Ruptured membranes or a trickle of urine?
I occasionally leak some urine now that I have entered my ninth month. When I go into labor, how can I tell whether it's my membranes rupturing or just a bit of leakage urine?Question:
It is indeed sometimes difficult to decide if leaking fluid is urine or ruptured membranes. The most important message is don't be afraid to request a test of the fluid if you are uncertain. It really is better to be safe.
Although there are several ways to help you tell the difference, none of them are absolute. Of course, we know that urine has a characteristic smell and color. Urine tends to leak more frequently when the bladder is full and when we cough, sneeze or exercise.
If there is doubt, it is best to lie down for about an hour and arise. Note if there is a tiny gush or increase in the flow. Amniotic fluid will tend to pool in the vagina and come out upon arising.
We differentiate amniotic fluid from urine in the clinic in two ways. One is testing the fluid with a pH paper called "nitrazine" paper. This test detects any fluid that is basic or has a higher pH. The problem with this type of test is that other fluids also turn the paper blue, indicating a high pH. These substances include urine, soap, semen, cervical mucus, blood and even tap water. So this is not an absolute test either.
Another test is to visualize a dried fluid specimen under the microscope and look for a characteristic ferning pattern, indicating the presence of estrogen. This test is a bit more reliable, but requires that a sterile speculum be placed and again it is not foolproof. Ferning is sometimes not seen despite the fact that the membranes have ruptured.
If a woman has any doubts, she should check with her midwife or physician, abstain from intercourse, not take tub baths, check her temperature frequently (if this becomes an ongoing issue) and place nothing in the vagina. Cervical exams are not done unless absolutely necessary.
The risk of chorioamnionitis, an infection in the fetal membranes and amniotic fluid, increases substantially after 18 to 24 hours after rupture and can take the life of the baby and the mother so it should not be ignored. On the other hand, in the case of premature rupture of the membranes remote from term, the membranes can "seal" over and cause no further problem. You continue to produce about one cup of fluid every hour, so the concept of "dry birth" is not a very accurate term.
I would encourage you to call your clinic if you have any doubts. Don't be afraid to "bother" them. Any care provider would rather see you many times rather than treat a subsequent infection.Answer: