12 November 2012

Uganda: Premature Breaking of Waters - Why You Must Act Promptly

One morning, Grace Achan woke up in a sopping bed. For a moment, Achan thought she had wet her bed. However, her waters had broken.

Achan was seven months pregnant, but had not experienced any uterine contractions.

"A midwife advised me to take antibiotics instantly to prevent infections, before seeking medical help," she says.

Medical workers say even for a normal pregnancy, sometimes the amniotic fluid can leak without the amniotic sac breaking. This can be likened to a water balloon with a pin-sized hole.

The amniotic fluid, which surrounds the foetus during pregnancy, allows the baby to move about. This fluid also provides a cushioning within the uterus and gives the foetus buoyancy.

"The amniotic fluid begins to fill up the amniotic sac from about two weeks of fertilisation. About another 10 weeks later, the fluid contains proteins, carbohydrates, electrolytes, lipids, phospholipids and even urea, which provide nutrition to the foetus," explains Dr. Robert Busingye, a gynaecologist at Busingye Medical Centre.

Towards the later stages of pregnancy, the fluid also contains foetal urine. In normal cases, a leakage of the amniotic fluid during pregnancy is a sign of labour, Busingye, explains. A leakage could also signal danger, and therefore, should not be taken lightly.


When the amniotic sac ruptures prematurely, it is important to determine the cause. Many times, the leakage is caused by a bacterial infection or a defect in the amniotic sac, uterus or cervix, Fred Mugisa, an obstetric gynaecologist at MedWatch Medical Centre in Ntinda, says.

The infection may spread from the vagina to the uterus and eventually to the foetus. Sometimes when there is a small tear in the amniotic sac, it may heal on its own over time and the leaking stops.

However, Busingye says, if the leakage is a result of a severe rupture of the membranes of the amniotic sac, then labour may begin within 48 hours. "When this happens, the mother must receive treatment to avoid causing an infection to the foetus," Busingye cautions.

Sexually transmitted infections can also cause premature rupture of the membranes.

According to online sources, rupture of membranes may be triggered by impending labour, natural weakening of the membranes and the force of premature contractions.

"When the body begins to prepare for labour, contractions may begin in anticipation of the event and they may be forceful enough to burst the amniotic sac. As the amniotic sac ages, it may also get thin and become more susceptible to the force of pre-term contractions."

Placental abruption - when the placenta separates from the uterus before the baby is delivered as well as prolapsed umbilical cord - when the cord descends before the baby, are also likely to cause the waters to rupture prematurely.


Mugisa says about one out of six expectant mothers has had this condition. And according to the World Health Organisation, more than eight million preterm babies are born in Africa annually due to loss of the amniotic fluids, caused by leaking of the amniotic sac.


Mugisa says a mother should be given bed rest to control/stop the amniotic fluids from being drained as well as to monitor the baby's heartbeat.

"The expectant mother has to be given antibiotics because at that point, whatever the cause of the leakage, she's at risk of getting a bacterial infection, which could affect the foetus or uterus," Mugisa says.

"On the other hand, we let the mother rest until she gives birth or until the leakage stops because when she walks or does any work, she might completely drain the fluids yet they are the life-supporting system of the foetus," he says.

However, medical experts say in some instances, labour might be induced to save the baby or mother's lives if they are in danger.


According to experts, one should guard against injury or trauma, among the factors that may cause bacterial infections.

Screening for certain infections and using condoms, while having sex can reduce the risk of these infections and in turn reduce the risk associated with premature rupture of the membranes.

Some medical researchers say that taking enough Vitamin C may lower one's chances of suffering from the condition. Expectant mothers should also desist from smoking and consuming alcohol, Busingye counsels.

"Bacterial infections can be acquired from dirty places like toilets and bathrooms. Over bending can also cause damage to the amniotic sac. A pregnant woman should, therefore, take extra care," Busingye cautions.

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