1.2.2 Show and leakage of amniotic fluid
During most of the pregnancy, the tiny opening in the cervix is plugged with mucus. In the last few days of pregnancy, the cervix may begin to open. Sometimes the mucus and a little bit of blood drip out of the vagina. This is called show. It may come out all at once, like a plug, or it may leak slowly for several days. When you see the show, you know that the cervix is softening, thinning and beginning to efface (open). Be careful not to confuse the show with the normal discharge (wetness from the vagina) that many women have in the two weeks before labour begins. That discharge is mostly clear mucus and is not coloured a little bit red with blood.
True labour may be spontaneously established with or without show and with or without leakage of amniotic fluid (the waters in the fetal membranes surrounding the baby). In many parts of Ethiopia, people think that labour is not progressing if they don’t see leakage of amniotic fluid either before or after labour begins. This is not true. You should be clear that show and leakage of amniotic fluid are not required for labour to begin or progress.
If labour has not started or not progressed much within 6 hours after the waters break, refer the woman to a higher health facility as soon as possible.
When the bag of waters breaks (fetal membranes rupture), there can be a big gush of amniotic fluid from the vagina, or a slow leak. In most women, the bag of waters normally breaks during early labour. If the fetal membranes rupture before labour begins, there should only be a few hours delay before labour starts. If labour does not start within 6 hours after the bag of waters breaks, there is a risk of infection entering the uterus, which gets stronger the more time that goes by after the membranes rupture. You learned about premature rupture of membranes (or PROM) in Study Session 17 of the Antenatal Care Module. Remember that ‘premature’ refers to the fetal membranes rupturing ‘early’ (before labour starts) – not to the gestational age of the baby, which may be preterm, term or post-term when the waters break.
However, even if the fetal membranes break after labour begins, as is normally the case, there are some risks associated with the leakage of amniotic fluid that you should be aware of.
Think back to what you already learned about PROM. Can you suggest what risks might occur if the waters break while the woman is already in labour?
Potential complications of rupture of fetal membranes during labour are:
- Infection: Since the ‘door’ to the uterus is open and you are going to do pelvic examinations with your gloved fingers to assess the progress of labour, there is a risk of transferring infection into the uterus unless you are very careful about hygiene (as you will learn in later study sessions of this Module). This risk gets bigger if the labour is prolonged.
- The umbilical cord may prolapse (be pushed out ahead of the baby as the waters gush out through the cervix), or the cord may become trapped against the endometrial wall by the baby which is no longer kept ‘floating’ by the amniotic fluid. If the cord is compressed, the baby can develop hypoxia (low oxygen levels) because the blood flow is restricted in the cord, and it may die or be brain damaged.
1.2.1 What is adequate uterine contraction?