What Is Weeping Eczema?

Written by Alexandra Benisek

• What Are Symptoms of Weeping Eczema?
• What Can Cause Weeping Eczema?
• How Do Doctors Diagnose Weeping Eczema?
• How to Treat Weeping Eczema?
• How Can You Prevent Weeping Eczema?

Weeping eczema is a problem that stems from eczema where your skin oozes clear or straw-colored liquid. It can sometimes show up as small, fluid-filled blisters. Weeping eczema is common and could happen in anyone with the skin condition. But the symptoms and intensity of your weeping eczema may be different based on the form of eczema you have.

With weeping eczema, blisters will ooze and cause your skin to be wet. Once the fluid dries, it’ll cause a yellow or orange layer of crust over your skin. This usually happens in areas where eczema is common, like where your skin bends (inside your elbow, behind your knees, or on the front of your neck). But weeping eczema can happen anywhere on your body.

There are many different symptoms of weeping eczema. You might have common signs, including:

• Open sores
• Blisters
• Fluid on your skin
• Redness
• Crusting
• Itching, burning, or soreness on your skin

It’s also common for those with weeping eczema to have worsened overall eczema symptoms. They may have worse skin dryness, swelling, or itchiness. People with severe weeping eczema might also notice:

• Fever
• Fatigue
• Achiness
• Chills
• Swollen lymph nodes (especially in your armpits, neck, or groin area)

The problem happens because of inflammation in your skin. Heavy swelling can lead to dilation of your skin’s blood vessels. The vessels will then leak serum into your skin’s soft tissue, which causes edema, or mild inflammation. The serum will also leak onto your skin’s surface.

When your skin dries out, cracks, or becomes inflamed, you’re more at risk for infection. This can worsen your eczema symptoms. Staph (staphylococcus), caused by bacteria, is the most common form of infection in people with weeping eczema.

If the herpes simplex virus (HSV-1) enters your skin, it can also cause weeping eczema.

You can’t spread eczema or weeping eczema to other people. But if your weeping eczema is paired with a secondary infection, you could spread that to others.

If you believe your eczema is weeping, call your doctor right away. Quick treatment will help you get the issue under control and lessen any symptoms.

When you go to your doctor’s appointment, they’ll want to confirm that you have eczema first. They’ll look over your skin to check for signs of the skin condition. They may also want to do blood tests, a skin biopsy, a bacterial culture, or allergy tests to ensure your symptoms are from eczema.

Once your health care team has confirmed you have weeping eczema, they’ll want to treat it. Your therapy will depend on what caused the disorder. Your doctor might suggest you use:

Antihistamines. You can get these drugs in pill form over-the-counter or as a prescription. Many people use them to treat allergies. They can also lessen itchiness from eczema.

Corticosteroids. These are topical medications that can treat itchiness and swelling. Your doctor may also prescribe an oral steroid for eczema. Corticosteroids work by lowering the production of chemicals that lead to inflammation. This will lessen tissue damage in your body. These drugs reduce your immune system’s activity, which will also lead to less tissue damage.

Immunosuppressants. With eczema, your immune system is overactive. These drugs lower your body’s immune response and in turn, lessen inflammation.

You may need different treatment if other infections start due to your weeping eczema. Your doctor will be able to prescribe the proper medications in these cases.

To completely treat your weeping eczema, you’ll need medication. But to ease the symptoms, you can also try home remedies such as:

Baths. Colloidal oatmeal is a ready-to-use, FDA-approved soothing agent. You can take an oatmeal bath to ease symptoms from weeping eczema.

You can also try a diluted bleach bath. Use a small amount of bleach in your bath to help kill bacteria on your skin. This can help lessen itching, redness, and rough skin. Be careful to only use this method in moderation. Too much bleach can dry out your skin. Talk to your doctor about the safest way to add this to your routine before you try it at home.

Vitamins and supplements. These can help lower inflammation or help overall eczema symptoms. It may be helpful to add vitamin D, vitamin B12, and fatty acids (like evening primrose and black currant seed) to your routine.

Probiotics. These are combinations of live bacteria or yeasts that are naturally present in your body. Probiotics are good bacteria that help keep you healthy. They can also help fight off bad bacteria. Experts believe that topical probiotics can help ease the intensity of eczema symptoms.

