Test for determining the leakage of amniotic fluid

Leakage of amniotic fluid can occur at various stages of pregnancy and may indicate various underlying conditions. At the "Dobrobut" Medical Center, experienced doctors perform tests that help determine whether there is leakage and choose the optimal strategy for managing the pregnancy and childbirth.

Causes of Amniotic Fluid Leakage

If the amniotic sac (amniotic membrane) ruptures before 37 weeks of pregnancy, it can lead to preterm labor, posing risks to the child's health due to prematurity, including respiratory issues and infections. If the amniotic sac ruptures after 37 weeks but before labor begins, it may indicate impending labor. In this case, it is necessary to monitor the amount of fluid leaking, and sometimes labor may need to be induced to prevent infection.

Causes of amniotic fluid leakage may include:

• Infections, such as bacterial vaginosis and sexually transmitted infections (STIs). Due to the infectious process, the amniotic sac weakens, which can lead to premature rupture. Such infections include those detected later in pregnancy (post-37 weeks).
• Trauma. Any significant abdominal trauma can cause the rupture of the amniotic membranes, resulting in fluid leakage. This may involve accidents, falls, or direct impacts to the abdominal area.
• Excess amniotic fluid (polyhydramnios): a larger volume of amniotic fluid increases pressure on the amniotic sac, which may lead to rupture and leakage.
• Weakness of the amniotic sac. Sometimes, the membranes can be inherently weaker and more prone to rupture under lower pressure.
• The onset of normal labor: typically, the amniotic sac ruptures during the natural process of labor, a process known as "breaking the waters," which is a sign that labor is imminent.

Symptoms of Amniotic Fluid Leakage

Signs of amniotic fluid leakage include:

• A sudden and continuous gush of clear or slightly colored fluid from the vagina;
• A constant trickle of fluid from the vagina, which may be mistaken for urine or increased discharge;
• The fluid has a different consistency and smell from urine, generally clear and odorless or has a slight sweet smell;
• Decreased fetal movement;
• Ultrasound signs of reduced fluid levels;
• Suspected infection.

If there is a suspicion of amniotic fluid leakage at any stage of pregnancy, it is essential to consult a doctor immediately. Timely diagnosis and effective treatment can help reduce risks to both mother and child.

What to Do: Tests to Determine Amniotic Fluid Leakage

Tests to determine amniotic fluid leakage are designed to diagnose premature rupture of membranes (PROM), a condition in which the amniotic sac ruptures before labor begins. Identifying PROM is crucial because it can have serious consequences for the health of both the mother and the fetus, including the risk of infection and preterm delivery.

To diagnose the condition of the pregnant woman, it is important to determine whether PROM is present or if the fluid leakage is coming from another source. For this, an express test — Actim, specifically designed to identify amniotic fluid — is often performed.

Additionally, the following methods are used to determine amniotic fluid leakage:

• Assessment of vaginal discharge and examination of the cervix for amniotic fluid accumulation in the vaginal fornix;
• Nitrazine test — amniotic fluid has an alkaline reaction, so placing a sample of the fluid on nitrazine paper will yield a pH level above 6.5;
• Fern test: a sample of vaginal discharge is placed on a microscope slide and allowed to dry; under the microscope, amniotic fluid forms a fern-like pattern as it dries;
• Amnisure test: a rapid immunoassay that detects placental alpha-microglobulin-1 (PAMG-1), a protein present in amniotic fluid;
• Actim — a common test for diagnosing PROM by detecting the presence of a specific insulin-like binding protein, insulin-like growth factor binding protein-1 (IGFBP-1), which is found in high concentrations in amniotic fluid.

How to Check for Amniotic Fluid Leakage

Tests for amniotic fluid leakage include several steps and are conducted in clinical settings according to the following plan:

1. A sterile swab is taken from the vaginal area to collect a sample of the fluid.
2. The swab is placed in a testing solution that extracts proteins specific to amniotic fluid.
3. The solution is applied to a test strip containing specific antibodies that respond to the presence of IGFBP-1.
4. After 5-10 minutes, the test strip is read. A positive result indicates the presence of IGFBP-1 and, therefore, confirms the leakage of amniotic fluid.

Advantages of the Amniotic Fluid Leakage Test

Conducting a test for amniotic fluid leakage has several advantages:

• Rapid results: the test is evaluated within minutes, facilitating quick diagnosis and treatment.
• Non-invasiveness: the procedure is safe and easy to perform — only a swab and test strip are needed.
• High accuracy: tests such as Actim PROM are very sensitive and specific, reducing the likelihood of false positives or false negatives.
• Cost-effectiveness: the test is relatively inexpensive, making it accessible for routine use.
• Convenience: the procedure can be performed in various settings, including outpatient clinics, hospitals, and even by a gynecologist at home.

Early and accurate diagnosis enables timely medical intervention, which is crucial in reducing the risks associated with PROM, such as infection or preterm delivery.