- Simultaneous discharge from the vagina of a large volume of clear watery liquid, often slightly stained with blood.
- Slow leakage ("drop by drop") of liquid discharge from the vagina, aggravated by lying down or by changing the position of the body.
- Reducing the volume of the abdomen.
- The onset of contractions (painful uterine contractions) following the release of fluid from the vagina.
Forms
The outflow of amniotic fluid is normal (timely) should occur in the first stage of labor after the complete opening of the uterine os (the external opening of the cervix (the long narrow part of the uterus passing into the vagina)).
Depending on when exactly and how the premature rupture of amniotic fluid occurred, there are:
- early rupture of amniotic fluid (opening of the membranes and release of amniotic fluid after the onset of regular contractions (painful uterine contractions), but before the cervix is fully dilated);
- premature rupture of amniotic fluid (opening of the membranes and outpouring of amniotic fluid before the onset of contractions);
- high lateral rupture of the membranes (leakage of amniotic fluid) - the appearance of a minimal defect in the membranes, leading to the gradual release of amniotic fluid in a small amount.
Causes
There are 3 types reasons occurrence of premature rupture of amniotic fluid.
- infectious causes: (infectious inflammation of the membranes and endometrium (uterine lining)).
- Iatrogenic causes
(caused by the actions of the doctor):
- multiple vaginal bimanual examinations (the doctor, by palpation (palpation), determines the shape, consistency of the cervix (the long narrow part of the uterus passing into the vagina), the degree of its disclosure, etc.);
- multiple transvaginal (performed through the vagina) ultrasound examinations (ultrasound) of the fetus;
- amniocentesis (obtaining for the study of amniotic fluid during the puncture of the membranes and the anterior abdominal wall);
- chorion biopsy (taking a piece of amniotic membrane tissue in order to study the chromosome set (genetic material) of fetal cells);
- suturing the cervix to prevent its premature opening in case of (premature opening of the cervix and isthmus of the uterus under the influence of increased intrauterine pressure).
- Injuries (blunt trauma to the abdomen).
- From the mother's side:
- the presence of chronic inflammatory diseases of the genitourinary system ((inflammation of the cervix), (inflammation of the vagina and its vestibule), (inflammation of the uterine mucosa), (inflammation of the fallopian tubes and ovaries (female gonads));
- low socioeconomic status;
- unbalanced nutrition of a pregnant woman (lack of food proteins, vitamins and trace elements);
- smoking;
- alcohol and drug use;
- (anemia);
- long-term treatment with steroid hormones (drugs of hormones of the adrenal cortex);
- premature rupture of amniotic fluid in past pregnancies.
- Uteroplacental factors:
- anomalies (violations) of the structure of the uterus (, doubling of the uterus);
- (violation of uteroplacental blood flow (blood flow in the "womb-placenta-fetus" system) at the level of the smallest vessels);
- (exfoliation of the placenta (an organ that interacts with the body of the mother and fetus) from the wall of the uterus before the birth of the child);
- (childbirth occurring during pregnancy from 22 to 37 weeks).
- fruit factors:
- (the presence in the uterus of more than two fetuses);
- (the presence of a large volume of amniotic fluid).
Diagnostics
- Analysis of complaints - when (how long ago) watery discharge from the genital tract appeared, their color, quantity, what preceded their occurrence, with which the woman associates the appearance of these symptoms.
- Analysis of obstetric and gynecological history (past gynecological diseases, surgical interventions, pregnancies, childbirth, their features, outcomes, features of the course of this pregnancy).
- Anamnesis of life (bad habits of a pregnant woman, dietary features).
- General examination of the pregnant woman, determination of her blood pressure and pulse, palpation (palpation) of the uterus.
- Vaginal examination - determination of the shape, consistency of the cervix (the long narrow part of the uterus that passes into the vagina), the degree of its opening, etc.
- Examination of the cervix in the mirrors - the doctor, using a vaginal mirror, examines the vagina for the presence of amniotic fluid and the cervical canal to detect the release of amniotic fluid from it.
- Nitrazine test - the use of special test strips with a reagent (special chemical substance): when amniotic fluid is applied, the color of the strip changes from yellow to blue.
- Ultrasound examination (ultrasound) of the fetus and uterus - the method allows you to determine the location of the placenta (an organ that interacts with the body of the mother and fetus), detect placental abruption (separation of the placenta from the uterus) from the uterine wall, determine the integrity and volume of amniotic fluid.
- "Tampon test" - used when gestational age is less than 27 weeks. Through a puncture in the anterior abdominal wall and the wall of the uterus, a dye is introduced into the amniotic fluid. At the same time, a tampon is inserted into the pregnant woman's vagina. With premature outflow of amniotic fluid, 25-30 minutes after the introduction of the dye, the swab becomes the same color as the dye.
- Determination of placental microglobulin (a special amniotic fluid protein) in vaginal discharge makes it possible to distinguish amniotic fluid from vaginal mucus, urine, etc.
Treatment of premature rupture of amniotic fluid
Treatment of premature rupture of amniotic fluid only conservative (non-surgical).
It boils down to:
- prolongation (maintenance) of premature (less than 38 weeks) pregnancy;
- stimulation of labor activity (promotes the onset of labor) in the case of a full-term pregnancy.
- signs (inflammation of the fetal membranes and mucous membrane of the uterus);
- acute (insufficient delivery of oxygen to the tissues of the fetus, manifested by an increase or decrease in the heart rate of the fetus);
- the presence of active labor activity (contractions - painful uterine contractions).
- Pregnancy up to 34 weeks should be prolonged. The treatment of premature rupture of amniotic fluid at gestational ages less than 34 weeks includes:
- glucocorticosteroids (drugs of the hormone of the adrenal cortex - cortisol), which can accelerate the maturation of the lungs of the fetus, which plays an important role for its viability;
- tocolytics (substances that relax the muscles of the uterus and reduce uterine contractions);
- antibacterial drugs (substances that kill bacteria or stop their growth).
- Pregnancy of 34 weeks or more should not be continued. Labor is stimulated.
- Early pregnancy (up to 22 weeks) cannot be prolonged. Medical termination of pregnancy (medical abortion) is recommended.
Complications and consequences
- (a serious condition of the fetus caused by insufficient blood supply through the exfoliated area (lost connection with the wall of the uterus) of the placenta (an organ that interacts between the body of the mother and the fetus)).
- Intrauterine fetal death.
- (inflammation of the membranes and endometrium (the lining of the uterus)).
- (inflammation of the endometrium after the birth of a child).
- Respiratory distress syndrome (impaired lung function of a newborn due to their insufficient maturity: there is no special substance in the child’s lungs that prevents the alveoli from “sticking together” (structural units of the lungs that carry out gas exchange)). This is a life-threatening condition in which the child is unable to breathe normally.
- :
- weakness of labor (uterine contractions are not strong enough to move the fetus through the birth canal);
- rapid labor (duration of labor less than 4 hours in primiparous and less than 2 hours in multiparous; lead to increased birth trauma of the mother and child);
- premature detachment of a normally located placenta (placental detachment from the uterine wall before childbirth).
Prevention of premature rupture of amniotic fluid
Prevention of premature rupture of amniotic fluid includes:
- pregnancy planning (exclusion of unwanted pregnancy,);
- timely preparation for pregnancy (detection and treatment of chronic and gynecological diseases before pregnancy);
- timely registration of a pregnant woman in a antenatal clinic (up to 12 weeks of pregnancy);
- regular visits (1 time per month in the 1st trimester, 1 time in 2-3 weeks in the 2nd trimester, 1 time in 7-10 days in the 3rd trimester);
- compliance with the diet of a pregnant woman (with a moderate content of carbohydrates and fats (excluding fatty and fried foods, starchy foods, sweets) and sufficient protein content (meat and dairy products, legumes));
- physiotherapy exercises for pregnant women (minor physical activity for 30 minutes a day - breathing exercises, walking, stretching);
- giving up bad habits (smoking, drinking alcohol).
