The outpouring of water is considered:

• early, if it occurs in the first stage of labor until complete or almost complete (7-8 cm) dilation,
• premature if the amniotic sac ruptures before regular contractions occur,
• belated if, when the uterine os is fully dilated, the fetal bladder remains intact for some time.

Causes

The exact causes of early or premature rupture of water are not known. However, in those women who were prepared for childbirth, such cases are less common. This is largely due to the woman’s emotional state, her ability to relax and her general attitude towards a successful birth.

What to do?

In the event of a sudden break of water, even if there are no contractions yet or they are weak and at large intervals, it is necessary to go to the maternity hospital immediately, without delay. It should be remembered that the more time passes after the water breaks, the higher the likelihood of complications. After all, the fetus is no longer protected by the membranes, and the risk of infection increases.

Be sure to note the time when your water broke. Pay attention to their color and smell. Normally, the waters are clear or slightly pink, odorless. Slightly greenish, dark brown or black color amniotic fluid indicates that the child is experiencing oxygen starvation and he needs urgent help. The unusual color of the waters is associated with the ingress of meconium (original feces), which is released from the intestines of the fetus during hypoxia.

Course of labor

Typically, labor develops 5-6 hours after rupture of the membranes. If contractions do not begin soon after the water breaks, they are stimulated.

The course of labor largely depends on the readiness of the woman’s body (cervix) for it, on the strength of labor and the location of the presenting part of the fetus. If the cervix is ​​ready for labor, premature rupture of amniotic fluid may not interfere with its normal flow.

Consequences

In some cases, premature or early rupture of amniotic fluid can lead to:

• weakness of labor,
• protracted course of labor,
• fetal hypoxia,
• fetal intracranial injury,
• inflammatory processes of the membranes and muscles of the uterus.

At belated outpouring of water Doctors perform an artificial opening of the fetal bladder - amniotomy.

Premature effusion amniotic fluid (AMF) is observed in only 2-5% of all pregnancies, but in 40% it is accompanied premature birth. The discharge of amniotic fluid due to rupture of the membranes is premature if it occurs before the onset of labor, regardless of the duration of pregnancy. Normally, the outpouring of water occurs at the end of the first stage of labor with complete (or almost complete) dilatation of the cervix. If the waters are poured out at the beginning of labor before the cervix is ​​dilated, then this is an earlier discharge of amniotic fluid. The time between the release of water and the onset of contractions is called the latent period. And the time between the outpouring of water and the birth of the fetus is a waterless interval. If the anhydrous interval is more than 6 hours, then the risk of purulent-septic complications for the mother and fetus increases sharply.

PIOV can happen simultaneously and then special diagnostics are not required. But in a third of cases, there is a slight leakage of amniotic fluid (due to the formation of microcracks in the membranes, or the occurrence of ruptures in the lateral sections of the amniotic bladder). This looks like an increase in vaginal discharge (which already increases in the third trimester of pregnancy). Therefore, recognizing this complication can be difficult.

What should a pregnant woman be wary of:

• increase in quantity vaginal discharge;
• change of character vaginal discharge (more abundant and watery);
• increased discharge when lying down;
• pain in the lower abdomen and bloody issues.

Factors that can lead to premature rupture of amniotic fluid:

1. Inflammatory diseases maternal genital organs and intrauterine infection (vaginitis, cervicitis, amnionitis). It has been proven that enzymes secreted by bacteria soften the membranes and can lead to their rupture. It is also possible for infection to penetrate to the fetus even through intact membranes.

2. Overdistension of the uterus(polyhydramnios);

3. Isthmic-cervical insufficiency(if the cervix is ​​incompetent, the fetal bladder protrudes, which leads to its rupture even with minor injuries);

4. Injuries (blunt abdominal injuries due to a fall or blow), sexual intercourse can also cause PIOV;

5. Fetal malformations;

6. Mother's bad habits(alcoholism, drug addiction);

7. Instrumental medical intervention ();

8. Lack of vitamins in the pregnant woman's body and trace elements (eg, ascorbic acid, copper) may contribute to the development of PIOV;

How to diagnose PIOV?

Of course, a doctor must diagnose this complication. If you suspect leakage of amniotic fluid, you must immediately contact the antenatal clinic or the emergency hospital.

