Amniotic fluid and amniotic sac

Amniotic fluid (amniotic fluid) is a biologically active liquid medium located inside the fetal membranes. It surrounds the fetus, providing the basic processes of its life.

Amniotic fluid is involved in the nutrition of the fetus. It contains nutrients that he absorbs along with small portions of liquid, swallowing or absorbing through the skin. Functions of amniotic fluid:

Protection of the fetus from infections due to the tightness of the fetal bladder and the presence of immunoglobulins;

Preventing the impact of mechanical factors from the outside by absorbing shocks and pressure;

Noise insulation of the fetus; maintaining constant temperature regime; ensuring free movement of the baby.

The amniotic sac, which contains the amniotic fluid, is formed by two membranes:

1. external (chorion); dense and elastic; forms a closed space and serves as an impenetrable barrier;
2. internal (amnion); soft and stretchable; produces amniotic fluid.

During full-term birth, rupture of the membranes occurs as a result of their natural thinning. But even before the water breaks, regular contractions of the muscles of the uterus appear - contractions. They contribute to the opening of the amniotic sac. If contractions intensify and the intervals between them become shorter, this indicates the onset of labor.

Course of labor

Let me remind you: the first birth lasts on average 9-12 hours, the second one – 6-8 hours. As you know, childbirth occurs in three stages:

I. preparation of the birth canal, dilation of the cervix;
II. period of expulsion of the fetus (immediate childbirth);
III. the afterbirth period, during which the placenta leaves - the “baby place”.

As we already said, the beginning labor activity is marked by the appearance of contractions - regular contractions of the muscles of the uterus and cervix, preparing the birth canal.

IN 1st period There is a gradual merging of the internal and external pharynx, the cervical canal disappears, and the cervix is ​​smoothed. By the beginning of the second period, the cervix softens and dilates to 10-12 cm so that the baby can pass unhindered. In this case, the uterine cavity passes into the vaginal tube. Together they form a single birth canal.

The discharge of amniotic fluid normally occurs at the end of the first stage of labor with complete (or almost complete) dilatation of the cervix. If the waters poured out during contractions, but before the complete (or almost complete) opening of the pharynx, then “early discharge of amniotic fluid” is stated. Rupture of the membranes and rupture of water before the onset of labor, regardless of the stage of pregnancy, is called premature. We will talk about this condition in this article.

Who is at risk?

An important factor causing rupture of membranes is intrauterine infection and the enzymes produced by bacteria. They soften the membranes, which leads to their rupture. The cause of premature rupture can also be changes in the membranes themselves: insufficient elasticity, flabbiness, dystrophy, etc.

Premature rupture of amniotic fluid (PROM) may be caused by the absence of a contact zone between the presenting part (head) of the fetus and the inlet of the pelvis. As a result, the distinction between front and rear waters is lost. In such cases, a significant amount of water moves (especially during contractions) to the lower part of the fetal bladder, which contributes to stretching and premature (early) rupture of the membranes. Risk factors for hyperextension and premature rupture of membranes:

Narrow pelvis
-breech presentation of the fetus,
-multiple pregnancy,
- large or, conversely, low-weight fruit,
- incorrect insertion of the head.

PIOV is a common complication of cervical incompetence - isthmic-cervical insufficiency. In this case, the fetal bladder, not receiving proper support from below, protrudes (prolapses) through the cervical canal and, as a result, ruptures even with minor loads. Functional insufficiency of the lower segment and cervix can occur with endocrine diseases and disorders of the innervation of the genital organs. The following women are also at risk of developing PIOV:

Having undergone interventions during pregnancy (amniocentesis, cordocentesis);
-suffering from systemic diseases connective tissue and anemia;
- having underweight and insufficiency ascorbic acid;
- nicotine and drug abusers;
-possessing low socio-economic status.

Clinical picture of ruptured membranes

The clinical picture of PIOV depends on the degree of damage to the membranes. If there is a complete rupture and massive rupture of amniotic fluid, the diagnosis is beyond doubt. At the same time, the pregnant woman secretes large number odorless, watery liquid. Due to the loss of a significant volume of water, the height of the uterine fundus may decrease. Shortly after PIOV, labor begins.

It is more difficult to suspect the occurrence of microcracks in the fetal bladder and slight leakage of water. In this case, the amniotic fluid, mixing with vaginal secretions, may go unnoticed. Symptoms suspicious for PIOV:

Copious and watery discharge;
-increased discharge when lying down;
-pain in the lower abdomen;
- bloody discharge;
-the appearance of discharge after injury, sexual intercourse, a fall, or against the background multiple pregnancy and/or an infectious process in the mother.

