test tube with the reagent with the end indicated by the arrows to the level indicated by the line.

The result will not take long to arrive. Within 30 seconds, if the amniotic sac is damaged, two stripes will appear. One stripe - all is well. To be sure of this, you should wait 10 minutes. A small amount of amniotic fluid will appear later, and one line may be paler. The test accuracy with two strips is 100%. The error of a negative result is 1%. In other words, in exceptional cases the test may not detect the protein:

1. if the outpouring of water occurred 12 hours before the test;
2. amniotic fluid enters the vagina in very small doses.

The price of the test for leakage of amniotic fluid is the only drawback. But when it comes to the well-being of mother and baby, the financial part fades into the background.

What to do next?

POPV is not treatable. Violation of the integrity of the membranes around the baby before the 22nd week of pregnancy often leads to fetal death or miscarriage. In such cases, doctors recommend termination of pregnancy.

If there is leakage at 36 weeks or more, the pregnancy is not maintained. Often within 12 hours the birth process begins. Depending on the case, labor induction is prescribed or C-section.

From 22 to 36 weeks, doctors take a “wait and see” approach. The woman is immediately admitted to a hospital under round-the-clock supervision. Using ultrasound, the amount of remaining water, heartbeat and general state baby.

Pregnancy is maintained as long as possible to give the baby more time. Special drug therapy is prescribed. Drugs are administered that accelerate the development and maturation of the lungs and other systems. In such situations, labor can begin at any time. If the condition of the child or mother worsens, the pregnancy is no longer maintained. Afterwards, the baby is placed in a special box - an incubator. Next comes treatment. The child will stay in the incubator until he gains the required weight and gets stronger.

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Amniotic fluid leakage is less common in the first trimester. If this happens, the amniotic fluid mixes with the blood. Leakage of amniotic fluid before 22 weeks also means the onset of a late miscarriage, and the pregnancy cannot be maintained.

The later it happens, the more favorable the prognosis for the woman and the fetus. After 37 weeks, the appearance of water in the discharge means the beginning labor activity and is acceptable. The most dangerous and ambiguous period according to the prognosis for the fetus is from 22 to 28 weeks.

The main reasons for water leakage: infections, polyhydramnios, Rh conflict, multiple pregnancies, cervical pathology, after amniocentesis (taking amniotic fluid for analysis), pathology of the uterine structure, fibroids, fetal malformations (defects or abnormalities incompatible with life), injuries, diabetes mellitus. It can occur both after physical activity or stormy intimate relationships, and even during sleep.

Symptoms In most cases, a woman notices abundant clear or whitish discharge, which intensifies and literally “flows down her legs.” Their color can also be yellowish, greenish, mixed with blood. Minor discharge from the genital tract is possible.

This is observed with high rupture of the membranes or with oligohydramnios. In this case, water can be confused with vaginal discharge, or vice versa. An unpleasant putrid or purulent smell of discharge indicates the suffering of the fetus.

Contractions or at least aching pain in the lower abdomen may also begin. The main symptoms are an increase in liquid discharge from the genital tract at any time; it appears periodically or leaks constantly.

Dangerous complications: the risk of infectious lesions, uteroplacental blood flow is disrupted, which can cause hypoxia and fetal suffering, and premature birth.

Premature rupture of amniotic fluid is also dangerous during full-term pregnancy, especially if the fetal presentation is not cephalic, but pelvic, transverse or oblique. In this case, along with the water, loops of the umbilical cord, arms or legs of the fetus may fall out, which threatens the life of the child.

Diagnosis of the condition includes: examination, vaginal smear, amniotest (vaginal pH, normally it should be acidic, but when water leaks, the pH shifts to an alkaline environment), fetal ultrasound. Additionally, monitoring may be prescribed in a hospital setting (monitoring the discharge on a pad - a sterile diaper, which must be used instead of pads).

Up to 22 weeks obstetrician-gynecologist tactics is clear – the pregnancy is terminated. After this period, various options are possible: prolongation of pregnancy (if the pregnancy is up to 34 weeks, tocolytic therapy is carried out aimed at relieving the tone of the uterus), stimulation of contractions when the pregnancy is closer to 37 weeks and later, emergency caesarean section - performed when water leaks after 22 weeks with signs of fetal suffering, presence of uterine bleeding.

Prevention: timely treatment of sexually transmitted infections; strengthening the immune system and limiting contact with sick people; timely detection and correction of ICI, Rh conflict, polyhydramnios; A pregnant woman should protect herself from injury and physical exertion.

Read more in our article about water leakage during pregnancy, its dangers and the actions of a gynecologist.

Amniotic fluid leakage is less common in the first trimester. If this happens, then the amniotic fluid, which at this time is still produced in small quantities, mixes with the blood and it is not possible to separate it separately.

Leakage of amniotic fluid before 22 weeks also means the onset of a late miscarriage, and the pregnancy cannot be maintained. The release of amniotic fluid after 22 weeks is a harbinger of premature or urgent (after 37 weeks) birth.