Leakage or early rupture of amniotic fluid is a problem for many pregnant women. Delaying treatment often poses a risk to both the unborn child and the mother.
What is amniotic fluid?
Amniotic fluid (amniotic fluid) is a clear and straw-colored fluid that surrounds the fetus, providing protection and nutrition to the fetus. It also helps in the development of the muscular and skeletal system of the unborn child.
Amniotic fluid is located in the fetal bladder (amniotic sac), the walls of which consist of two membranes: the amnion and the chorion. These membranes keep the unborn child in this sealed bag containing amniotic fluid. Her bubble begins to fill a few days after conception. The baby will regularly release small amounts of urine into the amniotic fluid from the tenth week of pregnancy (when the kidneys start working).
Together with the placenta and the umbilical cord, this is such a natural life support system for the embryo.
How important are they?
The amniotic fluid allows the baby to breathe properly. He starts to swallow liquid in the second trimester. Its main function is to protect the unborn child from injury.
The fluid contains essential nutrients that aid in the development of the fetus's digestive system, lungs, muscles, and limbs. This allows the child to kick and move without any interference. It also provides protection against infections.
The fetus uses this fluid for many functions. The water level will rise every day. Their number will increase from a few cubic milliliters to about a thousand as the pregnancy progresses, reaching its highest level at the thirty-sixth week. Then the number will begin to decrease from the thirty-eighth week until the day of delivery.
Premature loss of amniotic fluid is a serious threat to the unborn child and the mother herself.
What is premature rupture or leakage of amniotic fluid?
Normally, spontaneous rupture of membranes and the outflow of amniotic fluid occurs during childbirth, i.e. with full or almost complete disclosure of the cervix and the presence of regular contractions.
If the outflow (leakage) of water occurs earlier, then this condition is premature and refers to pregnancy complications. In medicine, this is called premature rupture of the membranes (PROM). This can happen at any stage of pregnancy and can be either a fluid stream or a slow leak. This problem is a common cause of preterm labor or miscarriage, depending on the term.
If a premature rupture occurs before the 24th week, the fetus is still absolutely not able to survive outside the mother's womb. But even before the 37th week, this puts the mother and fetus at great risk of complications.
Premature rupture of amniotic fluid is a problem that is often ignored by many pregnant women. The discharge is usually felt as a painless flow of fluid, but may also appear as a small stream or a slight discharge.
Symptoms
It can be difficult to determine if vaginal discharge is amniotic fluid when there is not a complete rupture of the membranes of the sac, but cracks in them. However, there are several differences.
amniotic fluid:
- Usually odorless
- Mostly transparent. Sometimes may be mucus, blood-streaked, or white discharge
- It leaks continuously. Has a very steady flow from time to time
- Unable to control leakage
- Have to change pads and underwear frequently as leakage is persistent
- Some discomfort and spasms may occur
It may not be amniotic fluid if:
- There is a yellow tint, like urine
- Smell like urine
- Sudden leakage, accompanied by movement of the baby in the uterus, but which was short-lived and stopped.
- The discharge has a slimy consistency that requires changing pads for hygienic purposes. Such a leak will not seep through the gaskets. This is a sign that you are simple.
Symptoms of a slow leak
You can talk about leakage of amniotic fluid during pregnancy if:
- You notice a sudden stream of fluid moving along the length of your legs.
- Your underwear is wet
- Small amount of fluid or trickle
The cause of a small leak can be difficult to determine. Therefore, it is better to go and consult with a gynecologist on this issue. Continuity of flow indicates leakage.
Leaking amniotic fluid may also be indicated by the fact that you continue to experience moisture even after emptying your bladder.
Early leakage of amniotic fluid
A miscarriage is the loss of a fetus in the early weeks of pregnancy. According to the American Pregnancy Association, many miscarriages occur in the first thirteen weeks. About 10-25% of all confirmed pregnancies usually end in miscarriage.
It is important to recognize the signs as this allows you to seek medical attention as soon as possible.
It is important to pay attention to:
- Isolation of a gray or light pink substance
- Spilling an unexpected large amount of fluid
- Passage of large pieces of tissue
- pinkish discharge
The release of tissue or fluid during early pregnancy could be a sign of a miscarriage, according to the Mayo Clinic. The released tissue or fluid may or may not contain any blood.