Oils. Some oils can lower inflammation, protect, and restore your skin. Try coconut, olive, or sunflower seed oil to help with eczema symptoms.

If you treat your weeping eczema right away, it should go away within 2 weeks. In really bad cases, it could cause scarring. If you don’t treat the issue, it can cause more serious problems and lead to other infections.

If you have eczema, there are things you can do to avoid infections and weeping. For the best outlook:

Keep a consistent skin care routine. Choose shampoos and washes that are free from dyes and perfumes. Moisturize your skin with an emollient cream twice a day.

Take a timeout. Lower your stress levels to prevent flares. Add more relaxing activities into your schedule or practice meditation and mindfulness.

Listen to your doctor. Follow your health care team’s suggestions about medications and supplements.

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What Is Weeping Eczema?

Written by Alexandra Benisek

• What Are Symptoms of Weeping Eczema?
• What Can Cause Weeping Eczema?
• How Do Doctors Diagnose Weeping Eczema?
• How to Treat Weeping Eczema?
• How Can You Prevent Weeping Eczema?

Weeping eczema is a problem that stems from eczema where your skin oozes clear or straw-colored liquid. It can sometimes show up as small, fluid-filled blisters. Weeping eczema is common and could happen in anyone with the skin condition. But the symptoms and intensity of your weeping eczema may be different based on the form of eczema you have.

With weeping eczema, blisters will ooze and cause your skin to be wet. Once the fluid dries, it’ll cause a yellow or orange layer of crust over your skin. This usually happens in areas where eczema is common, like where your skin bends (inside your elbow, behind your knees, or on the front of your neck). But weeping eczema can happen anywhere on your body.

There are many different symptoms of weeping eczema. You might have common signs, including:

• Open sores
• Blisters
• Fluid on your skin
• Redness
• Crusting
• Itching, burning, or soreness on your skin

It’s also common for those with weeping eczema to have worsened overall eczema symptoms. They may have worse skin dryness, swelling, or itchiness. People with severe weeping eczema might also notice:

• Fever
• Fatigue
• Achiness
• Chills
• Swollen lymph nodes (especially in your armpits, neck, or groin area)

The problem happens because of inflammation in your skin. Heavy swelling can lead to dilation of your skin’s blood vessels. The vessels will then leak serum into your skin’s soft tissue, which causes edema, or mild inflammation. The serum will also leak onto your skin’s surface.

When your skin dries out, cracks, or becomes inflamed, you’re more at risk for infection. This can worsen your eczema symptoms. Staph (staphylococcus), caused by bacteria, is the most common form of infection in people with weeping eczema.

If the herpes simplex virus (HSV-1) enters your skin, it can also cause weeping eczema.

You can’t spread eczema or weeping eczema to other people. But if your weeping eczema is paired with a secondary infection, you could spread that to others.

If you believe your eczema is weeping, call your doctor right away. Quick treatment will help you get the issue under control and lessen any symptoms.

When you go to your doctor’s appointment, they’ll want to confirm that you have eczema first. They’ll look over your skin to check for signs of the skin condition. They may also want to do blood tests, a skin biopsy, a bacterial culture, or allergy tests to ensure your symptoms are from eczema.

Once your health care team has confirmed you have weeping eczema, they’ll want to treat it. Your therapy will depend on what caused the disorder. Your doctor might suggest you use:

Antihistamines. You can get these drugs in pill form over-the-counter or as a prescription. Many people use them to treat allergies. They can also lessen itchiness from eczema.

Corticosteroids. These are topical medications that can treat itchiness and swelling. Your doctor may also prescribe an oral steroid for eczema. Corticosteroids work by lowering the production of chemicals that lead to inflammation. This will lessen tissue damage in your body. These drugs reduce your immune system’s activity, which will also lead to less tissue damage.

Immunosuppressants. With eczema, your immune system is overactive. These drugs lower your body’s immune response and in turn, lessen inflammation.

You may need different treatment if other infections start due to your weeping eczema. Your doctor will be able to prescribe the proper medications in these cases.

To completely treat your weeping eczema, you’ll need medication. But to ease the symptoms, you can also try home remedies such as:

Baths. Colloidal oatmeal is a ready-to-use, FDA-approved soothing agent. You can take an oatmeal bath to ease symptoms from weeping eczema.