2. Infectious complications(chorioamnionitis, endometritis, fetal infection);

3. Loss of umbilical cord loops, premature placental abruption.

Probability of labor development depends on the duration of pregnancy, the shorter the period, the longer the latent period (the period from effusion to the onset of contractions).

During pregnancy before 28 weeks the risk of premature birth is low If childbirth has taken place, then there is a high probability of lung hypoplasia in the fetus (underdevelopment of the lungs). Without special treatment after PIOV (if the latent period is long), the risk of infectious complications increases.

With a gestational age of 28-37 weeks with premature rupture, labor begins within 48 hours in 50% of cases.

For more than 37 weeks labor begins within 72 hours in almost 98% of pregnant women.

Infectious complications occur in 10-16% of cases. The incidence of infectious complications increases as the anhydrous interval increases.
Chorioamnionitis (inflammation of the membranes) is clinically manifested by an increase in body temperature in a woman (more than 37.5 C), the appearance of vaginal discharge with unpleasant smell, as well as tachycardia (increased heart rate) in the fetus (more than 160 per minute) and mother, and the uterus is painful on palpation. Chorioamnionitis can lead to intrauterine infection of the fetus, and even sepsis. Therefore, timely detection and treatment of this formidable complication is very important.

The tactics for managing pregnant women with premature rupture of amniotic fluid depends on many factors - the duration of pregnancy, the presence of labor, the condition of the cervix, and the condition of the fetus.
All women with PIOV are subject to hospitalization with dynamic observation (you should be examined by a doctor every 12 hours). Blood tests (clinical, biochemical, C-reactive protein test) and vaginal smears are required. It is also necessary to perform an ultrasound examination (with Doppler sonography), as well as a CTG (CTG) to assess the condition of the fetus.

Leakage of amniotic fluid or premature rupture of amniotic fluid (PIV or PIOV in different sources) is the rupture of the membranes and the rupture of amniotic fluid before the onset of regular labor with dilatation of the cervix up to 7 - 8 cm.

Normally, the discharge of amniotic fluid occurs spontaneously in the first stage of labor, when the cervix reaches 7–8 cm dilatation; during the next contraction, the woman notices a copious flow of fluid not associated with urination. After the water breaks, contractions usually intensify and the labor process accelerates.

Premature rupture of water can occur at any stage of pregnancy, as there are many factors that provoke this condition.

Predisposing factors for leakage of amniotic fluid:

1. Invasive diagnostic methods (amniocentesis)

Amniocentesis is a diagnostic method that involves puncture of the amniotic sac through the anterior abdominal wall under anesthesia and ultrasound control and sampling amniotic fluid for biochemical and chromosomal analysis.

In approximately 1% of cases, this procedure is complicated by termination of pregnancy, you will be warned about this in advance and the final decision is always made by the patient.

2. Untreated colpitis of various etiologies

Inflammation of the genital tract progresses without treatment; bacteria (most often a mixed infection) have an invasive ability and, with the help of their enzymes, dissolve the membranes. The connection between infection and premature rupture of amniotic fluid has been proven by many clinical studies; in about a third of cases, leakage of water is the main cause.

3. Intra-amniotic infection

Intra-amniotic infection acts in the same way (damages the membranes) only from the inside. Infection is introduced into the amniotic sac in different ways, both through the blood and ascending from the genital tract (infection from the vagina penetrates into the amniotic fluid without damaging the amniotic sac and already develops massively inside).

4. Clinically narrow pelvis, abnormal fetal positions (oblique, transverse, pelvic), multiple pregnancy, polyhydramnios

Normally, the fetal head at full term is pressed against the bony ring of the entrance to the pelvis, and thereby divides the amniotic fluid into anterior (in front of the fetal head) and posterior (all others). In these conditions, the head of the fetus/the first fetus of twins/triplets is high and there is a lot of water in the lower pole of the amniotic sac, which mechanically puts pressure on the membranes and the risk of leakage of amniotic fluid increases significantly.

ICN - shortening of the cervix and expansion of the internal uterine os, not corresponding to the gestational age ( ahead of schedule). The expansion of the internal os of the uterus can lead to prolapse (protrusion) of the fetal bladder outward, which leads to infection and rupture of the membranes.

