QuestionDear Dr. Rappaport,
I am 28yrs old, no live children, 1 missed mc with D&C in Jan 2005 at 12wks (baby stopped developing at 8wks due to unknown reasons). I am currently 14 weeks,6 days pregnant; LMP was March 20.
9 days ago, I had a sudden gush of fluid when I was sitting at my desk (around 1 to 2 Tbs). I called my OB and was told to go to the ER. I had borderline fever at the ER; also slight cramping then, but not before the leak. By the time a doctor saw me, it was 6 hours after the fluid and I had not leaked since. A swab test was negative, but he still thought it was amniotic fluid. He sent me home on bedrest and they called me back to the ER the next morning for an ultrasound. The baby was very active on the ultrasound and had a strong heartbeat. They said it showed "sufficient" amniotic fluid and they don't measure the amount since it can vary so much for each pregnancy (although it looked like less to me than what I saw on my 12wk ultrasound). The ER doctor (not an OB, but he called my OB to consult) assumed I had a small tear that had closed up on its own and told me the prognosis "looks good". I was advised to go about normal activities, but nothing too strenuous and to avoid intercourse for a few days.
Since then I have felt fine, until yesterday, when I had some cramping similar to menstrual cramps as well as some that felt like a fist tightening in my abdomen. I took my temperature and it was a bit high. I checked the baby's heartbeat with a fetal doppler I rented and it was normal (147bpm). Today, I feel fine again and my temperature is back to normal. My next obstetrician appointment is not until 17 weeks.
Is it likely that a leak can completely heal on it's own, or am I at risk for preterm labour as the baby grows and pressure increases? Should I be concerned about cramping, tightening sensation, fever or only leaking fluid? Are there any other warning signs? Would continued rest and abstinence be beneficial? Should the fluid level still be monitored with more frequent ultrasounds?
Thank you so much for your assistance!
AnswerVery often, one can get a "high leak" of amniotic fluid. In early pregnancy such as yours, this can often reseal and the pregnancy can continue to term without problems. As long as you do not have a temperature of over 100.4 degrees F, and there is no further "gush" of clear fluid, you need not worry. I would, however, get another sonogram at 20 weeks gestation. You will have some occasional contractions throughout the pregnancy. However, if you start to get tightening of your abdomen at the level of your belly button that occurs strongly more than every 10 minutes, and lasts for an hour, you should call your doctor. A sonogram after 20 weeks can assess the amount of amniotic fluid. Just be aware of any further leakage of fluid and notify your doctor if you see more fluid. Otherwise, if no more fluid is noted and if you do not get a high temperature, you do not have to worry.
