True bubble of protection of the fetus during all the pregnancy, the pocket of waters plays a major role in its development and its maintenance in good health. When it cracks, you have to react quickly. We take stock of the crack in the water pocket.
The water bag is an envelope filled with amniotic fluid, in which the baby bathes during pregnancy. “It consists of two joined membranes: the amnion and the chorion”, Specifies Dr Odile Bagot, obstetrician gynecologist.
This liquid protects the fetus:
- hot and cold by keeping it at a temperature of 37 ° C;
- bacteria ;
- noises and shocks.
It also allows him to move and brings him water and mineral salts (absorbed by the mouth and the skin).
The crack and the rupture of the water pocket are two different things
Water can be lost in two ways: by a rupture of the pocket or by a crack in the pocket. The rupture of the water pocket corresponds to the complete rupture of the membranes. It is easily identifiable because the flow is frank and rather abundant. It is a translucent, odorless liquid.
The crack in the water pocket is characterized by a partial rupture of the two membranes. “In this case, the flow felt by the pregnant woman is light but continuous and the pants are wet ”, says the gynecologist. It most often occurs at the end of pregnancy.
The crack in the water pocket is not always easy to identify
More discreet than the rupture of the water pocket, the crack can sometimes be confused with vaginal discharge or urinary leakage, which is frequent in late pregnancy. So how do you tell the difference? “Amniotic fluid looks like water and it has no particular odor unlike urine. As for vaginal discharge, it is often milky or transparent and a little viscous, which is not the case with amniotic fluidSays the specialist.
Small tip to differentiate a cracking of the pocket of the waters from a urinary incontinence: if the losses manifest themselves with laughter, coughing or during an effort, it is very likely that it is a urinary leak. On the other hand, if your fluid losses persist even after going to the toilet to urinate, it is a sign of a crack in the water bag.
In any case, if a crack in the water pocket is suspected, Dr. Bagot recommends that all pregnant women contact the health professional who is following the pregnancy (gynecologist or midwife) without further delay to decide whether or not to consider it. an emergency visit to the maternity unit.
She puts the baby at risk of infection
A crack in the water bag should always be taken seriously as it puts the baby at risk of infection, which is potentially dangerous when it occurs before the end of pregnancy. “This is called chorioamniotitis, infection of the chorion and amnion. It can be one of the consequences of the crack in the water pocket but it can also be the cause”, Warns Dr. Bagot. Indeed, the pocket being partially ruptured, it no longer plays its role of bacteriological protector because the egg is opened and the germs present in the vagina can reach it. In addition to this risk of infection, there is a risk of prematurity, respiratory distress, descent of the umbilical cord before the baby during delivery and irregular presentations.
For mom, there is an increased risk of cesarean and uterine infections.
Management differs depending on the stage of pregnancy
The diagnosis of the crack in the water pocket is simple. It is based on the patient’s interrogation and the assessment of the pH inside the vagina using a nitrazine test. It consists of inserting a small stick inside the vagina, if it changes color, this means that the pH is alkaline, a sign of the presence of amniotic fluid (the pH of the vagina is normally acidic).
Once the crack in the water pocket is confirmed, treatment will depend on the term of the pregnancy.
When the crack occurs after 35 weeks of pregnancy
At this stage, the baby can be born without problem. A blood test is prescribed to detect a possible infection thanks to an assay of the reactive protein C. If labor has not started spontaneously within 12 hours of rupture of the membranes, antibiotic treatment is given to the expectant mother. “Birth is started within 24 to 48 hours of rupture of the membranesSays the gynecologist. Samples will also be taken from the newborn after birth to detect a possible infection.
When the crack occurs between 22 and 35 weeks of pregnancy
Resting until delivery (lying down to limit fluid loss) and hospitalization are essential. The goal is to prolong the pregnancy as long as possible to reach at least 35 weeks of pregnancy.
Meanwhile :
- corticosteroid injections are given to the mother to speed up the baby’s lung development in case he is born before term.
- antibiotic treatment is in place to reduce the risk of infection.
- tocolysis may be considered (in the absence of infection).
- the expectant mother is put on monitoring to monitor the baby's health and the amount of amniotic fluid is evaluated by ultrasound.
In case of infection, delivery should be by vaginal delivery or by caesarean section depending on the presentation of the baby and the term of the pregnancy.
When the crack occurs before 22 weeks of pregnancy
The crack in the water bag is rare at this stage of pregnancy, but it is more dangerous for the baby. Again, the goal is to prolong the pregnancy for as long as possible while lying down. Antibiotic treatment is prescribed to prevent possible infection. The expectant mother is placed under high surveillance (the amount of amniotic fluid is checked regularly as is the level of CRP in the blood). At the slightest problem (infection, intrauterine growth retardation, absence of amniotic fluid, etc.), a medical termination of pregnancy can unfortunately be considered.
Certain factors increase the risk of a water pocket crack
The cause of a crack in the water pocket is not always identified. However, there are different risk factors:
- a urinary tract infection;
- a history of preterm delivery;
- a history of premature rupture of the membranes;
- open bite in the cervix;
- smoking;
- a placenta previa.
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