The above symptoms may be normal signs of hormonal changes in your body. But they can also indicate problems during pregnancy. You should always keep in touch with your gynecologist.
Leakage in middle pregnancies
Leakage of amniotic fluid at 16 weeks
Usually the water breaks at the beginning of labor. Any leakage that occurred earlier is considered premature. Leaks that occur between the 15th and 16th weeks usually require urgent medical attention.
Treatment includes:
- Arrangement in a medical institution for a thorough examination
- Checking for a miscarriage
- After observing you for a while, the doctor will discuss the next steps.
Leakage of amniotic fluid in the 2nd trimester
Leaking in the second trimester means you have a ruptured amniotic bladder. The tear may heal over time, or it may not heal.
A scan must be performed to determine what may be causing the leak. It is important to note that during pregnancy, many different and unusual changes occur in the body, so it is difficult to determine what is normal and what is not.
Regular examinations by a gynecologist will help the expectant mother to be calm. Some tests must be performed to determine what is behind the leaking amniotic fluid.
Leakage of amniotic fluid at 37-38 weeks
If the rupture of the membranes occurs 37 weeks after the last menstrual cycle (the so-called gestational age of the fetus), then the risks of complications are minimal and contractions usually begin soon after.
But still, such a gap is premature and, like earlier cases, may be associated with such factors:
- bacterial infection
- Cases of premature discharge of water during previous pregnancies
- Having a defect in the development of your fetus
- Infection in the vagina, uterus, or cervix.
- Bad habits such as smoking, drugs and alcohol abuse
- Straining of the amniotic sac due to a large baby or twins
- Poor nutrition
- Preliminary operations in the area of the cervix or uterus
Leak tests
It is most correct to contact a gynecologist, and he will conduct an examination and prescribe the necessary tests to confirm the leakage of amniotic fluid if there are suspicions. But it will also be useful to have simple pharmacy tests on hand to play it safe or reassure yourself. They can occasionally give a false positive, but should not give a false negative if used correctly.
ph strip test
Litmus strips are the easiest and cheapest test. You can even use strips designed for aquarium water to save money. To determine the leakage of water at home, you can use litmus test strips, which are sold in almost every pharmacy and have an affordable price. Litmus paper helps to establish the pH level of suspicious secretions.
The strip is applied to the vaginal wall after opening and will then show the acidity level (pH). Normal vaginal pH is between 4.5 and 6.0. Amniotic fluid has a higher level - from 7.1 to 7.3. Therefore, if the pouch membranes are ruptured, the pH of the vaginal fluid sample will be higher than normal. This will be indicated by a change in the color of the strip, which must be compared with the scale that comes with the test. Increased acidity will indicate that you have an infection or amniotic fluid is leaking.
Test strip for determinationThe pH of the aquarium water is also suitable for amniotic fluid leakage testing, and they can be cheaper.
Nitrazine test
The most common type of test. The price for one tampon is from 2 dollars. Popular brands are such as AmnioTest, Amnicator. It requires the application of a drop of vaginal fluid to paper strips containing nitrazine as an indicator, a substance more sensitive than litmus. On sale, such tests are available in the form of special swabs or pads, which facilitates its implementation.
The indicator changes color depending on the acidity of the liquid. They will turn blue if the pH is greater than 6.0. This means that with a high probability the shells of the bubble have ruptured.
However, this test can also give false positive results. If blood enters the sample or if there is an infection in the vagina, the acidity level may be higher than normal. Male sperm also has a higher pH, so recent intimacy may affect the outcome.
Alpha 1 microglobulin test
The most accurate, but also the most expensive test - more than $ 30 This is a modern and more accurate test, but its cost is many times more expensive (more than 30 shares). It also does not require special laboratory conditions, but more often it is performed by an obstetrician-gynecologist on an outpatient basis. The bottom line is the detection of such a biomarker as placental alpha-1-microglobulin. This substance is found in amniotic fluid and is not normally present in the vagina. To take a sample, a swab is used, which is then placed in a test tube with a special liquid, and then a test strip is placed in its place. According to the results of the number of stripes that appeared on it (1 or 2), it can be said with an accuracy of 97% about the presence of leakage of amniotic fluid.