Symptoms of amniotic fluid leakage

I. Rupture of membranes(this is an obvious condition, which is accompanied by the rupture of anterior amniotic fluid)

1) Copious painless discharge of light (turbid/greenish/straw-colored, etc.) fluid not associated with urination

2) Decrease in the height of the uterine fundus (the outpouring of water reduces the intrauterine volume and the abdomen becomes smaller in size and denser)

3) The development of labor after the rupture of water (does not always occur; the rupture of amniotic fluid in the early stages, as a rule, does not provoke the immediate development of labor)

4) Changes in fetal movements (slowing down movements, as the volume of the uterus has decreased and its tone has increased)

II. High/lateral opening of membranes(this condition may go unnoticed, as it occurs with subtle symptoms and is extended over time)

1) An increase in vaginal discharge, which becomes thinner, waterier, soaks the underwear and does not stop. They also get worse when coughing and lying down (for the majority).

2) Nagging pain in the lower abdomen, bleeding (does not always happen)

3) Change in fetal movements

Complications of premature water leakage

- termination of pregnancy (most often we are talking about late miscarriage up to 22 weeks)

- premature birth. Premature birth occurs between 22 weeks and 36 weeks and 5 days and entails many complications for the mother and fetus, the severity of the condition depends on the stage of pregnancy.

Abnormalities of labor (weakness of labor, discoordination of labor, etc.)

- hypoxia and asphyxia of the fetus (a long anhydrous period and anomalies of labor lead to disruption of the blood supply to the fetus through the umbilical cord and oxygen starvation of the fetus of varying severity develops)

Respiratory distress syndrome in a newborn (the surfactant in the baby’s lungs matures closer to 35 - 36 weeks, earlier rupture of water and childbirth entail inferior lung function)

Infectious and inflammatory complications in a newborn (inflammatory skin diseases, congenital pneumonia)

Intraventricular hemorrhages, cerebral (cerebral) ischemia in a child

Skeletal deformation and self-amputation of limbs in a child during a long anhydrous period (amniotic cords are formed that injure the fetus)

Chorioamnionitis (inflammation of the membranes during a long anhydrous period)

Postpartum endometritis. Endometritis (or metroendometritis) is an inflammation of the internal uterine wall, which most often develops in women with premature rupture of water, and the longer the anhydrous period (without antibiotic prophylaxis), the higher the risk of the disease. If chorioamnionitis develops during childbirth, then in the postpartum period there is an extremely high probability of developing endometritis.

Obstetric sepsis. Obstetric sepsis is the most serious infectious and inflammatory complication in the postpartum period with high mortality.

How to detect water leakage

1. How can you determine premature rupture of water at home?

If you noted unclear abundant watery discharge, then you should urinate, take a shower, dry yourself (dry the crotch thoroughly) and put a clean, dry white pad (a white cotton diaper is best) between your legs, after 15 minutes you should check the pad. Or lie down on a dry sheet without underwear. A wet spot on the sheet or a wet lining indicates possible leakage of amniotic fluid. In this case, you should pack a minimum of things to the maternity hospital and call “ Ambulance"(or go to the emergency room of the maternity hospital yourself).

- if you suspect water leakage, but the discharge is not abundant, does not wet the laundry, does not have a special smell or color, then you can do it at home placental microglobulin test(PAMG – 1), on this moment it is produced only under one brand name: Amnisure ROM Test (Amnishur).

This is a test - a system intended for independent use; all the necessary items indicated are included in the kit.

How to do a water leak test:

Place a tampon into the vagina to a depth of 5–7 cm for a period of one minute
Immerse the swab in the solvent tube for 1 minute and rinse well with a rotating motion.
Place the test strip in the tube for 15 – 20 seconds
Place the strip on a clean, dry surface and after 5 - 10 minutes you can evaluate the result
One strip – there is no leakage of water, two stripes – there is leakage of amniotic fluid
Test reliability 98.7%
Do not read the result if more than 15 minutes have passed

Test pads for leakage of amniotic fluid (Frautestamnio, Al-sense) are a pad with a reagent-impregnated area (indicator) or liner. The indicator contains a colorimetric indicator that changes yellow in blue – green when in contact with liquids with high pH. Normally, the pH in the vagina is 3.8-4.5, the pH of amniotic fluid is 6.5-7. The test pad changes color when it comes into contact with a liquid that has a pH level greater than 5.5.

