Leaking Amniotic Fluid During Pregnancy – Causes, Symptoms & Treatment

Pregnancy brings about many changes in your body, especially your uterus. The uterus prepares the right atmosphere for the growing foetus and ensures that it gets all the nutrients that it needs. An essential component of this nurturing process is the amniotic fluid.

The amniotic fluid keeps your baby cushioned and protected during the pregnancy. It ensures that the uterus doesn’t suffocate the baby by contracting tightly. The amniotic sac also keeps the germs away, protecting your baby from infections.

Leakage of the amniotic fluid is detrimental to the overall growth of your baby. Hence, it’s good to understand the complications associated with this leakage and the remedial measures that can be taken to treat and prevent it. Let’s dive in and learn about this leaking fluid in pregnancy and what you can do about it.

When Does the Amniotic Fluid Leak?

The amniotic fluid is held together by the amniotic sac, which has two membranes known as chorion and amnion. Leakage of amniotic fluid happens when there is a rupture in these membranes, even when you are not in labour.

Is It Common to Have Amniotic Fluid Leakage in Pregnancy?

No, the water breaking occurs during labour rather than beforehand. In medical terms, when the amniotic fluid leaks before labour, it’s referred to as PROM or premature rupture of membranes. This occurrence is relatively uncommon, with a likelihood of around 10 to 15 per cent after reaching 37 weeks of pregnancy. On the other hand, a more specific condition called preterm premature rupture of membranes (PPROM) is even rarer, happening in only 3 to 4 per cent of pregnancies. It’s important to understand that these situations involve the unexpected leakage of amniotic fluid and can require medical attention.

What Is the Normal Level of Amniotic Fluid?

Since the foetus continuously uses the amniotic fluid for its development, its level rises and falls. The level of amniotic fluid is at its highest during the 36th week of pregnancy.

The normal levels of amniotic fluid are:

• 60 ml – At 12 weeks
• 175 ml – At 16 weeks
• 400 to 1200 ml – From 36th to 38th week

After the 38th week, the level of fluid begins to reduce until delivery.

Causes of Amniotic Fluid Leakage

The most common cause of amniotic fluid leakage is labour. However, the amniotic fluid can leak during the second trimester due to many reasons.

• Labour causes a spontaneous rupture of membranes (SROM) which facilitates delivery.
• The membrane may also rupture around the 37th or the 38th week, which is known as premature rupture of membranes (PROM). This may be caused due to
  • A prior history of PROM
  • Infections in the vagina, cervix or the uterus
  • History of surgeries on the uterus or the cervical area
  • Tension in the amniotic membrane due to twin or multiple pregnancies or a large baby
  • Poor diet of the mother
  • Alcohol, drugs or smoking in the prenatal phase
  • Bacterial infection
  • Trauma to the amniotic sac due to accidents
  • Abnormal development of the uterus
• Oligohydramnios, a condition where the level of amniotic fluid is less.

Signs and Symptoms

During pregnancy, vaginal discharge and urine leakage are quite common. You can distinguish amniotic fluid from the other types of leakage with the help of this table.

Treatment

The treatment for amniotic fluid leakage depends on the stage of pregnancy. Your gynaecologist will check whether the leakage is indeed amniotic fluid and then suggest an appropriate method of treatment. In case the baby is fully developed, you may also be recommended to have labour induced and delivered.

1. For Premature Amniotic Fluid Leakage

If your water breaks ahead of the delivery date, it may be a premature amniotic fluid leakage. If so, you will need to consult a doctor immediately to prevent any chance of infection.

The foetus will be placed under observation, and the foetal heartbeat and the contractions will be tracked. Treatment is given based on the stage of the pregnancy.

