We often see in movies, soap operas, or even with a friend or close relative, that the water breaks and, right away, labor begins. But things don’t always happen as expected. Some surprises may occur, and one of them is a ruptured amniotic sac1.
What is a ruptured amniotic sac?
First, let me explain what the amniotic sac is. During pregnancy, the fetus is surrounded by a membrane inside the uterus that contains a fluid produced by the fetus itself. This fluid protects the baby from impacts and possible problems with infections. It is within this sac that the baby grows and develops, receiving nourishment from the placenta.
The ruptured amniotic sac is, in many cases, stealthy. It can let all the amniotic fluid leak out without the woman noticing that this is the reason for so much vaginal moisture. Many times, first-time moms may complain to their obstetrician, who says that this moisture is normal. However, the doctor should take action.
It is ideal to investigate the moisture if it is so much that it wets clothing, as was my case. A ruptured sac can make it easier for bacteria to get in, which are the cause of infections in the fetus and consequently in the mother, or it can be the other way around. A mother who already has some kind of infection can pass it to the baby. Even though a ruptured sac does not always mean an immediate birth, at any sign of rupture, no matter how small the fissure, seek medical advice.
How to identify a ruptured amniotic sac?
When I was 34 weeks pregnant, I started to feel excessively moist! I mentioned it to my obstetrician, and he said it was perfectly normal. Despite the symptoms, the examination at the office did not show any leakage of the amniotic sac. After insisting a lot, he finally ordered an ultrasound, and it was only discovered at 35 weeks that I really had very little fluid (a lot less) and also that my sac was ruptured.
But by then it was already late, and I don’t know how there weren’t more serious consequences. That is why it is important to stay alert to signs of a ruptured amniotic sac2 and if you have 2 or more symptoms, it is extremely important to talk to your obstetrician.
Signs of a ruptured amniotic sac
- Excess moisture
- Reduced amniotic fluid
- Sudden dropping of the belly
How to treat a ruptured amniotic sac
A ruptured amniotic sac may or may not occur with signs of labor itself, and it should be treated with antibiotics if labor does not occur within 24 hours. In fact, any case of a ruptured sac or full rupture should not go untreated for more than 24 hours to prevent infection.
Severe cases
The risk of infection can be greater in cases of early pregnancy like 24, 25 weeks for example. Although a rupture can happen at any time during pregnancy, it’s still very soon for the baby to be born. After all, there are still 6 months of pregnancy to go. In these cases, the risk of the baby staying inside the mother’s belly much longer than the ideal limit can get worse with infections, since the baby is still very small and fragile.
Ruptured amniotic sac at the end of pregnancy
A ruptured amniotic sac can also occur at the end of pregnancy, but the situation is simpler then. Bringing delivery forward is not necessarily a problem as it is with premature babies. Anyway, too much moisture in your underwear that leaks through and wets your pants or legs may be a sign of a ruptured sac and should always be reported to your obstetrician! See below for comments from Dr. Jaime Filho, Obstetrician and Gynecologist, regarding the ruptured amniotic sac.
Clearing up doubts with Dr. Jaime
Famivita: Dr. Jaime, how long can the sac remain ruptured? I don’t mean breaking and all the water leaking out, but just leaking. Even if premature, does delivery have to happen with any minimal leakage?
Dr. Jaime: Ruptured sac, or amniorrhexis, is the term used for the spontaneous rupture of the amniotic sac, which can happen before or during labor. When it happens before labor, we call it Premature Amniorrhexis3, regardless of gestational age. The length of time the sac can stay ruptured depends a lot on the clinical situation and gestational age, since after 37 weeks the protocol is to proceed with delivery (inducing labor or cesarean, depending on the case).
However, if the pregnancy is still premature (less than 37 weeks), and ruling out other complications, the preferred management is expectant care. In other words, to wait at least until close to 37 weeks. For example, if the sac ruptures in a pregnancy of 32 weeks, and there is no maternal infection, fetal distress or other issues, the pregnancy should be maintained as long as possible up to 36-37 weeks.
During pregnancy, the amount of time a sac can remain ruptured is variable, and it can remain so for weeks (of course, with monitoring for signs and symptoms of infection and fetal distress) without problems. This time varies greatly, and it is very common for patients to rush to the emergency room, desperate, thinking the baby is already being born. If the sac ruptures, the patient should go to the emergency room, but without panic. As I mentioned, the sac can remain ruptured for weeks, so there is enough time to get to the hospital.
In my case, Joana was almost full term, but it was still a little early for her to be born. She was born at 36 weeks of pregnancy, weighing 2.930kg and 45 cm, and had to stay hospitalized for 10 days with lung infection problems because the ruptured sac was not treated with antibiotics as it should have been, since I had a very high infection. It was quite a scare! Stay alert.
