Leaking Amniotic Fluid

Amniotic fluid is the watery substance that surrounds the fetus growing within the uterus. The fluid prevents the walls of the uterus from closing in too tightly around the fetus, thereby allowing the baby to move relatively freely without any hindrance. It also offers the needed buoyancy to the growing fetus.

The production of amniotic fluid commences about 2 weeks post fertilization. Over the course of the next ten weeks, it fills up with varied amounts of proteins, phospholipids, carbohydrates, lipids, urea, and electrolytes which nourish the growing baby. In the later stages, it may consist of fetal urine as well.

Normally, leaking amniotic fluid is regarded as one of the main symptoms of imminent delivery or labor. In case it occurs due to abnormal causes, then it may signal the presence of an underlying condition which poses risk to the health and life of the baby and/or the mother. Such instances require immediate medical care.

Signs of leaking amniotic fluid

• It is quite difficult to determine a case of leaking amniotic fluid.
• The body experiences elevated levels of pressure exerted by the fetus during the final trimester of pregnancy. This can result in some discharge to ooze out from the cervix.
• The additional pressure on the bladder by the growing uterus may also cause the expectant mother to leak urine.
• However, unlike urine and other discharges, amniotic fluid is typically colorless and does not have any odor. Also, if there is significant amount of leaking amniotic fluid, then the undergarments tend to get soaked. Once the shedding commences, there is continuous leaking of the fluid.
• Expectant women may use sanitary pads/napkins to verify if the leaking fluid is urine or amniotic fluid. Tampons should never be used during pregnancy. If the fluid collected on the pad is green or yellowish-brown in color, then immediate medical attention is required.

Causes  

Some of the common causes of leaking amniotic fluid are listed below:

• The most common cause of leaking amniotic fluid is SROM or spontaneous rupture of membranes. It occurs at the end of pregnancy due to the rupture of the membranes that hold the amniotic fluid. The fluid may either leak or rush out in a gush. The scenario is commonly referred to as ‘water breaking.’ It is an indication that the expectant woman will soon go into labor and childbirth.
• Another cause of leaking amniotic fluid is PROM. When the membranes surrounding the amniotic fluid rupture before the full term of pregnancy is complete, then it is referred to as PROM or premature rupture of membrane. It generally occurs between the 37^th and 38^thweeks of pregnancy.
  • The most common cause of PROM is the formation of a tear in the amniotic sac. Such a tear may develop due to a defect in the growth of the amniotic sac, or in the shape of the cervix or the uterus. It may also occur due to some kind of bacterial infection.
  • As per the severity of the amniotic sac tear, affected women may experience leaking amniotic fluid in the form of a slow trickle or as a sudden outflow of liquids. It is vital to immediately visit a doctor to diagnose the cause of the tear and seek relevant treatment.
  • Sometimes, the membrane of the amniotic sac may develop a minor tiny split which can then result in leaking amniotic fluid. Such a tear/split tends to heal by itself over the course of some time, thereby causing the leakage to eventually stop.
    • It may be noted that leaking amniotic fluid, however minor, can cause difficulties and complications during the growth process of the fetus. This can trigger the spread of bacterial infection from the vagina to the cervix and uterus and finally to the developing fetus. Hence, all cases of leaking amniotic fluid need to be checked by a doctor.

Treatment of leaking amniotic fluid

Doctors will first check if the leaking fluid is indeed amniotic fluid before starting out on a treatment plan.

A minor tear of the amniotic sac usually does not required any medical treatment, as it heals on its own, other than monitoring for development of any complications. A major, large tear however requires urgent medical attention and management therapies to prevent the occurrence of any pregnancy complications.

Treatment for leaking amniotic fluid is usually dependent on the stage of pregnancy. If the mother has not reached full term, then the doctors will opt for close monitoring as well as medical therapies, as listed below, if necessary. On the other hand, doctors may go for delivery if it is nearly full term.

• Hydramnios: Also called polyhydramios, the condition is marked by excess levels of amniotic fluid in the sac enclosing the fetus, leading to over-distension and preterm labor, i.e., early rupture of the sac.
  • It can trigger umbilical cord prolapse causing it to constrict and fall into the cervix, or early placenta detachment from the wall of the uterus, thereby endangering the uterus.
  • Hydramnios is usually associated with the presence of defects in the fetus.
  • Treatment involves constant monitoring of the health of the mother and the baby and reducing the production of amniotic fluid with medications and amnio-reduction, a medical procedure involving the insertion of a needle into the amniotic sac to remove the excess fluid.
  • Oligohydramnios: It is a condition characterized by reduced levels of amniotic fluid in the sac. It can adversely affect the growth of the fetus and cause pulmonary hypoplasia, i.e., stunted growth of the lungs; aspiration of the thick meconium leading to difficulties in the first bowel movement of the baby; and constriction of the umbilical cord during delivery. Treatment involves close monitoring of the levels of amniotic fluid. If it falls below the safe mark, then doctors will supplement the naturally occurring levels of fluid via:
    • Injection of fluids before birth through amniocentesis. In this, the fluids may become low once again a week after the procedure.
    • Amnio-infusion using an intrauterine catheter. It is performed at the time of labor. The extra fluid offers some padding space near the umbilical cord during delivery, thereby reducing the need for a C-section birth.
    • Rehydration, via oral and intravenous administration of fluids. This helps increase the overall amounts of amniotic fluid.