Leaking Amniotic Fluid
By Reeta Chaman On
Fluid leaking during the third trimester of pregnancy, especially during weeks 34 to 36 of pregnancy can be a bit tricky if not diagnosed properly. It could either be a normal expected flow of amniotic fluid or could be some other sort of leaking that may need urgent care.
When you do experience a leakage during pregnancy, it should be consulted and checked with your gynaecologist straight away. Leakages can be due to different causes and are of different nature. It is essential to differentiate between the ‘leaking fluid’ and the normal ones to be sure of any to the alarming signs.
Following could be the possibilities of fluid leakage in pregnancy:
What is Amniotic Fluid?
Amniotic fluid is secreted from the amniotic sac which lies over the placenta and is collected in between amnionic and chorionic space. Amniotic fluid consists of a major portion of water around 99 percent. Amniotic fluid is a clear, white coloured fluid which starts appearing around the 6th to the 8th week of pregnancy. Amniotic fluid is filtered via the pregnant woman’s blood and is absorbed by the foetus before entering the foetal circulation.
How to measure Amniotic Fluid?
Amniotic fluid is assessed by the quantity present in the amniotic sac. A pregnant woman may feel her tummy either growing larger than the gestational period (i.e. polyhydramnios) or a very lower than normal level of amniotic fluid, based on what is the current trimester of pregnancy (i.e. oligohydramnios).
Your gynaecologist may get the measurement of your amniotic fluid if it seems necessary to the doctor at the time. However, if you have any concerns regarding your tummy getting larger or not growing as normal with the gestational age, the doctor should then immediately get such measurements.
The amniotic sac is divided into four quadrants. The amniotic fluid measurement test is performed under ultrasound guidance and/or by measuring the deepest vertical quadrant for the amniotic fluid index.
The normal value of the amniotic fluid index in the deepest quadrant is 5-25 cms. The quantity of amniotic fluid from 8-18 is considered normal..
Functions of Amniotic Fluid
Amniotic fluid plays all the major functions for the foetus which leads to a safe and a healthy pregnancy till the due date arrives and baby enters the world.
1. As a shock absorber
Amniotic fluid acts as a cushion for the foetus. Quantity of amniotic fluid increases as the pregnancy progresses. It protects the foetus from getting hurt in case if the woman has any injury to the abdomen or when she is exercising and/or she falls. Amniotic fluid prevents foetus from harsh striking of woman against the uterine wall during any activity of expecting mother.
2. Allows easy movement of the foetus
Amniotic fluid makes movement easier for the unborn foetus inside the womb. Foetus’s movement helps in the skeleton and muscle development and its movement doesn’t hurt its joint and muscle when amniotic fluid is present in adequate quantity.
3. Growth of digestive system
Foetus drinks the amniotic fluid which fulfills it’s nutritional demand of water. Ingestion of amniotic fluid develops the alimentary system of foetus and helps in learning drinking and digestion.
4. Prevents baby from drying out
Amniotic fluid works as a moisturiser for foetus, it prevents foetus from drying out. The less quantity of this fluid may cause defects in foetus such as club feet. It may be harmful for the baby if amniotic fluid leaks out, baby may be prone to infections.
5. Maintains temperature of the foetus
Foetus inside the uterus needs to be in a suitable temperature. Amniotic fluid maintains the body temperature of the foetus. It keeps foetus safe and provides a comfy environment.
Types of Amniotic Fluid Imbalances
There are two main medical complications related with the quantity of amniotic fluid Polyhydramnios (too much amniotic fluid) and oligohydramnios (very less amniotic fluid).They both can be harmful to the foetus and the mother.
1. Polyhydramnios (Amniotic Fluid in Excess Quantity)
The amniotic sac is divided into 4 quadrants, each filled with filled with different quantities of amniotic fluid. When the deepest quadrant out of the four amniotic sac quadrants, measures to be more than 25 cm and the quantity of the amniotic fluid is more than 18, this condition of excess amniotic fluid is known as polyhydramanios.