You can also try a diluted bleach bath. Use a small amount of bleach in your bath to help kill bacteria on your skin. This can help lessen itching, redness, and rough skin. Be careful to only use this method in moderation. Too much bleach can dry out your skin. Talk to your doctor about the safest way to add this to your routine before you try it at home.

Vitamins and supplements. These can help lower inflammation or help overall eczema symptoms. It may be helpful to add vitamin D, vitamin B12, and fatty acids (like evening primrose and black currant seed) to your routine.

Probiotics. These are combinations of live bacteria or yeasts that are naturally present in your body. Probiotics are good bacteria that help keep you healthy. They can also help fight off bad bacteria. Experts believe that topical probiotics can help ease the intensity of eczema symptoms.

Oils. Some oils can lower inflammation, protect, and restore your skin. Try coconut, olive, or sunflower seed oil to help with eczema symptoms.

If you treat your weeping eczema right away, it should go away within 2 weeks. In really bad cases, it could cause scarring. If you don’t treat the issue, it can cause more serious problems and lead to other infections.

If you have eczema, there are things you can do to avoid infections and weeping. For the best outlook:

Keep a consistent skin care routine. Choose shampoos and washes that are free from dyes and perfumes. Moisturize your skin with an emollient cream twice a day.

Take a timeout. Lower your stress levels to prevent flares. Add more relaxing activities into your schedule or practice meditation and mindfulness.

Listen to your doctor. Follow your health care team’s suggestions about medications and supplements.

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Amniotic fluid – from A to Z

Everything in the body of a pregnant woman is arranged in order to safely bear and give birth to a child. For example, amniotic fluid is an amazing environment in which the baby lives all nine months of pregnancy and which helps him to be born softly and comfortably.

Water cycle

Where does amniotic fluid come from? Let’s start with the fact that a child swims in the uterus for a reason: around him, like around an astronaut, there is a kind of spacesuit – special membranes, they are called: fetal membranes. Together with the placenta, they form a fetal bladder, which is filled with amniotic fluid. At the very beginning of pregnancy, it is the cells of the fetal bladder that produce amniotic fluid. In the later stages, amniotic fluid is additionally produced by the baby’s kidneys. The baby first swallows water, they are absorbed in the gastrointestinal tract, and then they leave the body with urine back into the fetal bladder. Approximately every three hours, the fluid in the sac is completely renewed. That is, “waste” waters come out, and new ones take their place – completely renewed. And this water cycle continues for 40 weeks.

Why water is needed

It would seem that man is a land creature, and he cannot breathe for a long time, and simply cannot be under water. So why is the baby in the water during pregnancy? It’s very simple: for the development of a child at any stage of life, a harmonious environment is needed. And water is great for this. It softens the effect of the law of universal gravitation, too loud noises of our world do not reach through the water. And the amniotic fluid is always the same temperature, which means that the child will not overheat or become cold, even if the mother suffers from heat or, conversely, freezes from the cold. Together with the walls of the uterus and the muscles of the anterior abdominal wall, water reliably protects the child from bumps, pushes or excessive pressure, which are always present in our everyday life. Naturally, this does not mean that during pregnancy you can fall off a bicycle or go skiing, no, it is still dangerous. But there is no need to be afraid that, once again bending or turning the body, the woman will pinch something there and pass it on to the child.

But what about breathing, the baby will not choke in the water? Certainly. the child in the mother’s stomach breathes, but not yet with lungs – oxygen is supplied to it through the placenta. And only after birth and the first cry, the lungs will straighten out and the baby will take their first real breath with them. In the meantime, he just periodically swallows amniotic fluid, but it cannot get into the lungs.

By the way, even in childbirth you can’t do without water – during contractions, the baby’s head presses on the cervix and helps it open up. But the waters located in the fetal bladder in front of the baby’s head soften this pressure and the cervix opens more smoothly.

So everything is thought out in the body of a pregnant woman, and water is perfect for the life of a future baby.

Quantity and quality

With each ultrasound of the baby , the doctor also evaluates the amniotic fluid: their quantity, transparency, the presence of extraneous suspension.

Quantity. If there is less or more water than it should be within a certain period, then perhaps something is wrong in the woman’s body. But fortunately, this is rare, but the conclusion “moderate oligohydramnios” after an ultrasound examination occurs all the time. The expectant mother always worries about this diagnosis, but it usually means that the amount of amniotic fluid has decreased slightly. If additional examinations (CTG, dopplerography) show that everything is in order with the baby, then there is nothing wrong with moderate oligohydramnios, perhaps this is such a feature of the course of pregnancy.