The absence of damaging factors, as well as a decrease in clinical manifestations, does not exclude the possibility of PIOV, but only complicates the primary diagnosis of this condition. Delaying treatment for more than 24 hours greatly increases the likelihood of serious complications.

Diagnosis of premature rupture of amniotic fluid

If you suspect leakage of amniotic fluid, you can use a special amniotest (test strips), which at home will allow you to determine whether amniotic fluid is leaking or not. They have an alkaline reaction, and vaginal discharge is acidic. Changes in vaginal acidity are recorded using a test.

To carry out the test, vaginal discharge is applied to a strip with a cotton swab. Painting it blue or green indicate the presence of amniotic fluid. False-positive results are observed in 15% of cases when urine, semen, or blood enter the vagina.

IN lately To diagnose PIOV at home, the Amniosure test is widely used, which is based on the determination of a special protein (placental alpha-1-microglobulin). This test more informative.

If you detect leakage of amniotic fluid or if you have complaints characteristic of this condition, you should immediately consult a doctor. In order to establish a diagnosis, an examination is carried out. It includes the following methods:

Inspection using mirrors; allows you to detect fluid leakage through the cervical canal, which increases with coughing or straining; unfortunately, the method is not always diagnostically valuable;

Ultrasound; helps to assess the volume of amniotic fluid, exclude placental abruption, and determine management tactics; Ultrasound is not informative for microcracks with slight loss of amniotic fluid;

Amniocentesis with the introduction of indigo carmine into the amniotic cavity through a puncture of the anterior abdominal wall; the diagnosis of PIOV is established by staining a vaginal tampon; important: amniocentesis increases the risk of complications.

Consequences of premature rupture of membranes

The time between the outpouring of water and the onset of contractions is called the latent period, the period between the outpouring of water and the birth of the fetus is the anhydrous interval. If the latter exceeds 6 hours, then the risk of various complications increases sharply.

Their frequency and severity depend on the duration of pregnancy, the duration of the anhydrous interval and the actions of medical personnel. The most common complication of PIOV is the addition of an inflammatory process and the development of chorioamnionitis - inflammation of the membranes.

This condition is characterized by increased body temperature, chills, increased heart rate in the mother (above 100 beats per minute) and fetus (more than 160), tenderness of the uterus and the presence of pus-like discharge from the cervix. The occurrence of chorioamnionitis is an indication for delivery.

With premature and early rupture of water 1st period labor may be delayed due to the lack of amniotic fluid, which is necessary to smooth the cervix and open the pharynx. Premature rupture of water is often accompanied by weakness of labor forces, which also increases the duration of labor. Prolonged labor is unfavorable for the mother and fetus, especially during a long period without water.

As a result of PIOV, premature detachment of a normally located placenta is possible. This condition is accompanied by severe bleeding and severe hypoxia (oxygen starvation) of the fetus. The consequence of premature rupture of membranes and premature birth can be various diseases in the baby:

Respiratory distress syndrome; occurs due to immaturity of the lungs due to the lack of surfactant - a substance that prevents the alveoli of the lungs from collapsing;

Intraventricular hemorrhages; dangerous due to the occurrence of cerebral palsy (CP);

Deformations of the skeletal bones and limbs of the fetus; develop as a result of a long anhydrous interval due to compression of the fetus by the uterus.

With PIOV, bleeding in the afterbirth and early postpartum periods, cervical ruptures and endometritis (inflammation of the uterus) are more often observed.

Lead tactics

The tactics for managing a pregnant woman with premature rupture of amniotic fluid depends on a number of factors. Here are the main ones:

Woman's age;
-parity (what kind of births are there);
- gestational age;
-readiness of the cervix for childbirth;
- contractile activity of the uterus at the time of examination;
-sizes of the fetus and pelvis;
-presence of diseases in the woman and fetus, as well as complications of pregnancy;
-duration of the water-free period.

A pregnant woman with PIOV is hospitalized in maternity hospital, provide complete rest, carefully monitor the state of her health and the fetus. If there is a long anhydrous period (more than 5-6 hours) and signs of endometritis appear, antibiotics or sulfonamide drugs are prescribed.

