What Is Amniotic Fluid?
Amniotic fluid is present inside the sac of the womb of a pregnant woman's belly. It provides a warm, fluid cushion that protects and supports the baby inside as they grow in the womb. The amniotic fluid contains immune system cells, hormones, nutrients, and the baby's urine. The highest level of amniotic fluid is around 36 weeks of gestation during pregnancy. After 36 weeks of pregnancy, amniotic fluid levels start to decrease as a woman's body prepares for the birth of the baby. The doctor will perform ultrasounds before delivery to estimate the amount of amniotic fluid the baby is surrounded by. However, in some cases, it is also possible that the amniotic fluid may start to leak under certain circumstances.
When Does Amniotic Fluid Leakage Occur?
Amniotic fluid leakage can occur because of the rupture of the amniotic membrane, which leads to the leaking of amniotic fluid out of the uterus. This results in a deficiency of amniotic fluid inside the womb, which is also known as oligohydramnios. The rupture of the amniotic membrane is the most common reason. Preterm premature rupture of membranes accounts for greater than 37 % of all oligohydramnios cases occurring during the second and third trimesters. In rare cases, chronic amniotic fluid leakage may happen as a complication of genetic amniocentesis (prenatal genetic test done by removing a small amount of amniotic fluid).
How to Check for Amniotic Fluid Leakage?
During the last months of pregnancy, many women have issues with the leaking of urine. This makes it very difficult for women to identify the leakage as amniotic fluid leakage may seem like leakage of urine. However, some minor differences can be used to differentiate both.
Amniotic fluid is usually clear, white-flecked, and may be tinged with mucus or blood. It has no odor, and it often saturates underwear. Whereas urine typically has an odor and is also yellowish. A woman can either check on light-colored underwear or can also use the panty liner for an hour or so and observe the leakage on a white panty liner. This provides a woman clearer idea of the type of the vaginal leakage.
What Are the Risks of Amniotic Fluid Leakage?
Leakage of amniotic fluid can be risky for the woman and the baby at any point during the pregnancy. While a woman naturally leaks a small amount of amniotic fluid, losing too much can be harmful.
1. Leakage of Amniotic Fluid During the First or Second Trimester: It can cause serious complications, such as:
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The most common complication can be fetal lung complications. Amniotic fluid is vital for normal anatomic development of the lungs of the baby. Thus, infants with low levels of amniotic fluid may have severely hypoplastic (underdeveloped) lungs and typically will die of respiratory insufficiency.
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Fetal skeletal deformity.
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Premature birth.
2. During the Third Trimester: Resultant low levels of amniotic fluid during the third trimester can cause the following issues;
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Difficulties during the labor process include squeezing the umbilical cord, which can affect the oxygen supply of the baby inside the womb.
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Increased risk for cesarean delivery.
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Retarded growth.
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Fetal heart rate decelerations during labor.
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Nonreactive fetal tracings during labor.
What to Do When the Amniotic Fluid Leaks?
In case of leaking amniotic fluid, prompt medical intervention should be taken.
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Confirming the leak is the first thing to do. There will be a continuous trickle of fluid from the vagina, which could be pink (if a tinge of blood is present) or colorless.
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Contact the doctor and notify them about the problem and follow the further instructions.
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Monitor the fetal movements.
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Refrain from inserting tampons or douches.
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Stay hydrated and rest.
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Be vigilant of signs of infection like fever, chills, foul smelling vaginal discharge.
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If the healthcare provider confirms the leakage, then prepare for labor.
When to See the Doctor?
If a woman suspects any leakage of liquor other than urine, then consulting the doctor is necessary to rule out chronic leakage of amniotic fluid.
How Is Leakage of Amniotic Fluid Diagnosed?
1. History and Physical Examination: The gynecologist will take a detailed history of the condition and perform a physical examination for ruptured membranes, that is pH test, the nitrazine test, and the rupture of fetal membranes test.
2. Ultrasound: After that, the doctor will perform an ultrasound. During the ultrasound examination, there are two methods for examining amniotic fluid as below:
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The doctor will assess the uterus into four quadrants to carefully assess the amniotic fluid index. This way, the doctor will examine each quadrant systematically. A normal amniotic fluid index is 5cm (centimeter) to 25 cm using the standard method of assessment. Less than 5 cm indicates oligohydramnios.
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The doctor may also use alternative methods to measure the amniotic fluid volume. In this approach, the doctor examines the entire uterus and identifies and measures the single deepest vertical pocket of amniotic fluid. A normal single deepest vertical pocket is 2 cm to 8 cm in size, while in the case of oligohydramnios, this level drops to less than 2 cm.
3. Nonstress Tests: The doctor will perform non-stress tests at least once per week till the birth of the baby.
How Is Amniotic Fluid Leakage Managed?
Prenatal management of leakage of amniotic fluid includes measuring maximum vertical pocket dimensions and nonstress tests weekly, which have been demonstrated to decrease the incidents of unexplained fetal death. Moreover, the gynecologist will perform a serial assessment of fetal growth. In addition, maternal hydration status also plays a critical role in the management of chronic amniotic fluid leakage.
In case of acute amniotic fluid leakage such as after amniocentesis, the doctor will advise the hospitalization of affected women for strict bed rest and efficient management. In such acute cases, cessation of fluid leakage and reaccumulation of normal levels of amniotic fluid occurs within a week.
During labor, if there is a low level of amniotic fluid due to leakage, the doctor will administer one to two liters of oral or intravenous fluids. This will transiently increase amniotic fluid volume and decrease cord compression during labor.
Conclusion:
Leakage of amniotic fluid at any stage of the pregnancy can cause serious harm to the baby and the mother. Thus, routine prenatal care throughout the pregnancy is essential. Regular prenatal care allows doctors to recognize and diagnose complications, including oligohydramnios. The gynecologist can then formulate a follow-up plan to lower the risk of fetal and maternal complications that may arise due to low levels of amniotic fluid. The care plans may include management of the pregnancy before the delivery, the timing of delivery, and also postpartum care.