Quality. Normally, amniotic fluid is clear, like water. By the end of pregnancy, they sometimes become a little cloudy due to the fact that epidermal cells from the baby’s skin, particles of the original lubricant get into them – they give a small suspension in the waters, which can be seen on ultrasound. This is also a variation of the norm.

Final stage

All expectant mothers have heard about the fact that at some point in childbirth or right in front of them, amniotic fluid is poured out. And naturally, pregnant women have the same questions: how and when does this happen? what will i feel? what to do after the water breaks? Everything is simple here.

When the waters break. Ideally, the waters flow out during the first stage of labor, when the cervix is ​​fully or almost fully dilated. The fetal bladder becomes thinner and breaks during contraction. Immediately after this, the contractions intensify significantly, and the birth of a child is just around the corner. But the waters can break even before the start of contractions, so to speak, “out of the blue.” This moment is called premature outpouring of waters. If there are contractions, but the cervix is ​​not yet ready, then such an outpouring of water is called early .

How the waters break. Amniotic fluid is poured out in different ways. They can, like in feature films – suddenly, in a public place, the expectant mother starts to have water flowing down her legs. Yes, this happens, but still, the drama of the situation in the cinema is somewhat exaggerated. Amniotic fluid does not always flow in a strong stream, very often not all waters come out, but only the so-called front , that is, those that are located in front of the baby’s head, and they are usually 100–200 ml. The rest of the amniotic fluid – rear water – is poured out after the birth of the child.

So usually the expectant mother feels that her underwear has suddenly become very wet. or she thinks she has had involuntary urination. But there may be such an option: the fetal bladder did not burst completely, but only torn somewhere and the water leaves in small portions. Then the woman will only feel that the discharge has become more abundant and watery than before. This is called amniotic fluid leakage.

What to do after the water breaks. It does not matter whether there are contractions or not, a lot of water has broken or just a little bit – all this is a reason for to immediately go to the maternity hospital . There is nothing to be afraid of here: today it is believed that the safe waterless period is no longer 6 hours as before, but much longer. But, nevertheless, if the waters have poured out, the mother needs to be under the constant supervision of doctors.

Pregnancy fears

Expectant mothers are often worried, and various horror stories from the Internet and stories of good friends only increase anxiety. What usually worries a woman when it comes to amniotic fluid?

The fetal bladder will burst (tear) ahead of time, but I will not notice it. Usually this fear appears at the end of pregnancy, when the amount of vaginal discharge increases under the influence of hormones. Often there are so many of them and they are so plentiful that it seems to a woman that her water is leaking. In fact, water and discharge can be distinguished: the discharge is mucous, denser or thicker, leaving a characteristic white color or a dried spot on the linen. The amniotic fluid is still water, it is not viscous, does not stretch like discharge, and dries on the linen without a characteristic trace. But if doubts remain, is it water or just liquid vaginal discharge, you should not sit at home and be afraid. It is better to go to the doctor for a consultation – he will certainly see what it is. If the situation repeats, then you can buy a special test at the pharmacy that shows whether there is water leakage or not (it can be in the form of a regular strip, similar to a pregnancy test, or even in the form of a special pad).

In childbirth, all women have their fetal bladder pierced, and what if they do it to me?
The opening of the fetal bladder is very actively discussed and condemned on the Internet, and this is understandable: many women do not understand why they did it. Yes, this manipulation is indeed carried out often, but rumors that the fetal bladder is opened in maternity hospitals for everyone in a row are somewhat exaggerated. So why are they opening it anyway? Ideally, just to help mother and child.

– For example, if the contractions are weakened, then opening the amniotic sac can intensify them and then there is no need to prescribe stimulation with the help of oxytocin.

– Sometimes the fetal bladder does not have anterior waters, such a bladder is called flat. As a result, its membranes are stretched over the child’s head, and the bubble not only does not help normal labor, but also delays it.