If the pregnancy is full-term, the cervix is ​​mature, and the anhydrous period was short (no more than 2-6 hours), then on the estrogen-glucose-calcium-vitamin background, labor is stimulated with oxytocin and prostaglandin. In response, primiparous women experience dilatation of the cervix at a rate of 1 cm per hour, multiparous women - 1.5-2 cm per hour and the advancement of the fetus along the birth canal.

Expectant management helps the mother’s body prepare for childbirth and reduces the incidence of obstetric injuries and surgical interventions. At the same time, vaginal sanitation and monitoring of the condition of the mother and fetus are carried out: blood tests, bacteriological and bacterioscopic examinations, thermometry, cardiotocography, ultrasound with Dopplerometry.

If there is no effect from the induction of labor within 4 hours, the issue of surgical delivery is decided. C-section also performed for immature cervix.

In case of premature pregnancy, as in full-term pregnancy, expectant management is more often used, which contributes to the maturation of the lung tissue in the fetus. However, in some cases you have to be proactive. Indications for early delivery with PIOV are:

Chorioamnionitis;
- complications of pregnancy: eclampsia and preeclampsia, bleeding, abruption or placenta previa;
-suffering of mother and fetus;
-developing active labor.

Prevention

You can reduce the risk of developing PIOV! For this purpose, it is necessary to carefully prepare for pregnancy, undergo routine examinations, promptly identify and treat sexually transmitted infections, eat well, use multivitamin complexes with vitamin C, and refuse bad habits, read competent literature and, of course, think positively.

Be happy and healthy!

Always with you

It is no secret that the fetus in the womb is surrounded by amniotic fluid, which is also called amniotic fluid. They play a very important role in the development of the fetus, so their outpouring occurs already during childbirth. If fluid begins to leak earlier, this can lead to complications or premature birth. In this publication we will look at the signs of amniotic fluid leakage and why this situation is dangerous for the woman and child.

Main symptoms of leakage

In the third trimester, there is a physiological process of increased secretions. At this stage, it is very important to determine what type of discharge the woman has started. Naturally, this should be done by the gynecologist in the residential complex who is observing the pregnant woman. But life circumstances do not always turn out well and it happens that a woman cannot see a doctor in the next few days. Therefore it is very important for expectant mother independently recognize the premature passage of amniotic fluid.

• the fluid released increases when moving or changing position;
• if this is a small rupture of the amniotic sac, then water can flow down the legs and the woman, even with tension in the pelvic muscles, cannot hold back the discharge;
• if the gap is very tiny, then the leakage can only be determined using a test or smear in the LC (antenatal clinic).

What does amniotic fluid look like?

Quite often, women try to determine by the color of the discharge on the pad whether leakage has begun. This is quite difficult to do; most waters have a clear, less often pink, greenish, brown or cloudy tint.

Tests for leakage of amniotic fluid

1. You do not need to purchase any equipment for this test. Go to the toilet as soon as possible, wash yourself and dry yourself very thoroughly with a towel so that there is no moisture left anywhere. After this, lie down on a dry, clean sheet. If after 15-20 minutes wet spots appear on it, there is a high probability of amniotic fluid leakage. Credibility this method approximately 80%.
2. A gasket that allows you to determine the likelihood of leakage can be purchased at a pharmacy for literally 290-330 rubles.

Dear women, remember, at the first sign of leakage, immediately contact your gynecologist at the residential complex or maternity hospital. If the baby is for a long time being without water is dangerous for his health and even for the life of the baby.

How does amniotic fluid leak normally?

In most cases, the following sequence of events occurs:

• at 38-42 weeks of pregnancy, labor begins;
• during one of the contractions, the amniotic sac ruptures and the liquid pours out in one stream;
• if there is no rupture of the bladder, then the obstetrician-gynecologist on the chair independently punctures the amniotic sac - this process is called Amniotomy.

What are the consequences of leakage for the woman and the fetus?

If the waters completely break in the second trimester, this can lead to infection of the fetus, which in this case will easily pass through all the protection.

As soon as the obstetrician-gynecologist determines that the pregnant woman is leaking amniotic fluid, the woman will be sent for ultrasound diagnostics to determine the degree of maturity of the child in the womb. If respiratory system and the fetal kidneys are ready to function outside the uterus, labor will be stimulated. This is necessary to prevent the consequences of infection. If the baby is not yet ready to be born, then a number of measures will be taken to prolong the pregnancy. The woman will be prescribed antibacterial drugs and means to stop labor, and will begin to wait until the child reaches the developmental threshold that will allow him to breathe on his own.