Other tests that may be done in the hospital
The so-called “fern” symptom is traces on a microscope slide after the amniotic fluid has dried. After the urine has dried, there are no such traces. Inspection of liquid under a microscope. If leakage occurs, then the amniotic fluid mixed with estrogen, when dried due to salt crystallization, will create a “fern” symptom (will resemble fern leaves). For holding, a few drops of liquid are placed on a microscope slide for examination.
Dye test. Inject a special dye into the amniotic sac through the abdominal cavity. If the membranes are torn, colored fluid will be found in the vagina within 30 minutes.
Tests to measure levels of chemicals that are present in amniotic fluid but not in vaginal secretions. These include prolactin, alpha-fetoprotein, glucose, and diamine oxidase. High levels of these substances mean that a rupture has occurred.
Amniotic fluid, urine or vaginal discharge?
Three main types of fluid can come out of the vagina: urine and amniotic fluid. While noting the differences between them, you can use the following hints to identify one of them.
Leakage of amniotic fluid
It will have the following properties:
- May contain clear or whitish mucous patches
- Odorless and colorless. May have a sweet smell in some cases
- Presence of blood spots
- Does not smell like urine
Constant discharge means that the fluid is indeed amniotic.
Urine
Urine usually has the following properties:
- Ammonia smell
- Dark or pure yellowish color
Bladder leakage will occur mainly in the second and third trimester. The fetus will already put pressure on the bladder at these times.
Vaginal discharge
Vaginal discharge during pregnancy is also not uncommon. They have the following properties:
- The smell may or may not be present. However, they do not have an ammonia smell similar to urine.
- May be yellowish or whitish
- Have a firmer consistency than urine or amniotic fluid (No ratings yet)
Normally, the fetal bladder should burst in the 1st phase of labor. At the same time, the fetal membranes soften, a large number of enzymes are produced that are responsible for the timely detachment of the placenta. Under various pathological conditions, this mechanism changes, and this causes premature outflow of water. It can happen at any time.
Inflammatory diseases of the genital organs of a woman, intra-amniotic infections lead to premature rupture of the fetal membrane during premature pregnancy. It has been proven that there is an association between ascending infection in a woman and premature rupture of amniotic fluid. Every third patient with premature pregnancy has positive cultures from the genital organs for bacteriological cultures. In premature pregnancy, premature rupture of the membranes is very dangerous, threatening the life of the woman and the fetus.
Causes of premature rupture of amniotic fluid during full-term pregnancy
The cause of premature rupture of the membranes during full-term pregnancy is a clinically narrow pelvis, pathology of the position of the fetus. In this case, labor has already begun, but the cervix has not dilated enough. Normally, the presenting part of the fetus should fit snugly against the bones of the woman's pelvis. In this case, it forms the so-called "contact belt", dividing conditionally amniotic fluid into anterior and posterior.
If a woman has a narrow pelvis or she develops presentation pathologies, such a belt does not form. As a result, most of the amniotic fluid accumulates in the lower part of the bladder, which leads to a rupture of its membranes. In this case, the negative impact of premature rupture of amniotic fluid on the health of the woman and the fetus is minimal.
Other causes of premature rupture of amniotic fluid
Premature rupture of the membranes can also occur as a result of cervical insufficiency. This condition is typical for preterm pregnancy, but can also occur at a later date. It can be provoked by multiple bimanual examinations, bad habits of the mother, multiple pregnancy, anomalies in the development of the uterus, trauma.
Women with systemic connective tissue pathologies, underweight, beriberi, anemia, who take hormonal drugs for a long time are at risk of developing premature rupture of the membranes. This group also includes patients with low social status who abuse drugs, alcohol, and nicotine.
Causes and risk factors for premature rupture of amniotic fluid
Premature rupture of amniotic fluid is a common problem that can be dangerous for mother and baby. Why is it so important for a baby to be in a liquid environment and in a whole amniotic sac? Let's talk about this topic.