It is not always possible to determine the cause of premature rupture of amniotic fluid (PIOV) before the onset of labor. The main factors are:

• Infections. In 90% of cases it is the cause of PIOV. Both recent sexually transmitted infections and diseases such as rubella, cytomegalovirus, and herpes (part of the TORCH infection complex) play a role. Inflammation of the membranes occurs (if pathogens are localized in the vagina) or intrauterine infection of the fetus (if pathogens circulate in the blood), which leads to premature rupture of water and termination of pregnancy.
• Polyhydramnios. An increased amount of amniotic fluid compared to the norm at any time creates additional pressure on the cervix, which can lead to leakage of water. Therefore, it is important to promptly identify pathology and carry out treatment.
• Rhesus conflict. If the blood of the fetus and mother are incompatible with Rh antigens, the woman’s body tries to “get rid” of a foreign and dangerous agent. As a result, termination of pregnancy occurs, which may begin with leakage of water.
• Multiple pregnancy. The pressure of two babies on the cervix is ​​higher, which can cause the development of isthmic-cervical insufficiency (ICI). At the same time, the cervix “opens”, the fetal bladder prolapses into the cervical canal and vagina. Any load or simply a vertical position leads to rupture of the shells and leakage of water. It is important to promptly identify signs of ICI and provide the necessary treatment.

• Pathology of the cervix. Many diseases can lead to the formation of ICI. For example, previously suffered conization or high amputation of the cervix (removal of part), including for malignant diseases. As well as ruptures after childbirth and other injuries. In this case, the cervix does not perform its main function - closure, and the membranes freely descend into the vagina and rupture on their own.
• After amniocentesis. It is believed that the risk of water leakage after this procedure is minimal, but it exists. The first three days after manipulation are especially dangerous, during which a therapeutic and protective regimen is recommended.
• Anomaly in the structure of the uterus. Multiple fibroids, the presence of a septum in the cavity, developmental anomalies (for example, bicornuate, saddle-shaped) lead to an increase in the tone of the uterus as the period increases. This provokes termination of pregnancy, which often begins with the rupture of water.
• Fetal pathology. Multiple defects or fetal anomalies incompatible with life can also cause PIOV. In this case, nature independently “carries out natural selection” and terminates the doomed pregnancy.
• Injuries. Any physical impact, direct or indirect, on the abdominal area can also cause leakage of water, as well as bleeding.
• . Decompensated forms lead to changes in the metabolism of the woman and fetus. This is often accompanied by polyhydramnios.

Symptoms of the problem

Determining water leakage during pregnancy is not always easy. In most cases, a woman notices abundant clear or whitish discharge, which intensifies and literally “flows down her legs.” Their color can also be yellowish, greenish, mixed with blood - if the pregnancy has a complicated course.

In addition, slight discharge from the genital tract is possible. This is observed with high rupture of the membranes or with oligohydramnios. In this case, water can be confused with vaginal discharge or vice versa.

Amniotic fluid does not have a specific aroma. A slight sour smell is acceptable. Unpleasant putrefactive or purulent indicates the suffering of the fetus.

Along with leaking water, a woman may begin to experience at least aching pain in the lower abdomen. Sometimes it takes from several hours to a day or two before they begin. The rupture of amniotic fluid can occur both after physical activity or stormy intimate relationships, and against the background of general calm and well-being, for example, during a night's sleep.

The main symptoms of amniotic fluid leakage during pregnancy are as follows:

• an increase in liquid discharge from the genital tract at any time;
• They appear periodically or leak constantly.

Expert opinion

If in any doubt, you should consult a doctor, since premature rupture of amniotic fluid poses a threat to the mother and fetus. And only a specialist can figure out whether it is water or vaginal discharge, and sometimes just one examination is not enough - dynamic observation, ultrasound, and special tests are necessary.

What are the dangers of water leakage?

The discharge of amniotic fluid before 22 weeks is the first sign of miscarriage; the pregnancy cannot be maintained, and the embryo is not viable. The later the leakage of water occurs, the more favorable the prognosis for the woman and the fetus. After 37, the appearance of water in the discharge means the beginning of labor and is acceptable.

The most dangerous and ambiguous period according to the prognosis for the fetus is from 22 to 28 weeks. The fetus is not yet mature enough; there is a high risk of death, including intrauterine death, as well as in the first week or month after birth.

Water leakage is also dangerous due to the following complications:

• risk of infectious complications - in women with PIOV, chorioamnionitis (inflammation of the membranes and placenta), congenital pneumonia and other inflammatory complications in the newborn are more often recorded;
• uteroplacental blood flow is disrupted - the longer the fetus is exposed to water leakage, the higher the risk of developing hypoxia and suffering;
• risk - rupture of water leads to a decrease in the internal volume of the uterus and its contraction, which often turns into spontaneous labor, which cannot be stopped with modern drugs.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Premature rupture of amniotic fluid is also dangerous during full-term pregnancy, especially if the fetal presentation is not cephalic, but pelvic, transverse or oblique. In this case, along with the water, loops of the umbilical cord, arms or legs of the fetus may fall out, which threatens the life of the child. Therefore, it is important to seek medical help as quickly as possible, even if you suspect a water leak.

