Second Trimester Amniotic Fluid Leak: Understanding the Situation

Question
A close friend has experienced some vaginal bleeding and loss of amniotic fluid at 18 weeks. An ultrasound on that day showed no fluid but the heartbeat was strong and the baby was not in any distress. There were no labor symptoms. Bleeding and the leak stopped after 3-4 hours. Subsequent ultrasound a week later with bed rest and increased fluid intake showed only one pocket of 2.5cm fluid. In such cases, what would be the expected amniotic fluid increase? Is it too slow and a cause for concern? It seems that amniotic fluid regenerates itself every 3-4 hours. However, what happens when the existing fluid is lost due to rupture?

Answer
If there is a large rupture of the sac, there will be copious amounts of amniotic fluid lost. Most of the time, the baby continues to regenerate the fluid, but, at times, if too much fluid was lost, the baby will not survive and the patient will go into labor or have a fetal demise. HOwever, if the leak stopped and she is starting to replace the fluid, it is certinly worth serial unltrasounds to see if all the fluid is reformed. There is still hope. If, on the other hand, the rupture is so great that the fluid keeps escaping, there is usually no chance of survival at 18 weeks gestation.