Throughout pregnancy, the fetus floats in the amniotic fluid that fills the amniotic sac. It performs a wide range of functions. Amniotic fluid is involved in the metabolism of the baby, protects it from external influences (mechanical, sound, light) and various infectious diseases. In addition, with its help, the child’s digestive and respiratory systems are trained. Amniotic fluid is constantly updated. Its amount can also tell about the condition of the fetus inside the womb.
The outflow of amniotic fluid normally occurs during the birth process. When the cervix matures, the membranes soften and enzymes are released that help the placenta to separate. The fetal bladder loses elasticity and strength and bursts. Amniotic fluid leaks out. After the amniotic fluid breaks, contractions usually intensify.
If the fetal bladder loses its integrity until the fetus ripens and is ready for natural childbirth, then they speak of premature rupture of the membranes. The degree of threat to the mother and child is assessed depending on the duration of pregnancy. The main risks are due to preterm birth and infection of both the fetus and the pregnant woman.
The causes of premature rupture of amniotic fluid are numerous. The most common is infection of the genital organs of a pregnant woman. In this case, the cervix softens ahead of schedule, and the released enzymes thin the fetal bladder, leading to the separation of the placenta. In this case, the infection of the baby is most likely.
To PRPO (premature rupture of the membranes) can also lead to structural features of the pelvis, the condition of the cervix, and the position of the fetus. A weak neck creates conditions for protrusion of the bladder and violation of its integrity. The narrow pelvis and the unusual position of the fetus create a threatening condition, when most of the water accumulates at the bottom of the bubble and breaks it. Normally, the fetus is tightly adjacent to the pelvic floor and creates a belt of contact that does not allow the bulk of the water to pass to the bottom of the bladder.
Medical intervention associated with a puncture of the bladder for fluid analysis can provoke further violation of the integrity. Uterine anomalies such as the presence of a septum, placental abruption, polyhydramnios, and multiple pregnancies are risk factors. Provoke premature rupture of amniotic fluid during full-term pregnancy can be physical activity, with premature blunt abdominal trauma and bad habits of the mother associated with the use of alcohol and nicotine, narcotic substances. Taking certain potent drugs can also have a negative effect.
Finding the symptoms of amniotic fluid rupture is quite easy. During this process, a fairly large amount of liquid is released so that it can be confused with something else. The waters are normally colorless and have a slightly sweet smell. It is more difficult to determine the presence of shell cracks. After all, then the amniotic fluid flows out drop by drop and is easily mistaken for vaginal discharge. Another premature rupture of amniotic fluid has signs in the form of an increase in the amount of discharge in the supine position.
If there is a suspicion of leakage of amniotic fluid, tests are prescribed - a smear for pH, ultrasound. They may suggest amniocentesis with staining or some other technique. The Amnishur test has proven itself well. After establishing the fact of violation of the integrity of the membrane, a decision is made on further actions depending on the duration of pregnancy and the presence of complications.
Doctors, depending on the timing at which premature rupture of amniotic fluid occurred, offer various ways to reduce the risk of complications. If the pregnancy is full-term, then usually childbirth occurs on its own within the next two days. In this case, the woman is placed in a hospital and is under observation. Rehabilitation of the genital tract is carried out to avoid infection, the birth canal is prepared. The decision to wait for natural childbirth reduces the risk of birth injuries and other negative consequences.
For periods up to 22 weeks, PROM is usually an indication for termination of pregnancy due to too high risks of complications of infection of the fetus and mother. If the pregnancy has exceeded the specified period, then many factors are taken into account. The more the baby has developed, the better the prognosis. The main indicator of the possibility of having a viable child is the maturation of his lungs. For this, the woman is placed in almost sterile conditions. Provide bed rest and antibiotic prophylaxis. Everything is done to save the life and health of mother and baby.
1. Premature rupture of amniotic fluid - rupture of the membranes and outflow of amniotic fluid before the onset of labor.