The pad should be attached to the underwear as usual, with the yellow indicator facing the vagina. The pad is used for about half an hour, or until sufficiently moistened, it can be used for up to 12 hours, and then the color is assessed and compared with the color scale on the packaging. Blue – green color may indicate leakage of amniotic fluid. The indicator color remains stable for up to 48 hours. If after drying the color turns yellow again, this most likely means that there was a reaction with ammonia in the urine. But only a doctor will give you a final conclusion.

There are also gaskets on sale with a removable indicator liner (Al - Rekah), after using the gasket as described above, the liner is removed by pulling the protruding tip, placed in a bag and wait for the result for about 30 minutes. The color will also change to blue-green.

The gaskets are easy to use and accessible, but their information content is somewhat lower than the test systems.

A false positive result can be caused by:

Colpitis of any etiology
- bacterial vaginosis
- recent sexual intercourse
- douching

In all these cases, the pH of the vaginal secretion changes and a false positive result is possible.

2. Obstetric diagnosis of water leakage

Gynecological examination in speculum with cough test

When examined in the speculum, the cervix is ​​exposed, and the doctor asks the patient to cough; if the amniotic sac ruptures, the amniotic fluid will leak in portions with a cough impulse. Sometimes, when examined in the mirrors, a clear leakage of water is visible, the fluid is in the posterior fornix, then a cough test may not be performed.

The nitrazine test (amniotest) shows the most reliable result within 1 hour after the water is poured out. The amniotest is a swab with a cotton tip soaked in a reagent, which must be placed in the posterior vaginal fornix and the color change assessed. However, a false positive result can be caused by the same factors as when using test pads.

Ultrasound (the ultrasound doctor measures the level of amniotic fluid, also known as the amniotic fluid index - AIF, and compares it with the data of the previous ultrasound; after the rupture of water, it decreases sharply).

Oligohydramnios (severe oligohydramnios) in combination with fluid leakage confirmed by gynecological examination confirms the diagnosis of PIV.

Treatment for leakage of amniotic fluid

Tactics for the expiration of amniotic fluid at different times.

Up to 22 weeks

Prolonging pregnancy is not advisable due to the minimal chance of fetal survival and the frequency of purulent-septic complications on the part of the mother. The patient is subject to hospitalization in the gynecological department, where the pregnancy is terminated for medical reasons.

22–24 weeks

Hospitalization of the patient to the pregnancy pathology department and explanation of the risks and consequences for the mother and fetus.

The prognosis for the fetus at this stage is still extremely unfavorable. Parents are warned that children born at this stage are unlikely to survive, and those that survive will not be healthy (the risk of cerebral palsy, blindness, deafness and other neurological disorders is high). If the patient categorically insists on prolonging pregnancy, despite these risks, antibiotic prophylaxis is carried out as indicated below.

25 – 32 weeks

Up to 34 weeks, in the absence of contraindications, expectant management is indicated, taking into account the duration of pregnancy. Waiting tactics in the period 25 – 32 weeks no more than 11 days.

32 – 34 weeks

Watchful waiting is indicated for no more than 7 days.

34 – 36 weeks

Waiting tactics are indicated for no more than 24 hours.

37 weeks or more

Expectant management is indicated for no more than 12 hours, then the beginning of labor induction is indicated. In this case, antibiotic prophylaxis begins after an 18-hour water-free period.

Contraindications to watchful waiting:

Chorioamnionitis
- preeclampsia/eclampsia
- premature abruption of a normally located placenta
- bleeding with placenta previa
- decompensated condition of the mother
- decompensated condition of the fetus

If there is a contraindication to expectant management, the method of delivery is selected on an individual basis.