– Rarely, but it happens that the fetal membranes are so dense that even when the cervix is ​​fully opened, the bubble itself does not open. If it is not opened, then the straining period is delayed, since such a fetal bladder interferes with the advancement of the baby’s head. Previously, if the bladder was not opened, the child could be born in fetal membranes in a state of asphyxia. They said about such children: “Born in a shirt, he will be happy!” And happiness here is in one thing – they managed to get him out of this “shirt” alive.

After birth, the child no longer needs the aquatic environment. Now he has a different type of breathing, circulation, digestion. And a new, amazing and interesting life on land begins.

Memo for moms

1. Water can break both during contractions and without them (“out of the blue”).
2. Amniotic fluid pours out in different ways: it can gush like a fountain, or it can leak imperceptibly.
3. It doesn’t matter if there are contractions or not, a lot of water has broken or just a little bit, you need to go to the hospital in any case.
4. If you are afraid that water is leaking, go to the doctor, he will see exactly what it is. You can buy a special test for water leakage.
5. Are you offered to open the fetal bladder? Do not worry – this is a completely painless manipulation.

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Clinical Hospital IDKMother and Child Clinic Enthusiastov Samara

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signs, symptoms, how it looks, how to determine and what to do at home

Amniotic fluid is the safe environment in which the child develops before birth. Of course, if the liquid begins to drain earlier than the prescribed time, this is not normal.

According to some reports, every third case of preterm birth is provoked by premature rupture of the membranes and partial or complete rupture of amniotic fluid (1). At the same time, the risk of developing life-threatening complications greatly increases.

Infectious diseases are the main cause of neonatal morbidity and mortality in premature rupture of membranes (2). Therefore, it is so important to know what amniotic fluid is, what it is for, and also to understand how to identify leakage and what to do in this case.

What is amniotic fluid

Amniotic fluid or otherwise amniotic fluid is a biologically active liquid medium that is inside the membranes during pregnancy. They protect the baby from infections.

According to obstetrician-gynecologist Yulia Golesheva, amniotic fluid is necessary for the normal development of the child. They play the role of a shock absorber between the baby and the wall of the uterus, protecting it from mechanical pressure from the outside.

In addition, water is a source of nutrients for the fetus, they have antibacterial properties, protect the baby from external influences of microbes, and the umbilical cord from squeezing, help the maturation of the lungs. Thanks to the waters, the baby can move, which contributes to the normal development of the musculoskeletal system, and the amniotic fluid also maintains the temperature regime. The volume of amniotic fluid may fluctuate.

– Water does not leak out due to the fetal membranes. Both the condition of the amniotic fluid and the prognosis for pregnancy depend on their strength and integrity. The fetal membranes are hermetic, says the specialist.

What amniotic fluid leakage looks like

Much depends on the extent of the problem. If the rupture of the membranes is small or there is only a crack, the leakage of water will look like a normal discharge. The only thing that will distinguish them is the watery consistency. Amniotic fluid is similar to ordinary water, usually colorless and odorless. In some cases, there may be a specific smell, a yellowish, green or pink tint. Only a doctor can establish the cause: there may be a variant of the norm or a sign of a dangerous infection.

With a larger rupture of the membranes, the volume of secretions will increase significantly, up to the complete outflow of water. And it is already difficult to confuse with the usual discharge during pregnancy. You need to see a doctor right away.

Leakage of amniotic fluid at different periods

2nd trimester	Such a phenomenon in the middle of pregnancy is dangerous because it can lead to miscarriage (up to 22 weeks) or premature birth (from 22 weeks). In case of detection of signs, you should immediately consult a doctor. Most likely, you will need to stay in the hospital, where you will need to pass the appropriate tests to confirm the leak, and then undergo treatment.
3rd trimester	In this case, everything depends on the term. Until 34 weeks, the baby and the mother’s body are not yet ready for childbirth, so it is important to do everything to save the pregnancy. After this period, there are two completely acceptable options: prolongation of pregnancy or delivery. In any case, you should not sit at home, if you find signs of leakage, immediately consult a doctor.

Important!

There is no universal solution that applies to every pregnant woman with amniotic fluid leakage. To keep the pregnancy or not, in each case is decided individually, based on tests, examination results, gestational age and other factors.

How to detect amniotic fluid leakage

Photo: @mart-production, pexels.com

It is rare for a woman to detect amniotic fluid leakage on her own. If there is any suspicion of this, home tests can be used.