Early ^ rupture of amniotic fluid - rupture of membranes and rupture of amniotic fluid after the onset of labor, but before opening the pharynx by 7-8 cm.
The above complications are most often associated with a high location of the presenting part of the fetus (anatomical narrowing of the gas, large fetus, extensor presentation of the head, hydrocephalus, breech presentation of the fetus, oblique or transverse position of the fetus with a functional inferiority of the lower segment of the uterus, when there is no well-defined contact belt), except In addition, the causes of prenatal and early discharge of amniotic fluid can be anatomical changes in the cervix, inflammatory processes in the cervix, changes in the fetal membranes.
Prenatal rupture of the fetal bladder is diagnosed on the basis of anamnestic data (leakage of water), the detection of fetal scales in the amniotic iodine, and examination of the presenting part using an amnoscope. In doubtful cases, secretions from the genital tract are collected in a tray or examined without staining under a microscope (hairs are found in the waters) or, placing them on a glass slide, mixed with saline (amniotic fluid gives an arborization reaction). When opening the uterine os, the absence of the fetal bladder can be detected by palpation.
If the body of a pregnant woman is ready for childbirth (mature cervix, data from a coliucitologist or a positive oxytocin test), prenatal rupture of amniotic fluid can interfere with the normal course of childbirth. Usually in such cases, labor activity develops after 5-6 hours.
after rupture of membranes. An uncomplicated course of childbirth is observed with an early outflow of water in women in labor with good labor activity and the presenting part inserted into the entrance of the small pelvis.
Premature and early discharge of amniotic fluid leads to the development of serious complications: weakness of the birth forces. protracted course of childbirth, hypoxia and intracranial trauma of the fetus, chorioamnioitis during childbirth, prolapse of the umbilical cord and small parts of the fetus.
Treatment is carried out only in a hospital. If amniotic fluid is shed in the presence of an immature fetus, treatment is aimed at maintaining the pregnancy. I appoint! bed rest, strict control of the temperature 1C.S and the picture of the blood, preventive uterine contractions are used.
With a pregnancy of 36 weeks or more, the doctor's tactics should be individual:
in the group of pregnant women and women in childbirth who do not have signs of dystocia for childbirth and complications are observed that indicate the possibility of developing weakness in their labor forces. should expand!, indications for caesarean section;
if the issue of expectant management of childbirth is being resolved, it is necessary to create a > strictly vitamin-glucose-calcium background. In b hours, in the absence of a good labor activity, I begin! introduces! - funds that reduce the uterus. If the woman in labor is tired, it is necessary to give her rest in a timely manner by introducing appropriate pharmacological agents; 11 times without water! For a period of more than 10 hours, when the imminent end of labor is not expected, antibiotics are administered. In the process of childbirth, accompanied by premature and early discharge of amniotic fluid. systematically carry out measures to combat fetal hypoxia.
Prevention: "prohibition of sexual intercourse in the last 1.5-2 months of pregnancy; exclusion of heavy physical activity:
hospitalization of pregnant women in whom rupture of the membranes can be expected before delivery, for 1 weeks before delivery. With the onset of childbirth, such women in labor should be in a prone position.
2. Belated rupture of the membranes - preservation of the integrity of the membranes despite the complete opening of the uterine os. ., Causes - excessive density of the membranes, excessive elasticity of the membranes, a very small amount of anterior amniotic fluid (flat dense bladder). :
The clinical course of childbirth with a belated opening of the membranes is characterized by a protracted period of expulsion, painful uterine contractions, slow advancement of the presenting part, and the appearance of bloody discharge from the genital tract. There is a risk of placental abruption and fetal hypoxia.
The diagnosis is based on palpation data during vaginal examination. If the presence of a flat bubble makes it difficult to determine the integrity of the shells, an examination using mirrors should be made.
Treatment consists in the artificial opening of the membranes of the fetal bladder (amniotomy) with the index finger or with the help of bullet forceps under the control of the fingers of the right hand or mirrors. If the head is not fixed in the pelvic inlet, the amniotic fluid should be released slowly to avoid prolapse of the umbilical cord or small parts of the fetus.