Diagnosis of the expectant mother

To confirm the fact of leakage of near-midday waters, the following studies are carried out:

• Inspection. During a vaginal examination, the doctor notes the opening and softening of the cervix. When examined in the speculum, a clear liquid is visualized in the vagina, which leaks from the cervical canal. With a high rupture of the membranes, examination, as a rule, is not enough, since the discharge of water can be one-time and not abundant, and the cervix is ​​not structurally changed.
• Vaginal smear. Vaginal discharge is applied in a thin layer to a glass slide. When examined under magnification, in the presence of water, a “fern” symptom is determined - the dried liquid forms a pattern similar to the leaves of this plant.
• Amniotest. These are special tests that determine vaginal pH. Normally, it should be acidic, but when water leaks, the pH shifts to an alkaline environment.
• Ultrasound of the fetus. When water leaks, an ultrasound examination reveals it.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

To confirm water leakage, if the doctor has doubts, the woman is asked to monitor the discharge on a pad - a sterile diaper, which must be used instead of pads - in a hospital setting.

Table. How to distinguish water from other secretions

What will the doctor do in the third trimester?

If up to 22 weeks the obstetrician-gynecologist’s tactics are clear - termination of pregnancy is carried out, then after this period various options are possible. The following is possible:

• Prolongation of pregnancy. If the period is up to 34 weeks, tocolytic therapy is carried out aimed at relieving the tone of the uterus. At this time, it is necessary to prevent fetal respiratory distress syndrome with hormones in order to reduce the likelihood of lung dysfunction after birth.
• If a woman’s amniotic fluid stops leaking, and ultrasound shows a noticeable increase in its quantity and there is no fetal suffering or inflammatory changes in tests, it is possible to prolong pregnancy even for several weeks. One day of fetal life is equivalent to 7 days of being in intensive care, so it is important to carry the pregnancy to term as long as possible.

• Stimulation of contractions. When the pregnancy is closer to 37 weeks and later, provided that the cervix is ​​mature and ready for childbirth, it is possible to administer drugs (for example, oxytocin or prostaglandins) to initiate labor.
• Emergency caesarean section. Performed when water leaks after 22 weeks with signs of fetal suffering and uterine bleeding.

Preventing water leaks

The leakage of amniotic fluid is easier to prevent than to deal with the consequences. However, leakage of amniotic fluid in the first, second and third trimester of pregnancy cannot always be predicted. Prevention of this complication includes the following:

• timely treatment of sexually transmitted infections;
• strengthening the immune system and limiting contact with sick people;
• timely detection and correction of ICI, Rh conflict, polyhydramnios;
• A pregnant woman should protect herself from injury and physical exertion.

In most cases, water leakage can be avoided by regularly following all the doctor’s advice and recommendations. antenatal clinic. If you suspect PIOV, you should immediately seek medical help at any time.

Useful video

About the causes, symptoms, diagnosis and resolution of the situation with leakage of amniotic fluid, watch this video:

Hormonal changes that occur in the female body during pregnancy affect everything, including the nature of discharge from the genitals. From a school biology course, each of us knows that normally they should not have color or smell, however, it turns out that this is not all.

During pregnancy, they should remain just secretions, and not drops of leaking amniotic fluid. How to distinguish one from the other and how to understand that water is leaking during pregnancy? Let's talk about this.

Much has been said about the role amniotic fluid plays. This is a barrier, protection, and habitat for the baby, so their condition, or more precisely, the absence of signs of leakage, should be closely monitored. How long can they take to leak? Either way, and the leakage is not always significant or massive. Sometimes everything happens little by little.

It’s easiest in the later stages, especially just before delivery. There, the water often comes out quickly: the bubble bursts, and its contents are suddenly poured out. In total, about a glass of liquid comes out, so it is very difficult to confuse this process with something else.

In the early stages, everything is usually different: the leakage is so insignificant that it is sometimes not given any importance, because it mixes with natural secretions. The situation is aggravated by the fact that during pregnancy itself the amount of these secretions increases. That is, a woman seems to constantly feel moisture on her underwear, as a result of which she stops paying attention to it, but in vain. The condition is insidious and fraught with serious consequences.

How to check if there are water leaks? Ideally, this can only be done with the help of special tests and analyzes carried out in laboratory conditions. But there are also ways in which the presence of a problem can be suspected. Take a closer look at yourself. If you notice that when you change your body position, while sneezing or coughing, the amount of discharge increases slightly, it’s time to see a doctor.

You should also suspect something is wrong if you see a wet spot on the sheet after sleep. This happens in the second or third trimester, when the amount of amniotic fluid is quite large. By the way, if you feel leakage when coughing or sneezing, do not rush to panic. In women, especially after 30 years, muscles may weaken, resulting in minor urinary incontinence. There is little pleasure, but compared to the consequences that occur due to leakage of amniotic fluid, this is just a banal nuisance.

Finally, it is worth noting that a doctor can identify the problem during an appointment. Drops in the area of ​​the posterior vaginal vault will prompt him to think about bad things. If they are present, a smear is taken and further research is carried out within the walls of the laboratory.

How to tell if there is a water leak at home

Leakage is a problem in which, in some cases, even termination of pregnancy may be recommended. That is why you need to monitor your own health very carefully. How? To begin with, for the entire period of pregnancy it is better to refuse bright, seductive (should read: bikini, thong) underwear. Simply because no traces are visible on them.

Another thing is regular cotton white panties. How can you use them to determine if there is a problem? When leaking, there will always be a wet spot on them, which, of course, is slightly darker in color than the color of the linen itself.

