Premature rupture of the amniotic sac: managing the risks

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IntroductionVaginal wetness is common during pregnancy. Every year, theOffice for National Statistics (2017)records around 696,000 live births in England and Wales, and about a third of these women will experience some sort of vaginal leakage. Furthermore, the Hygeia Foundation and Institute for Perinatal Loss (Odunsi et al 2017) state that approximately 20% of pregnant women present at hospital or birth units reporting wetness. In most cases, it is harmless, resulting from urinary incontinence or changes to the vaginal secretions. TheChartered Society of Physiotherapy (2014)and theRoyal College of Midwives (2012)confirm that one in three women (34%) experience urinary incontinence during pregnancy. It is also not unusual for hormonal changes during pregnancy to increase the amount of mucous and moisture in the vagina, which might be mistaken for something more serious. Mild infections, such as thrush or bacterial vaginosis may also mimic amniotic rupture.Although dampness may indicate a rupture of the membranes, it is important to promptly rule out other causes. When women experience vaginal wetness during pregnancy, it can cause embarrassment, confusion and/or fear of the consequences. Others may dismiss it, assuming it to be a normal part of pregnancy, possibly only mentioning it in passing. This presents midwives with a tough challenge as without invasive intervention, it can be difficult to tell whether it is urine, vaginal discharge or leaking amniotic fluid. If it is leaking amniotic fluid, there is an urgent need for attention and action. Finding the right balance for the best outcomes for mother and child can be problematic. Health care professionals in primary and community settings have often felt they have little choice but to refer women to the hospital for further tests.

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