“If the discharge is small, you can use home tests for amniotic fluid leakage to decide whether you need to go to the maternity hospital,” says Yulia Golesheva. – They are based on determining the change in the acidity of the pH of the vaginal environment, which becomes more alkaline due to mixing with waters. But the result may not be accurate, because. for example, a shift in pH can also be observed in bacterial vaginosis, which is not accompanied by a violation of the integrity of the membranes. More accurate and sensitive tests are based on the determination of specific proteins that are present only in the amniotic fluid, and nowhere else – microglobulin-1, and placental growth factor. Microglobulin-based tests are the most accurate, scoring above 97%.

What to do in case of amniotic fluid leakage

If you suspect something is wrong, first of all, you need to calm down and act according to a certain algorithm.

Check for signs and symptoms of amniotic fluid leakage

Signs that a pregnant woman may be experiencing fluid leakage:

• sudden watery discharge
• more fluid and copious discharge than before.

Learn more

To check if the amount of discharge has really increased, take a diaper and sit on it for about an hour. Normally, the diaper should not get wet through.

The second, simpler and more reliable option is to test for amniotic fluid leakage.

The diaper is dry, the test is negative, which means you can exhale, you should not have been afraid.

Seek immediate medical attention

If the diaper gets wet or the test shows positive, this is definitely a reason to see a doctor, and as soon as possible. If necessary, call an ambulance. Leakage of amniotic fluid is a dangerous phenomenon that needs to be quickly eliminated.

– If you suspect a leak or outflow of water, regardless of the gestational age, you need to see a doctor, – says our expert. – If the outpouring is complete, then immediately to the hospital. When the fetus is full-term, the woman is prepared for childbirth, at an earlier date antibacterial treatment and prevention of RDS (respiratory distress syndrome) of the fetus are carried out, preparing the lungs of the child. Whenever a water leak is suspected and a positive test is obtained, we prepare for an early delivery, regardless of the gestational age.

Leakage of amniotic fluid is especially dangerous at 22-34 weeks of gestation, because the birth canal is not yet ready (3). And this is a factor that causes protracted labor, the development of complications in the mother and child. At the same time, doctors note that even at such terms there is a possibility of prolonging pregnancy: with careful clinical and laboratory monitoring and antibacterial, tocolytic and hormonal therapy (3).

Popular Questions and Answers

Obstetrician, gynecologist, gynecologist-endocrinologist, reproductologist Yulia Golesheva answers readers’ questions.

Is there a safe waterless gap?

Even with normal term delivery, an anhydrous gap is inevitable. Since from the moment the front waters are poured out to the birth of the baby, some time passes. In obstetrics, there are norms and algorithms for conducting childbirth.

Conditionally “normal” can be called an anhydrous period of up to 6 hours. After this time, the decision on management tactics is made by the doctor, depending on the condition of the woman and the baby. Sometimes, if all indicators are good, they can simply continue observation for up to 12 hours.

How does the water flow?

Normally, the amniotic membranes rupture only during childbirth – at the peak of contractions before the end of the first birth period.

The passage of water at any other time is considered premature. Sometimes there is a crack in the amniotic membranes or a small high lateral tear, so the outflow of water may not be as noticeable. But some signals can make a pregnant woman think about water leakage. It may be a sudden discharge of a watery consistency, or a discharge that has become more liquid and plentiful than before.

Consult your doctor regardless of how far along you are. Violation of the tightness of the shells leads to the fact that favorable conditions are created for the penetration of microbes.

Accordingly, if there is a suspicion of a violation of the integrity of the fetal bladder, immediate measures are taken: prevent infection of the child by prescribing antibacterial drugs.

Is it normal for the amniotic fluid to become cloudy?

Amniotic fluid is usually clear and colorless. But in some cases, the outflowing waters have a color. The greenish color of the water is due to the ingress of meconium (the first stool) into the amniotic fluid, which is possible with oxygen starvation (asphyxia), infection. With prolonged asphyxia, even the color of the membranes can change. Long-term existence in these conditions, with the constant ingestion of meconium in the prenatal state, the fetus has problems with the development of the central nervous system.

Red color or pinkish due to blood from the vessels of the umbilical cord, yellowish – with Rhesus conflict. Therefore, the coloring of water, cloudiness is always an alarming sign.

Sources

1. Approaches to the management of preterm pregnancy with premature rupture of amniotic fluid.