If the period has passed the first trimester, the matter may be so serious that even a panty liner will not save you from excess moisture. Have you suspected this in yourself? You need to see a doctor immediately.

How else can you tell if there is a water leak? There are several ways:

• Ordinary, homely. This is the simplest option, in which you need to allocate 20 - 30 minutes of free time, empty your bladder, even if there is no particular urge to urinate, and then lie down on the bed, having previously laid out a white cotton sheet. If spots appear on it after 15–20 minutes, leakage cannot be ruled out.
• Homemade, but more accurate. The disadvantage of the first method is that water in such conditions can easily be confused with normal secretions. To verify your guesses, you need to take a pharmacy amnitest. Essentially, it is a set of pads or strips soaked in a special liquid and instructions for use.

How it works? It's simple: ideally, the expectant mother's environment is acidic, while the waters are neutral. Therefore, the test reacts to the presence of a neutral medium and indicates leakage if it turns green-blue. He, of course, does not react to urine or secretions.

Note! The presence of moisture on the sheet or confirmation on the test is not a death sentence, and here’s why. In the first case, a woman may experience an increase in the amount of vaginal discharge, which then produces a wet spot. True, you can try to distinguish them by character.

• The waters are usually clear and very similar to ordinary water (in consistency). Exceptions are cases when they have a pronounced or unpronounced yellowish, brownish tint. They indicate the presence of an infectious process and require immediate hospitalization.
• The discharge is thick, whitish or mucous. Again, there may be exceptions in the form of giving them other characteristic shades, but this should be reported to the doctor immediately, because the baby’s health is at risk.
• With urine, everything is clear: it is yellowish and has a specific smell.

Pharmacy tests can lie. This happens when, under the influence of certain conditions, the vaginal environment changes. For example, in the presence of infection, the acidic environment changes to alkaline or neutral.

In any case, the reliability of both methods is about 80%. They can be used, but there is no need to believe them unconditionally and, especially, to panic. It is better to simply contact a specialist and he will prescribe tests that can accurately obtain reliable results.

Why is water leakage dangerous?

Do you suspect you have a leak and are still wondering what to do? Call your gynecologist immediately. Do you know why? It turns out that premature leakage (up to 37 - 38 weeks before the onset of labor) is a direct threat to the health and life of the baby. And it’s easy to verify this by analyzing the functions of amniotic fluid.

Needless to say, the rupture of amniotic fluid jeopardizes all the functions performed by them, and with them the health of the baby.

Prevention and treatment

Before deciding on treatment tactics, the doctor finds out why the water is leaking. Moreover, there are many reasons. Among them:

• Infection. Under its influence, the cervix ripens faster, which means that enzymes are released that lead to placental separation and softening of the walls of the bladder. Need I say that during premature pregnancy the condition is dangerous due to the development of hypoxia during childbirth and the appearance of massive bleeding.
• Fetal presentation (or incorrect position), narrow pelvis. Leakage for this reason is usually detected in the first stage of labor. Is this bad? Ask a woman in labor, who, because of this, will have to “enjoy” the process longer in conditions of slow dilatation of the cervix, or even go for a CS.
• Cervical insufficiency. It is diagnosed in every fourth person and leads to protrusion of the bladder and its increased vulnerability. As a result, the shells can rupture at the slightest mechanical impact.
• Bad habits and chronic diseases in a pregnant woman (anemia, dystrophy).
• Multiple pregnancy, uterine development abnormalities (shortness, isthmic-cervical insufficiency, etc.).

During therapy, they try to remove the cause of the leakage, but first of all, they look at how much time has passed since the membranes ruptured, and do an ultrasound to find out the condition of the fetus.

At short notice, if the leakage is insignificant, most often they just wait. The woman is prescribed bed rest, and, if necessary, special medications to delay the onset of contractions and the birth itself. The goal is to survive the period of 35 - 36 weeks, after which the baby becomes viable and can breathe on its own.

At the same time, they may prescribe antiseptic treatment of mucous membranes to prevent infection. If the water has completely drained and the water-free period has not lasted longer than 6 hours, antibiotics are prescribed.

If there is leakage at 39–40 weeks, it is stimulated.

Amniotic fluid surrounds the baby in the womb, providing him with development, nutrition, and protection. If the pregnancy is without pathologies, the water breaks a few hours before birth. This is one of the signs of active labor. Leakage of water ahead of time is a threat to the health of mother and baby.

How to distinguish premature leakage of amniotic fluid from natural discharge? How much and how does amniotic fluid flow? What are the causes and negative consequences of the pathology? How can a woman find out on her own if amniotic fluid is leaking? Can this be determined at home? What to do to save the child?

What is amniotic fluid?

During the entire 9 months of gestation, the fetus resides in the uterine cavity. Its protective shell is a bladder filled with odorless and colorless amniotic substance. The liquid substance is 97% water. A special biological environment is secreted by the amnion, the inner layer of the bladder. In addition to water, the liquid includes the following nutrients: carbohydrates, proteins, enzymes, hormones, minerals, vitamins, oxygen, immunoglobulins, lipids, skin lubricant.