• Before 24 weeks: As it’s very early for safe delivery, and there are chances of miscarriage, you will be closely monitored at the hospital.
• Between 24 and 31 weeks: You’ll be given antibiotics to avoid an infection. Steroids may be injected to aid the development of the baby’s lungs. Delivery is usually delayed until the 33rd week if the leak stops and the baby is fine.
• From 32nd to 33rd week: The baby’s lungs will be monitored and checked for maturity. Steroids may be given to develop the baby’s lungs. Antibiotic treatment is given to prevent infection, after which labour is induced.
• From the 34th week until the due date: The baby is constantly monitored, and antibiotics are given to prevent infections. A delivery becomes likely after the 34th week.

2. For Low Amniotic Fluid Levels

In case the leakage is leading to low levels of the amniotic fluid, then the following treatments are considered.

• Amnio-infusion: A catheter is used to add amniotic fluid to the uterus. This procedure provides extra padding around the umbilical cord.
• Hydration: You will be given IV or oral fluids to increase the level of amniotic fluid.

Complications

Amniotic fluid leakage, if untreated, can lead to severe pregnancy complications. Some of them are:

1. Amniotic fluid leakage during the first and second trimester can result in a miscarriage or stillbirth.
2. It can cause developmental issues in your baby.
3. You may be exposed to infection.
4. Amniotic fluid leakage can necessitate a premature and C-section delivery.
5. It can compress the umbilical cord or deprive your baby of oxygen.

Things to Consider in Case of Amniotic Fluid Leakage

If you are leaking fluid while pregnant when you least expect it to, ensure that:

• You inform your doctor immediately.
• You keep track of when the leakage began and the amount of leakage.
• You don’t insert fingers or anything else into the vagina.

When You Should Call the Doctor?

Reach out to your doctor as soon as possible in the following circumstances:

• You are leaking amniotic fluid at 20 weeks, i.e., haven’t crossed 37 weeks yet, and you suspect amniotic fluid leakage.
• You experience heavy amniotic fluid leakage, with or without vaginal discharge and a fever.
• The fluid has a greenish tinge to it. This indicates meconium, the baby’s faeces.
• You have a persistent flow of amniotic fluid.
• The leaking fluid is brownish-yellow or greenish-yellow in colour.

If you notice the leaking of amniotic fluid at 38 weeks, then labour may have begun. If the leakage happens earlier, it’s best to consult your gynaecologist for a quick diagnosis.

References/Resources:

1. Preterm labor and premature birth: Are you at risk?; March of Dimes; https://www.marchofdimes.org/find-support/topics/birth/preterm-labor-and-premature-birth-are-you-risk

2. Amniotic Fluid; Cleveland Clinic; https://my.clevelandclinic.org/health/body/23310-amniotic-fluid

3. Oligohydramnios; March of Dimes; https://www.marchofdimes.org/find-support/topics/planning-baby/oligohydramnios

4. Premature rupture of membranes; MedlinePlus; https://medlineplus.gov/ency/patientinstructions/000512.htm

5. Preterm Premature Rupture of Membranes (PPROM); Stanford Medicine; https://www.stanfordchildrens.org/en/topic/default?id=premature-rupture-of-membranes-prompreterm-premature-rupture-of-membranes-pprom-90-P02496

6. Water breaking: Understand this sign of labor; Mayo Clinic; https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142

7. Premature Rupture of Membranes (PROM)/Preterm Premature Rupture of Membranes (PPROM); Children’s Hospital of Philadelphia; https://www.chop.edu/conditions-diseases/premature-rupture-membranes-prompreterm-premature-rupture-membranes-pprom

8. Shehla Noor, et al.; Prevalence Of PPROM And Its Outcome; Journal of Ayub Medical College Abbottabad 19(4):14-7; ResearchGate; https://www.researchgate.net/publication/23162252_Prevalence_of_PPROM_and_its_outcome; October 2007

9. Fischer. R. L; Amniotic Fluid: Physiology and Assessment; Global Women’s Medicine; https://www.glowm.com/section-iew/heading/Amniotic%20Fluid:%20Physiology%20and%20Assessment/item/208; 2008

Also Read:

Water Breaking during Pregnancy
Watery Discharge in Pregnancy
How to Increase and Decrease Amniotic Fluid during Pregnancy Naturally?