Amniotic fluid leak is the most commonly faced problem by pregnant women. If not treated on time, could pose a serious threat to both mother and baby. Every year approximately 13 million premature babies are born worldwide out of which almost 11 million are born in Africa and Asia.
In 2005, WHO estimated that 12.9 million births, or 9.6 per cent of all births worldwide, were pre-term. An average of 10 per cent of births worldwide occur before 37 weeks gestation and an estimated 28 per cent of the 4 million annual neo-natal deaths are due to pre-term births. However, this rate ranges between 3.8 per cent for countries in central Asia and 17.5 per cent in southern Africa. In fact, amniotic fluid leak is one of the major causes of
pre-term delivery.
Amniotic fluid is the baby’s ‘life support system’ along with placenta and umbilical cord. It is the liquid that protects the baby and aids in the development of muscles, limbs, lungs and digestive system. This fluid is generated soon after the amniotic sac is formed i.e. about 12 days after conception. However, initially the fluid is made up of water provided by mother but post 20 weeks into pregnancy; it primarily forms into foetal urine.
Amniotic fluid not only facilitates the growing baby’s movement in the womb but also enables the baby to breathe and swallow the liquid in the second semester. Furthermore, amniotic fluid levels increases regularly until about 32-33 weeks gestation, and then they level off.
Complications of pregnancy
Complications of Pregnancy are health problems that occur during pregnancy, that could involve the mother’s health, the baby’s health, or both. One of the most commonly ignored problems among pregnant women
is amniotic leak.
The forewaters i.e. bag of water in front of baby’s head are released when the amnion ruptures. This is commonly known as the time when a woman’s
‘water breaks’. When this
occurs during labour at term, it is known as ‘spontaneous rupture of membranes’ (SROM).
If the rupture precedes labour at term, however, it is referred to as ‘premature rupture of membranes’ (PROM). The majority of the hindwaters i.e. bag of water around the body remain inside the womb until the baby is born.
Amniotic fluid leakages can cause severe complications and therefore it is imperative that the expectant mother receives medical guidance and the proper treatment. However, there are times, when the amniotic sac may develop a tear or may rupture causing the amniotic fluid to leak before term. When this occurs 37 - 38 weeks before term, it is referred to as ‘Preterm Premature Rupture of Membrane’ or PPROM.
When either of these cases occurs, the fluid either gushes or leaks out in a continuous trickle resembling a discharge. When premature rupture of the amniotic sac occurs, it is necessary to determine the cause of the leaking amniotic fluid.
However, if the leaking amniotic fluid is a result of a severe rupture of the membranes of the amniotic sac, then labour may begin within 48 hours. When this happens, the mother-to-be must receive treatment in order to avoid causing an infection to the foetus.
Detection and diagnostics
A general to identify amniotic fluid leak is to ask the mother-to-be to lie down for 30 minutes and once she sits up, there is a gush that occurs it may be the result of the broken water bag. There is no other way for a pregnant woman to detect amniotic fluid leak especially if it is a small one. Moreover in certain cases of pregnancy especially in the last trimester, a woman may have excessive vaginal discharge. This could be urine, the cervical mucus or a combination of both. Hence it is extremely imperative to ascertain the cause of the wetness and evade any confusion to be sure and safer. Thus, routine monitoring of amniotic fluid level should be mandatory.
Factors causing amniotic fluid leak
■ A bacterial infection, an injury or trauma or a defect in the amniotic sac can trigger off this problem including amniocentesis, which is a specialised test that involves taking a sample of amniotic fluid through a needle from the womb and examining it in the laboratory to check for congenital abnormalities.
■ Depending on the severity of the problem, there may be excessive discharge of fluid or a slight trickle.
■ This is a serious problem that needs to be addressed as soon as possible as this may cause Oligohydramnios or low levels of amniotic fluid which in turn increases the chances of a premature delivery.
■ Moreover a tear in the amniotic sac can cause infection in fetus within 24 hours of such a leak.
■ The growth of the fetus can also be restricted especially if the tear happens early in pregnancy.
■ Stress and other psychological issues could act as a precipitating factor towards the leak.
■ Sometimes the tear is quite insignificant and will heal itself after a couple of days.