Amniotic fluid creates favorable conditions for fetal development. They provide it with nutrients and protect it from shock and injury. The shell is completely sealed and a constant temperature is maintained inside. What does amniotic fluid look like? This is a liquid transparent substance that is odorless.

Functions of a bladder filled with liquid nutrient medium:

• nutrition;
• protection from premature contact with the environment, germs and bacteria;
• shock absorption;
• maintaining a comfortable temperature;
• preventing compression of the umbilical cord, which ensures normal blood flow and oxygen supply;
• enlargement of the uterus to provide space for the growing fetus.

Amniotic fluid increases in volume as the fetus grows, reaching a maximum of one and a half liters by 36 weeks. The protective fluid barrier is not broken until the birth process begins.

Why can water leak in pregnant women?

The factors that provoked the early discharge of amniotic fluid are not always determined unambiguously. The doctor assesses the woman’s health status in a comprehensive manner. The effectiveness of treatment depends on how correctly the causes of the pathology are identified. Why do the walls of the amniotic sac rupture? The reasons are as follows:

• Inflammation, infections in the mother’s genitourinary system (colpitis, endocervicitis). The walls of the shell become thinner and lose elasticity. The cervix matures ahead of schedule, and sometimes the placenta exfoliates. This condition is dangerous due to uterine bleeding and lack of oxygen.
• Carrying more than one child.
• Isthmic-cervical insufficiency is a pathology in which the cervix does not close completely. She cannot withstand the increasing pressure, which provokes effusion.
• Blows to the stomach, physical activity.
• Polyhydramnios.
• Benign and cancerous formations of the reproductive system of a pregnant woman.
• Narrow maternal pelvis, abnormal fetal position. If carried out correctly, childbirth is not dangerous, but it can cause complications. There is no threat to the health of the mother and baby, since such a course occurs immediately before childbirth.
• The mother has a harmful addiction to alcohol, nicotine, and drugs.
• Inaccurate collection of material during invasive diagnostics: chorionic villus biopsy, puncture of the amniotic sac to collect water, amniocentesis.
• The development of infection in the amniotic sac (chorioamnionitis), which disrupts the structure of the bladder tissue.
• Diseases and congenital pathologies of the mother (anemia, anorexia, uterine septum, shortened cervix) (see also: how does pregnancy proceed if the cervix is ​​shortened?).

First signs and general symptoms

How do amniotic fluid leak? This happens in small quantities. It is often difficult to distinguish the secreted amnion from urine and female secretions. You can tell by the feeling of moisture in the perineum. Underwear has to be changed up to ten times a day - it is constantly wet. The use of sanitary pads helps the situation for a short time. With tension or physical effort, the leakage becomes stronger. This occurs when lifting weights, laughing, coughing, or sudden movements.

How can amniotic fluid leak when the cervix is ​​closed? This happens when the membranes rupture. Signs of leakage depend on the size of the damage. When a medium or large volume of fluid is released, the woman feels it flowing down her legs. The pads do not cope with the absorption function. There may be little leakage even with a large tear if sections of the shell are layered on top of each other at the point of damage.

The photo shows what amniotic fluid looks like. It is transparent, colorless. The discharge does not smell. The presence of a strong stench indicates an infection. This is dangerous for the life of the woman and baby. Traces of blood are a sign of placental abruption. Meconium is detected - the fetus lacks oxygen. Leaks can occur periodically, be regular, and be accompanied by contractions.

Diagnostic measures

If you suspect POV, you should consult a gynecologist as soon as possible. The further course of pregnancy and the birth of a healthy baby depend on this. How to recognize a leak? Testing methods available for use at home may initially confirm concerns. There are several methods based on the reaction of indicator strips. The leak test is based on the elevated pH of the leaking water. Only a specialist will be able to reliably distinguish whether amniotic fluid, urine or vaginal discharge is leaking.

In a hospital setting

A gynecologist examines a pregnant woman. The doctor asks the woman to move on the chair and cough. With POV, fluid will appear from the vagina. This is a primary diagnostic method with low efficiency. More reliable methods are a cytological smear of the posterior vaginal vault, amniotest, frautest.

A gynecological smear helps determine POV. When amniotic fluid dries on a glass slide, it forms a pattern of crystals. It resembles a fern leaf.

The amniotest has a high degree of reliability. The procedure involves intramuscular injection of dye into the abdominal area. A white tampon is placed in the vagina. If it changes color, it means POV. Such a test is not only expensive and painful, but also risky, so it is rarely used. In one case out of 200, puncture of the bladder leads to internal bleeding and infection. The most terrible consequence is termination of pregnancy.

A lack of amniotic fluid at a certain stage of pregnancy is sometimes detected during a routine ultrasound examination. This indirectly indicates a leak. In some cases, on the ultrasound monitor screen you can see damage to the membrane surrounding the fetus, their size and location. A small gap will be difficult to detect.

A laboratory test for leakage of amniotic fluid is based on the detection of specific proteins. A gynecological smear is taken with a sterile swab. It is placed in a test tube with the reagent. The laboratory technician evaluates the result, identifying premature rupture of the amnion.

