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Is induction warranted if I’m leaking fluid?
Q: A day after experiencing irregular contractions, I felt a sudden trickle of water down my legs. My doctor did a pelvic examination and fetal heart check. The fetal heart rate was fine and there was no sign of labor, but my doctor gave me an antibiotic after the urine analysis found eight to 10 pus cells. Now I’m worried. Should my doctor have induced me because of the leak, or was it the right decision to wait for labor pains to come naturally? My other two kids were born after 40 weeks, and I was induced with both of them.
A: Leaking fluid can be a confusing sign late in pregnancy. I can’t tell you how many times I get calls from patients descoting similar circumstances. The first and most important way I distinguish what has happened is by asking the patient questions. What I’m trying to determine is whether the leak was fluid or a mucus discharge. I need to know if the patient leaked while getting up or while reclined because changing position makes it easier to leak urine. I’d also try to find out if the leak is continuous. That’s because once the bag breaks, fluid typically trickles out on a regular basis.

Once I’ve made this determination, I decide if I should see the patient. In the office or hospital, I can determine if the bag of water surrounding the baby has broken with three tests: checking the pH of the fluid, checking if the discharge is pooling in the vagina and studying a fluid sample under the microscope for telltale signs of amniotic fluid.

Occasionally, even after these three steps I’m still not 100% sure of the diagnosis. In these cases I perform an ultrasound to check the amount of amniotic fluid surrounding the baby. If there is a large amount, I tend to think the bag did not break. When I notice a reduced amount of fluid, I am inclined to think the bag is leaking.

As for your question about being induced, I would trust that your doctor has made the right diagnosis. If your bag is leaking, inducing labor is the right option. If it was just urine or vaginal discharge there’s no reason to intervene. Remember, if your bag is leaking, it will do so continuously and become apparent to you and your doctor. About 75% of women whose bags break go into spontaneous labor within 24 hours.