There are at least 3 major reasons that lead to the development of excessive quantity of amniotic fluid. These reasons include:
· Larger than normal sized placenta
· Foetus not drinking enough fluid
· Impaired absorption of fluid by the foetus
Multiple pregnancies and diabetic mothers are at least 2 reasons a pregnant woman may have a larger than normal sized placenta. Further, if the foetus is experiencing medical conditions such as spina bifida or anencephaly (a baby who has no brain development), it may not be able to drink enough fluid which eventually increases the level of amniotic fluid of the baby.
A healthy foetus regularly absorbs a certain amount of amniotic fluid through its body. There are cases where the foetus is unable to absorb enough amniotic fluid leading to increasing levels of amniotic fluid in the amniotic sac. This condition is most commonly seen with identical twins and can result in preterm labour.
Signs and symptoms of Polyhydramnios
A pregnant woman may observe a few signs and symptoms when her level of amniotic fluid is more than normal. These signs and symptoms include:
· Nausea, vomiting
· High pulse rate
· Shortness of breath
· Intense abdominal pain
Treatment of Polyhydramnios
Mild polyhydramnios can be treated only with mild sedation at night. Complete bed rest is advised which prevents symptoms of polyhydramnios. If distress to the mother keeps increasing, drainage of fluid is attempted by the doctor, which may relieve the symptoms. If distress occurs during week 35 or later weeks of gestation, labour may be induced to prevent baby from further complications.
How to prevent development of excess amniotic fluid?
Unfortunately, there is not much the pregnant woman can do to prevent polyhydramnios. The pregnant woman can only make sure to keep visiting the doctor on a regular basis. The doctor will then assess and regularly keep a check on the amniotic fluid index.
Oligohydramnios (Amniotic Fluid in Less Quantity)
Oligohydramnios is a condition where the quantity of amniotic fluid is lesser than 5. The development of lesser than normal quantity (8 to 18) of amniotic fluid is caused by renal tract malformation where urination of foetus is compromised. Due to the lack of amniotic fluid, the foetus may become dry and stretchy which in turn cause defects or malformation in unborn foetus. This dryness of the foetus may then lead to condition such as pulmonary hypoplasia (incompetent lungs), umbilical cord compression and foetal breathlessness.
There are several cases where woman with oligohydramnios may experience abortion, restricted foetal growth or risk of caesarean delivery if oligohydramnios occurs in the early stages of pregnancy.
Prevention and Treatment
Oligohydramnios may be prevented and/or treated by infusion of saline into the amniotic sac via cervix.
Amniotic Fluid Leakage vs other Types of leakages
During pregnancy, as women get closer to the third trimester, they may experience differ sorts of leaking of fluids. These leaking fluids could be urine, discharges due to vaginal infections or more commonly the leakage of amniotic fluid (or generally called as water breaking). They have almost the same presentation but the nature of fluid differs from each other and so does their treatments.
Is it Amniotic fluid Leakage?
Amniotic fluid is a clear, odourless, white flecked fluid, sometimes with an addition of mucus or even blood. Amniotic fluid wets your under pants and somewhat saturates in your clothing. Amniotic fluid usually leaks slowly or rapidly depending on the cause of the leakage.
Is it a Urine Leakage?
Urine has odour, is a clear fluid with no addition of flecks or mucus .a woman may leak urine while sneezing, coughing or laughing. It happens due to pressure over the bladder of the enlarged uterus as pregnancy progresses. It may be excluded if you ask the woman to tighten her pelvic floor muscles as if stopping the urine to pass and check if she leaks .If she leaks after trying to tighten her muscles, then it is most probably amniotic fluid not urine.
Is it a Leakage caused by a Vaginal Infection?
Vaginal infections often lead to leakage in pregnant woman. These infections may be due to bacterial overgrowth, a fungal infection or even a parasitic infection. However, the characteristics of leakages due to vaginal infections are a bit different from amniotic fluid leakages. As mentioned above, amniotic fluid leakages are clear and odourless. On the other hand, vaginal infections, maybe greyish in colour and fishy smelling and can therefore be differentiated from amniotic fluid leakages.