Home Leak Tests

Pharmacological companies produce special tests with instructions. With their help, you can independently determine the POV. The test is attached to underwear like a regular pad. You need to wear it for 12 hours. The indicator embedded in the pad will react to the presence of amniotic fluid by changing color (we recommend reading: signs that pregnant women’s water is breaking). The normal pH of vaginal discharge is up to 5.5, and that of amniotic fluid is up to 7. The test for water leakage contains an indicator. Upon contact with amniotic fluid, it will become a bright green or blue color.

There are pads that can be removed after getting wet. They are placed in a special container for half an hour. When the indicator changes color to yellow-green, this means that liquids are leaking from the bubble.

What is the danger of leakage?

Rupture of the membrane and loss of amniotic fluid cause serious consequences. The most dangerous and common complications:

• rupture of the membrane protecting the fetus prematurely;
• infection;
• premature delivery, which is dangerous due to asphyxia, unpreparedness of the newborn’s lungs to function, and cerebral hemorrhage.

The severity of the consequences for mother and child depends on the period of gestation at which the leakage occurred. This factor also determines the possibility of further pregnancy.

In the early stages

Leakage, release of amniotic fluid before 20-22 weeks is considered early. In most cases, the baby’s life cannot be saved. The rupture of the membrane is accompanied by infection of the protective environment, which is not comparable to the vital activity of the fetus. If the amount of leakage is small, after a full examination, a conclusion is made that it is permissible to continue the pregnancy. A newborn may be born with a number of congenital pathologies: paralysis, blindness, lung problems, heart failure.

If the fetus or membrane is infected, further pregnancy is impossible. This causes inflammatory processes in the mother's reproductive system, which is dangerous for her life. To prevent possible complications, the uterine cavity is cleaned.

In the 2nd and 3rd trimesters

There are no medications that can be used to repair membrane rupture. If there is leakage after the second trimester, the pregnant woman is sent to the hospital under constant medical supervision. The lining of the bladder is examined using an ultrasound machine. No therapeutic measures are carried out. Doctors monitor the woman’s condition over time. Regular gynecological examinations are carried out.

A pregnant woman should be in a calm atmosphere. Bed rest and lack of physical activity are indicated. Leakage of amniotic fluid in the later stages (from 35 weeks) does not threaten the life of the child and the mother (see also: how long can a child remain in the womb without water if the amniotic fluid has drained?). The condition is met if the woman seeks medical help immediately after detecting signs of POV. When the water breaks out at 39-40 weeks, this means the beginning of labor.

What to do?

If you suspect water leakage during pregnancy, you should immediately do a test. The results should be reported to the gynecologist immediately. This is exactly the case when it is better to play it safe and raise a false alarm than to put the life of a child at risk. It is advisable that during pregnancy a woman always has a test pad on hand to detect leakage. If you feel moisture, you should use it immediately. If there is a bubble rupture, the clock counts. The task of doctors is to prevent the spread of infection and provide inpatient monitoring.

In the third trimester, labor is induced during POV. Previously, an ultrasound machine analyzes the degree of maturity of the fetal life support systems outside the mother’s womb. If the lungs are not ready to breathe on their own, efforts are directed toward prolonging pregnancy. To prevent the spread of infection, the woman is prescribed antibacterial drugs. Fetal blood flow and the presence of movements are assessed daily. The mother is prescribed bed rest. Body temperature is constantly monitored. Its increase may indicate the development of an infection.

When do you need to see a doctor urgently?

The release of water at any stage of gestation requires immediate contact with a gynecologist. If the pregnant woman’s well-being allows, on a weekday she should immediately go to the consultation where the woman is registered. On a weekend or when there is a significant amount of fluid being released, it would be a good idea to call an ambulance.

Doubts regarding the origin of the discharge can be checked using the dry diaper method. If after lying for half an hour a wet spot appears on the fabric, a visit to the doctor cannot be postponed. Dangerous symptoms are pain in the lower abdomen, chills, temperature 38 and above, discharge mixed with pus or blood.

Leakage of amniotic fluid or premature rupture of amniotic fluid (PIV or PIOV in different sources) is the rupture of the membranes and the rupture of amniotic fluid before the onset of regular labor with dilatation of the cervix up to 7 - 8 cm.

Normally, the discharge of amniotic fluid occurs spontaneously in the first stage of labor, when the cervix reaches 7–8 cm dilatation; during the next contraction, the woman notices a copious flow of fluid not associated with urination. After the water breaks, contractions usually intensify and the labor process accelerates.

Premature rupture of water can occur at any stage of pregnancy, as there are many factors that provoke this condition.

Predisposing factors for leakage of amniotic fluid:

1. Invasive diagnostic methods (amniocentesis)

Amniocentesis is a diagnostic method that involves puncturing the amniotic sac through the anterior abdominal wall under anesthesia and ultrasound guidance and collecting amniotic fluid for biochemical and chromosomal analysis.

In approximately 1% of cases, this procedure is complicated by termination of pregnancy, you will be warned about this in advance and the final decision is always made by the patient.

2. Untreated colpitis of various etiologies

Inflammation of the genital tract progresses without treatment; bacteria (most often a mixed infection) have an invasive ability and, with the help of their enzymes, dissolve the membranes. The connection between infection and premature rupture of amniotic fluid has been proven by many clinical studies; in about a third of cases, leakage of water is the main cause.

