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Water breakage, what to do?

by Content Editor
Water breakage, what to do?

A majority of future mothers break their water during labor. However, in 5 to 10% of pregnant women, a rupture or a crack of the water bag can occur during the pregnancy. We’ll tell you everything.

Table of contents

Cracking or rupture of the water sac, what is the difference?

Most often, the amniotic membranes (amnion and chorion) make up the water sac tear close to the internal orifice of the cervix; the flow is then frank and relatively abundant. Sometimes the rupture takes place higher up, and the quantity of liquid that escapes is less important. This is what is known as a crack in the water bag. In some exceptional cases, the breach can be sealed, but generally, nothing can prevent the amniotic fluid from flowing once the water sac is open.

Is a leak always amniotic fluid?

Mothers-to-be sometimes have a little trouble identifying fluid leakage, especially when it starts with a few drops. Amniotic fluid can be confused with urine loss or vaginal discharge, which are common during pregnancy. To help you tell the difference, use a sanitary napkin. Unlike urine, amniotic fluid is colorless or slightly whitish (like slightly soapy water). It has a bland odor, and the discharge is permanent. When you change position or cough, it tends to increase. Sometimes the discharge is frank but does not recur. This may be due to the rupture of an amnio-chorionic sac. This liquid effusion is formed between the two membranes, but the baby remains protected as the opening only concerns the outermost membrane.

How is a water break diagnosed?

At the maternity hospital, the midwife will examine you. Suppose the loss of liquid is not obvious. In that case, she will put a speculum and will be able to visualize the amniotic liquid which escapes from the external orifice of the cervix. The discharge can be more difficult to confirm when it is a high rupture (fissure) or old. Fortunately, specific biological tests exist.

The simplest (but there are others) can be performed during the examination, and the result is immediate. It is based on the PH. The pH of the vagina is acidic (between 4.5 and 6), while that of the amniotic fluid is basic (7 to 7.5). A large cotton swab is inserted into the vagina. When amniotic fluid is present, it changes color from yellow to blue. Ultrasound can also help with the diagnosis. It shows the amount of amniotic fluid remaining and allows you to follow its evolution.

At what point in the pregnancy can the water break?

Fortunately, most often, the rupture occurs at term, during labor, and allows the birth of a healthy baby. In 5 to 10% of pregnancies, the water bag breaks before the start of labor: this is known as premature rupture of the water bag (PMR). A third of cases occur in a mother-to-be who is not at term (before 37 SA) and can have harmful consequences for the fetus, mainly related to prematurity. The risks for the future baby and the course of action to take vary according to the age of the pregnancy.

Are there any factors that favor the rupture of the water bag?

Bacterial infection plays an important role. It is found in about 40% of ruptures. Mothers who have a history of premature delivery or premature rupture of the membranes are also more exposed. The same applies to mothers with cervical problems (herniation, exposure to Distilbene®, cerclage) or if the placenta is in an abnormal position (placenta previa). Uterine overdistension is also incriminated, for example, in the case of multiple pregnancies or too much amniotic fluid (hydramnios). Deficiencies in iron, zinc, and vitamin C, which weaken the membranes, can also interfere. Smoking and drug use can also interfere.

Water breakage: the consequences for the baby

The consequences for the unborn child depend on how early the rupture occurs. They are more numerous and severe if the pregnancy is young. The crack would be responsible for 30 to 40% of premature deliveries. According to studies, 6 out of 10 pregnant women give birth in the week following the rupture when it occurs at 29 weeks gestation.

In addition to the problems (especially pulmonary and neurological) linked to early birth, the risks for the fetus are also infectious. As the baby is now in contact with the outside environment, microbes can colonize the amniotic fluid. This is known as chorio-amniotitis. Neonatal infection can also occur. Finally, too much fluid leakage can cause oligohydramnios. This happens when the production of fluid is no longer sufficient to cover the losses. In early pregnancy, this complication can affect the development of the baby and lead to severe malformations.

Breakage of the water bag: A risk for the mother?

The dangers are less serious than for the future baby. They are mainly infections of the uterus. They are found in 10 to 20% of patients. In addition, when the water breaks prematurely, the rate of cesarean section is higher.

What happens after my water breaks?

Any loss of fluid during pregnancy should lead you to seek medical attention. If the rupture of the water bag is confirmed, you will be hospitalized. Fortunately, strict bed rest is no longer recommended, and you will be able to get up to go to the toilet or take a few steps in your room. Hospitalization at home is sometimes considered on a case-by-case basis after the first check-ups, but it depends on the term of the pregnancy and the obstetrical conditions.

Between 24 and 34 weeks, the mother-to-be will receive corticosteroid injections. These are essential to increase the baby’s lung maturity and limit the complications linked to prematurity. If necessary, in order to complete the corticoid treatment and prevent birth, an anti-contractions treatment will be put in place for 48 hours. Finally, to treat or prevent an infection, the mother will receive antibiotics. The birth will be decided in a center with a neonatal unit if there are any signs of infection or fetal suffering.

Between 34 and 37 weeks, only antibiotics will be prescribed. Obstetrical management is very complex. Obstetricians and pediatricians must weigh up two major risks: prematurity and infection, decide whether to wait and watch for the slightest sign of foetal distress and infection, or deliver a premature baby to avoid infectious complications.

At term, the mother should give birth without waiting too long. Either labor begins spontaneously (this is the case for 8 out of 10 pregnant women at the end of pregnancy) or is induced artificially after 12 to 24 hours of rupture.


The amniotic sac—alternatively termed the membranes or bag of waters is a sac that surrounds your baby during pregnancy in your uterus (womb). Occasionally, the doctor or midwife may break the membranes to initiate or accelerate labor. This is referred to as an artificial membrane rupture.

Your contractions may become more intense after the rupture of your membranes.

When the bag of waters ruptures, contact your health care practitioner. The longer your bag of water is ruptured before delivery, the greater the likelihood that your baby may have an infection.

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