Waiting tactics

1. Examination of the cervix in speculum, vaginal examination is carried out only upon admission, not further

2. During the initial examination in the speculum - culture for flora and sensitivity to antibiotics

When the fact of ruptured water is established, immediate initiation of antibiotic prophylaxis for purulent-septic complications of the mother and fetus (chorioamnionitis, neonatal sepsis, obstetric sepsis)

Erythromycin peros 0.5 g every 6 hours to 10 days;

Ampicillin peros 0.5 g every 6 hours up to 10 days;

or when beta-hemolytic streptococcus is detected in microbiological cultures

Penicillin 1.5 g IM every 4 hours

3. Prophylaxis of respiratory distress syndrome (RDS) with dexamethasone (8 mg IM No. 3 under the supervision of a physician with monitoring of fetal movements and heartbeat), it should take about two days to obtain an effect. Dexamethasone is a glucocorticoid hormone that accelerates the maturation of surfactant in the baby's lungs. Prevention of SDR is carried out within 24–34 weeks.

4. Thermometry every 4 hours

5. Monitoring the fetal heart rate, discharge from the genital tract, and uterine contractions at least 2 times a day

6. Complete blood count upon admission and subsequently at least once every 2-3 days;

7. Ultrasonography Once every 7 days with determination of the amniotic fluid index and Doppler blood flow in the uterine arteries and umbilical cord artery

8. Cardiotocography with assessment of a non-stress test (reaction of the fetal heartbeat to its own movements) at least 1 time per day

9. If there are uterine contractions with a frequency of more than 3-4 in 10 minutes - tocolysis (introduction medicines, which relieve contractile activity of the uterus, the drug hexoprenaline is most often used; the dose and rate of administration are chosen by the attending physician)

10. If labor develops no less than 48-72 hours after the first injection of dexamethasone, tocolysis is not performed.

After the maximum waiting period has expired, a consultation of doctors is examined to select a method of delivery. Preparation of the cervix and labor induction or caesarean section are possible. Both methods have their advantages and risks, so in each case the issue is resolved strictly individually.

Pregnant women with HIV infection

1. For PIV after 32 weeks - immediate induction of labor.

2. For PIV up to 32 weeks, expectant management is indicated, aimed at preventing fetal SDR and chorioamnionitis (antibiotic prophylaxis, as indicated above).

3. Prevention of vertical transmission of the virus.

4. Labor induction is indicated 48 hours after the start of fetal SDR prophylaxis.

5. With premature rupture of amniotic fluid C-section does not reduce the risk of transmission of the virus from mother to fetus.

Despite the simplicity and availability of home diagnostic methods, you should not neglect an emergency visit to your doctor if you suspect leakage of amniotic fluid. The earlier the diagnosis is made, the more favorable the result at any stage of pregnancy. We wish you have a safe pregnancy and easy delivery on time. Take care of yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

During pregnancy, the uterine cavity is filled with a special fluid - amniotic fluid. The name itself explains that this liquid surrounds the fetus. It is necessary to protect a growing baby from external influences - bruises, compression, hypothermia and overheating, and protects him from the penetration of viruses and bacteria. In addition, the presence of water allows the child to move quite freely, which contributes to proper development.

The danger of prenatal rupture of amniotic fluid
Normally, rupture of the membranes and rupture of water occurs in the first stage of labor. However, in some cases, the amniotic sac ruptures long before labor begins. If you are more than 22 weeks pregnant, this is called antepartum rupture of membranes (APL). It is divided into two types: DIV before the onset of premature labor - when the membranes rupture before the full 37 weeks of pregnancy - and DIV before the onset of term labor, if this occurs later.
Actually, antenatal rupture of water complicates the course of premature pregnancy only in 2% of cases, but is associated with 40% of premature births and, as a consequence, is the cause of a significant part of neonatal morbidity and mortality. The risk for the mother is associated primarily with chorioamnionitis - inflammation of the membranes (chorion and amnion) resulting from their infection.
The incidence of antenatal rupture of water in full-term pregnancy is about 10%. Most women after DIV develop labor independently:
. almost 70% - within 24 hours;
. 90% - within 48 hours;
. in 2-5% labor does not begin within 72 hours;
. In almost the same proportion of pregnant women, labor does not occur even after 7 days.
In 1/3 of cases, the cause of DIV during full-term pregnancy is infection (subclinical forms).
There is a proven connection between ascending infection from the lower genital tract and prenatal rupture of amniotic fluid. Every third patient with DIV with premature pregnancy has positive tests for the presence of urogenital infection; moreover, studies have proven the possibility of bacteria penetrating even through intact membranes.

Further pregnancy or childbirth?
A high rupture of membranes is said to occur when the membranes rupture not in the lower pole, but above. If there is any doubt whether it is water or just liquid leucorrhoea from the vagina (a typical situation with a high lateral rupture of the membranes), you must urgently visit a gynecologist, having first placed a “control” diaper so that the doctor can assess the nature of the discharge. In doubtful cases, a vaginal smear is taken to check for the presence of amniotic fluid or an amniotest is performed.
If leakage of amniotic fluid is confirmed, but there are no contractions, the doctor decides on further management of the pregnancy depending on its duration. Until 34 weeks, obstetricians do everything possible to prolong it, since the fetal lungs are immature and after birth the newborn may experience respiratory disorders.
The woman is under constant observation (body temperature is measured, the content of leukocytes in the blood is examined, a clinical blood test, ultrasound, CTG - a study of fetal cardiac activity, a study of discharge from the genital tract for infections is carried out). The expectant mother is prescribed strict bed rest in a hospital setting, if necessary, antibacterial therapy is administered, and drugs are administered that accelerate the maturation of the fetal lungs (Dexamethasone, Betamethasone). If it is not possible to prolong pregnancy and childbirth occurs before 35-36 weeks, then surfactant is used to treat respiratory disorders in newborns.
If there are no signs of infection and there is a sufficient amount of water in the amniotic sac according to ultrasound, pregnancy can be extended to 35 weeks. If, as a result of the examination, it is discovered that the uterus tightly covers the fetus and there is no water, you cannot wait more than 2 weeks even if there are no signs of infection (however, this situation is extremely rare). At 34 weeks or more, when water leaks, the woman is prepared for the upcoming birth.

Two tactics for premature rupture of water
In case of premature rupture of amniotic fluid, doctors choose between expectant and active tactics, and the patient and her family should receive full information about the benefits and risks of both approaches.
Thus, the advantage of expectant management is the development of spontaneous labor, reducing the proportion of births by cesarean section and associated complications of anesthesia, the operation itself and the postoperative period. However, this significantly increases the likelihood of developing an infection.
The use of active tactics prevents infection. But then the risks inevitable during labor induction increase significantly: hyperstimulation, increased frequency of cesarean sections, pain, discomfort and the development of septic complications in the mother. Elective cesarean section, compared with vaginal birth, does not improve outcomes for the premature baby and increases maternal morbidity. Therefore, birth naturally for a premature fetus in a cephalic presentation is preferable, especially after 32 weeks of intrauterine development. The decision to choose a method of delivery is made strictly individually based on clinical data, and surgery is performed according to routine obstetric indications.

The importance of prolonging pregnancy
The problem of premature birth has an important social aspect. The birth of a premature sick child is a psychological trauma for the family. About 5% of premature babies are born before 28 weeks of pregnancy (extreme prematurity), with extremely low body weight up to 1000 g; 15% appear at 28-31 weeks weighing up to 1500 g (severe prematurity); 20% - at 32-33 weeks. In all these groups there is marked immaturity of the lungs. Moreover, the shorter the pregnancy, the more pronounced the symptoms of respiratory failure. Finally, 60-70% of babies are born at 34-36 weeks. Prolonging pregnancy indirectly helps prepare the premature fetus for birth. Therefore, specialists at St. Petersburg Maternity Hospital No. 16 adhere to a wait-and-see approach. In case of full term and immature birth canal, therapeutic tocolysis is prescribed (long-term, about 6 hours, intravenous drip administration of Ginipral).

Our many years of experience in managing preterm birth with DIV shows what can be achieved good results in terms of survival of fetuses with extreme body weight, it is precisely by maximizing the possible prolongation of pregnancy. Among other things, qualified prenatal care, effective prevention of the development of respiratory distress syndrome, antibacterial therapy and gentle delivery are used. Every year, about 5,000 children are born in the 16th maternity hospital, of which approximately 10% are the result of premature birth. In almost half of the cases, their mothers' pregnancies were prolonged, including for the maximum possible period - from the 23rd to the 27th week. In addition, we have accumulated experience in long-term prolongation of twin pregnancies with premature rupture of water in the first fetus during the period of extreme prematurity. This allows babies to be born, albeit prematurely, but quite viable. Moreover, the longer the anhydrous period lasted, the more mature the fetal lungs turned out to be. Premature babies, and sometimes even fetuses with extremely low body weight, could breathe on their own.