3. Intra-amniotic infection

Intra-amniotic infection acts in the same way (damages the membranes) only from the inside. Infection is introduced into the amniotic sac 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 amniotic sac and already develops massively inside).

4. Clinically narrow pelvis, abnormal fetal positions (oblique, transverse, pelvic), multiple pregnancy, polyhydramnios

Normally, the fetal head at full term is pressed against the bony ring of the entrance to the pelvis, and thereby divides the amniotic fluid into anterior (in front of the fetal head) and posterior (all others). In these conditions, the head of the fetus/the first fetus of twins/triplets is high and there is a lot of water in the lower pole of the amniotic sac, which mechanically puts pressure on the membranes and the risk of leakage of amniotic fluid increases significantly.

ICI is a shortening of the cervix and expansion of the internal uterine os that does not correspond to the gestational age (premature). 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 membranes(this is an obvious condition, which is accompanied by the rupture of anterior amniotic fluid)

1) Copious painless discharge of light (turbid/greenish/straw-colored, etc.) fluid not associated with urination

2) Decrease in the height of the uterine fundus (the outpouring of water reduces the intrauterine volume and the abdomen becomes smaller in size and denser)

3) The development of labor after the rupture of water (does not always occur; the rupture of amniotic fluid in the early stages, as a rule, does not provoke the immediate development of labor)

4) Changes in fetal movements (slowing down movements, as the volume of the uterus has decreased and its tone has increased)

II. High/lateral opening of membranes(this condition may go unnoticed, as it occurs with subtle symptoms and is extended over time)

1) An increase in vaginal discharge, which becomes thinner, waterier, soaks the underwear and does not stop. They also get worse when coughing and lying down (for the majority).

2) Nagging pain in the lower abdomen, bleeding (does not always happen)

3) Change in fetal movements

Complications of premature water leakage

- termination of pregnancy (most often we are talking about late miscarriage up to 22 weeks)

- premature birth. Premature birth occurs between 22 weeks and 36 weeks and 5 days and entails many complications for the mother and fetus, the severity of the condition depends on the stage of pregnancy.

Abnormalities of labor (weakness of labor, discoordination of labor, etc.)

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

Respiratory distress syndrome in a newborn (the surfactant in the baby’s lungs matures closer to 35 - 36 weeks, earlier rupture of water and childbirth entail inferior lung function)

Infectious and inflammatory complications in a newborn (inflammatory skin diseases, congenital pneumonia)

Intraventricular hemorrhages, cerebral (cerebral) ischemia in a child

Skeletal deformation and self-amputation of limbs in a child during a long anhydrous period (amniotic cords are formed that injure the fetus)

Chorioamnionitis (inflammation of the membranes during a long anhydrous period)

Postpartum endometritis. Endometritis (or metroendometritis) is an inflammation of the internal uterine wall, which most often develops in women with premature rupture of water, and the longer the anhydrous period (without antibiotic prophylaxis), the higher the risk of the disease. If chorioamnionitis develops during childbirth, then in the postpartum period there is an extremely high probability of developing endometritis.

Obstetric sepsis. Obstetric sepsis is the most serious infectious and inflammatory complication in the postpartum period with high mortality.

How to detect water leakage

1. How can you determine premature rupture of water at home?

If you notice vague, copious watery discharge, you should urinate, take a shower, wipe yourself dry (dry the perineum thoroughly) and place a clean, dry white pad (a 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 or a wet lining indicates possible leakage of amniotic fluid. In this case, you should pack a minimum of things for the maternity hospital and call an ambulance (or go to the emergency room of the maternity hospital yourself).

- if you suspect water leakage, but the discharge is not abundant, does not wet the laundry, does not have a special smell or color, then you can do it at home placental microglobulin test(PAMG – 1), at the moment it is produced only under one brand, Amnisure ROM Test (Amnishur).

This is a test - a system intended for independent use; all the necessary items indicated are included in the kit.

How to do a water leak test:

Place a tampon into the vagina to a depth of 5–7 cm for a period of one minute
Immerse the swab in the solvent tube for 1 minute and rinse well with a rotating motion.
Place the test strip in the tube for 15 - 20 seconds
Place the strip on a clean, dry surface and after 5 - 10 minutes you can evaluate the result
One strip – there is no leakage of water, two stripes – there is leakage of amniotic fluid
Test reliability 98.7%
Do not read the result if more than 15 minutes have passed

Test pads for leakage of amniotic fluid (Frautestamnio, Al-sense) are a pad with a reagent-impregnated area (indicator) or liner. The indicator contains a colorimetric indicator that changes color from yellow to blue-green when in contact with liquids with high pH. Normally, the pH in the vagina is 3.8-4.5, the pH of amniotic fluid is 6.5-7. The test pad changes color when it comes into contact with a liquid that has a pH level greater than 5.5.

The pad should be attached to the underwear as usual, with the yellow indicator facing the vagina. The pad is used for about half an hour, or until sufficiently moistened, it can be used for up to 12 hours, and then the color is assessed and compared with the color scale on the packaging. Blue-green color may indicate leakage of amniotic fluid. The indicator color remains stable for up to 48 hours. If after drying the color turns yellow again, this most likely means that there was a reaction with ammonia in the urine. But only a doctor will give you a final conclusion.