The composition and volume of amniotic fluid is one of the main components of a normal pregnancy. Being in this liquid, the fetus is protected from the effects of many negative factors: from noise, from infections, from mechanical stress. In addition to protection, amniotic fluid provides the unborn child with nutrients and comfortable conditions. Therefore, throughout pregnancy, its constant balance is so important. If changes occur in the volume of fluid (oligohydramnios, polyhydramnios), then both mother and child suffer, and various complications arise.

Normally, amniotic fluid should leak only before the onset of labor after the rupture of the amniotic sac. If a slow or copious outpouring of fluid occurs during gestation and long before the onset of labor, then various complications for the health of the fetus and the woman are possible. This is a situation in which nothing depends on a woman’s desires and actions. An examination and further recommendations from specialists are necessary on how the pregnancy will proceed in the future.

Signs of amniotic fluid leakage

If the amniotic sac has a small rupture or crack in the fundus or side of the uterus, fluid will leak slowly. This process may continue long time and will remain unnoticeable, since the liquid is constantly renewed and restored. It is difficult for a woman to notice the beginning of the problem and is easily confused with vaginal discharge or urinary incontinence. But over time, she can pay attention to the following changes in her body:

the discharge became liquid and constant;

appeared aching pain lower abdomen;

The fetal movements have changed - they have become slow and irregular.

Amniotic fluid is colorless, and its smell has nothing in common with the smell of urine. With incontinence, urine leaks from small physical efforts: coughing, laughing, straining. Amniotic fluid seeps out spontaneously, without outside influence.

If there is excessive leakage of water, it is already difficult to confuse the problem with other ailments:

discharge of a light liquid (may have a brownish or greenish tint) heavily wets the underwear and can flow down the legs;

the stomach decreased in size and became denser;

fetal movement has almost stopped;

contractions began.

In the first and second cases, the instructions are the same: consult a doctor immediately.

Test for leakage of amniotic fluid

Most women prefer to independently verify the presence of a problem and only then contact a doctor with a complaint. What can a woman do at home if she suspects a water leak? First, make sure that the fluid being released is not urine or vaginal discharge. If you regularly use light-colored knitted underwear and pads, it will be easier to detect unusual discharge. Urine has a specific odor that is difficult to mistake for anything else. Dark underwear will help identify vaginal discharge. There will be a light leucorrhoea residue left on it. If the laundry is damp, odorless and has mucous whitish residue, it is most likely amniotic fluid.

Another recommendation to test leakage at home is to empty your bladder as much as possible, wash your genitals and wipe dry. After this, use a light, clean napkin as a pad. If after half an hour a wet spot remains on it, there is every reason to suspect leakage of amniotic fluid. Also, after a shower, you can lie down on a clean sheet and turn on your side. In a lying position, amniotic fluid leaks out faster. If you find a wet spot, you need to go to the hospital for help.

More accurate information can be provided by special tests that can be purchased at the pharmacy. Test pads are impregnated with a special reagent that detects high levelspH. Normally, a pregnant woman's vaginal discharge should be acidic. If water leaks, the levelpHwill be neutral or alkaline. If there is a problem, the gasket indicator will turn blue-green.

The disadvantage of such tests is false positive results if a woman has vaginal dysbiosis, inflammation of the mucous membrane, or shortly before diagnosis, douching or sexual intercourse took place. In all such situations the level changespH.

Tests for the detection of protein-1 and placental microglobulin will be more reliable, since they are based on the identification of components that are contained only in amniotic fluid.

Only a doctor can definitively make a diagnosis. He will also conduct testing, examine the woman using mirrors, and send her for an ultrasound. Based on all the data obtained, tactics for further pregnancy management will be chosen.

Causes of amniotic fluid leakage

Loss of amniotic fluid occurs through cracks in the amniotic sac. Damage to its shells can occur for many reasons:

inflammation of the vaginal mucosa, which is based on infection. The most common pathogens are mycoplasmas, chlamydia, trichomonas, streptococci. Many women hope that the body will cope with the disease on its own and do not seek treatment. Bacteria continue to develop, penetrate the area of ​​the amniotic sac and dissolve its membrane. In 30% of cases of amniotic fluid leakage, the culprit is infection;

infections that enter the fetal membrane through the blood or from the genital tract without damaging the bladder. Continuing to develop inside, the pathogens violate the integrity of the shell and provoke leakage;

falls, injuries, blows to the abdominal area. Any mechanical impact can cause a shell rupture;