An analysis of expectant management of labor during full-term pregnancy and period of pregnancy revealed a sharp decrease in birth trauma in newborns associated with labor stimulation, carried out earlier with an increase in the anhydrous interval of more than 2 hours, and the absence of labor. The percentage of surgical deliveries among women who underwent pregnancy prolongation decreased 4 times. Women entered labor on their own, without additional stimulation. Experience shows that expectant management during full-term pregnancy can be carried out for up to 4 days, and only a longer water-free period is fraught with serious problems.

In conclusion, I would like to note that premature rupture of amniotic fluid is not a reason for panic, but for an early visit to the doctor. If you quickly take the necessary measures, pregnancy in most cases can be extended to a period when the life of even a premature baby is out of danger. Therefore, the main thing for an expectant mother is to know where and who to turn to to receive qualified medical care.

Vladimir Shapkaits, chief physician of St. Petersburg State Healthcare Institution “ Maternity hospital No. 16",

Doctor of Medical Sciences, Professor, obstetrician-gynecologist of the highest qualification category

Elena Rukoyatkina, Deputy Chief Physician for the Medical Department of St. Petersburg State Healthcare Institution “Maternity Hospital No. 16”,

Candidate of Medical Sciences, obstetrician-gynecologist of the highest qualification category

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 solid amniotic sac? Let's talk about this topic.

Throughout pregnancy, the fetus floats in the amniotic fluid that fills the amniotic sac. She performs big set functions. Amniotic fluid is involved in the baby's metabolism, protects him from external influences (mechanical, sound, light) and various infectious diseases. In addition, it helps train the child’s digestive and respiratory systems. Amniotic fluid is constantly renewed. Its quantity can also tell about the condition of the fetus inside the womb.

The discharge of amniotic fluid normally occurs during birth process. As the cervix ripens, the membranes soften and enzymes are released to help the placenta separate. The amniotic sac loses its elasticity and strength and bursts. Amniotic fluid leaks out. After the amniotic fluid breaks, contractions usually intensify.

If the amniotic sac loses its integrity before the fetus matures and is ready for natural birth, then they speak of premature rupture of the membranes. The degree of threat to mother and child is assessed depending on the duration of pregnancy. The main risks are due to premature 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 earlier due date, and the released enzymes thin the amniotic sac and lead to separation of the placenta. In this case, the baby is most likely to become infected.

PPROM (premature rupture of the membranes) can also be caused by structural features of the pelvis, the condition of the cervix, and the position of the fetus. A weak neck creates conditions for the bladder to protrude and disrupt its integrity. The narrow pelvis and unusual position of the fetus create a dangerous condition when most of the water accumulates at the bottom of the bladder and ruptures it. Normally, the fetus is tightly adjacent to the pelvic floor and creates a zone of contact that does not allow the bulk of water to pass to the bottom of the bladder.

Medical intervention associated with puncture of the bladder for fluid analysis may provoke further damage to the integrity. Uterine abnormalities such as the presence of a septum, placental abruption, polyhydramnios, and multiple pregnancies are risk factors. Physical activity can provoke premature rupture of amniotic fluid during a full-term pregnancy; in a premature pregnancy, blunt trauma to the abdomen and bad habits mothers associated with the use of alcohol, nicotine, and drugs. Taking some potent medications can also have a negative effect.

It is quite easy to detect symptoms of rupture of amniotic fluid. In this process, quite a large number of liquid so that it can be confused with something else. The waters are normally colorless and have a slightly sweet odor. 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 taken for vaginal discharge. Another sign of premature rupture of amniotic fluid is an increase in the amount of discharge in the lying position.

If leakage of amniotic fluid is suspected, tests are prescribed - pH smear, ultrasound. They may offer amniocentesis with dyeing or some other techniques. 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 risks of complications. If the pregnancy is full-term, then labor usually occurs spontaneously within the next two days. In this case, the woman is placed in a hospital and is under observation. The genital tract is sanitized to avoid infection, and the birth canal is prepared. Deciding to wait for a natural birth can reduce 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 the 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. To do this, the woman is placed in virtually sterile conditions. Provide bed rest and antibiotic prophylaxis. Everything is done to preserve the life and health of mother and baby.

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