There are also gaskets on sale with a removable indicator liner (Al - Rekah), after using the gasket as described above, the liner is removed by pulling the protruding tip, placed in a bag and wait for the result for about 30 minutes. The color will also change to blue-green.

The gaskets are easy to use and accessible, but their information content is somewhat lower than the test systems.

A false positive result can be caused by:

Colpitis of any etiology
- bacterial vaginosis
- recent sexual intercourse
- douching

In all these cases, the pH of the vaginal secretion changes and a false positive result is possible.

2. Obstetric diagnosis of water leakage

Gynecological examination in speculum with cough test

When examined in the speculum, the cervix is ​​exposed, and the doctor asks the patient to cough; if the amniotic sac ruptures, the amniotic fluid will leak in portions with a cough impulse. Sometimes, when examined in the mirrors, a clear leakage of water is visible, the fluid 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 water breaks. The amniotest is a swab with a cotton tip soaked in a reagent, which must be placed in the posterior vaginal fornix and the color change assessed. However, a false positive result can be caused by the same factors as when using test pads.

Ultrasound (the ultrasound doctor measures the level of amniotic fluid, also known as the amniotic fluid index - AIF, and compares it with the data of the previous ultrasound; after the rupture of water, it decreases sharply).

Oligohydramnios (severe oligohydramnios) in combination with fluid leakage confirmed by gynecological examination confirms the diagnosis of PIV.

Treatment for leakage of amniotic fluid

Tactics for the expiration of amniotic fluid at different times.

Up to 22 weeks

Prolonging pregnancy is not advisable 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 the pregnancy is terminated for medical reasons.

22–24 weeks

Hospitalization of the patient to the pregnancy pathology department and explanation of the risks and consequences for the mother and fetus.

The prognosis for the fetus at this stage is still extremely unfavorable. Parents are warned that children born at this stage are unlikely to survive, and those that survive will not be healthy (the risk of cerebral palsy, blindness, deafness and other neurological disorders is high). If the patient categorically insists on prolonging pregnancy, despite these risks, antibiotic prophylaxis is carried out as indicated below.

25 – 32 weeks

Up to 34 weeks, in the absence of contraindications, expectant management is indicated, taking into account the duration of pregnancy. Waiting tactics in the period 25 – 32 weeks no more than 11 days.

32 – 34 weeks

Watchful waiting is indicated for no more than 7 days.

34 – 36 weeks

Waiting strategy is indicated for no more than 24 hours.

37 weeks or more

Expectant management is indicated for no more than 12 hours, then the beginning of labor induction is indicated. In this case, antibiotic prophylaxis begins after an 18-hour water-free period.

Contraindications to watchful waiting:

Chorioamnionitis
- preeclampsia/eclampsia
- premature abruption of a 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 selected on an individual basis.

Waiting tactics

1. Examination of the cervix in speculum, vaginal examination is carried out only upon admission, and is not carried out further

2. During the initial examination in the speculum - culture for flora and sensitivity to antibiotics

When the fact of ruptured water is established, immediate initiation of antibiotic prophylaxis for 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 when beta-hemolytic streptococcus is detected in microbiological cultures

Penicillin 1.5 g IM every 4 hours

3. Prophylaxis of respiratory distress syndrome (RDS) with dexamethasone (8 mg IM No. 3 under the supervision of a physician with monitoring of fetal movements and heartbeat), it should take about two days to obtain an effect. Dexamethasone is a glucocorticoid hormone that accelerates the maturation of surfactant in the baby's lungs. Prevention of SDR is carried out within 24–34 weeks.

4. Thermometry every 4 hours

5. Monitoring the fetal heart rate, discharge from the genital tract, and uterine contractions at least 2 times a day

6. Complete blood count upon admission and subsequently at least once every 2-3 days;

7. Ultrasound examination once every 7 days with determination of the amniotic fluid index and Doppler blood flow in the uterine arteries and umbilical cord artery

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. If there are uterine contractions with a frequency of more than 3-4 in 10 minutes - tocolysis (administration of drugs that relieve contractile activity of the uterus, the drug hexoprenaline is most often used, the dose and rate of administration is chosen by the attending physician)

10. If labor develops no less than 48-72 hours after the first injection of dexamethasone, tocolysis is not performed.

After the maximum waiting period has expired, a consultation of doctors is examined to select a method of delivery. Preparation of the cervix and labor induction or caesarean section are possible. Both methods have their advantages and risks, so in each case the issue is resolved strictly individually.

Pregnant women with HIV infection

1. For PIV after 32 weeks - immediate induction of labor.

2. For PIV up to 32 weeks, expectant management is indicated, aimed at preventing fetal SDR and chorioamnionitis (antibiotic prophylaxis, as indicated above).

3. Prevention of vertical transmission of the virus.

4. Labor induction is indicated 48 hours after the start of fetal SDR prophylaxis.

5. In case of premature rupture of amniotic fluid, cesarean section does not reduce the risk of transmission of the virus from mother to fetus.

Despite the simplicity and availability of home diagnostic methods, you should not neglect an emergency visit to your doctor if you suspect leakage of amniotic fluid. The earlier the diagnosis is made, the more favorable the result at any stage of pregnancy. We wish you a safe pregnancy and an easy full-term birth. Take care of yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.