A little OB help please

[DancingFajitas]

I've been reading a lot about OB, but I can't seem to find direct answers to these questions:
1-when should membranes rupture? I know that pre-mature rupture of membranes is prior to the onset of labor, but when during labor should they rupture? at any time?
2-how do you know exactly when labor has started? i know its contractions leading to cervical change, but I'm confused as to how to tell these apart from Braxton-Hicks/false labor? Should a patient wait until they have ruptured to come to the hospital or should one advise them to come in with the onset of contractions?

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[cpants]

I've been reading a lot about OB, but I can't seem to find direct answers to these questions:
1-when should membranes rupture? I know that pre-mature rupture of membranes is prior to the onset of labor, but when during labor should they rupture? at any time?
2-how do you know exactly when labor has started? i know its contractions leading to cervical change, but I'm confused as to how to tell these apart from Braxton-Hicks/false labor? Should a patient wait until they have ruptured to come to the hospital or should one advise them to come in with the onset of contractions?

1. I don't believe there is a specific time when the membranes should rupture. Any time during labor is fine. You run into problems when the membranes rupture and then labor is delayed, not when labor proceeds but rupture is delayed. Make sense?

2. Labor is defined not by contractions, but by dilation of the cervix. If the patient is contracting and undergoes cervical changes, she is in labor. Braxton-Hicks contractions and false labor will usually present as irregular/infrequent contractions with no cervical changes.

Patients should be educated about Braxton-Hicks contractions and false labor. They should be advised to come into the hospital when contractions become strong, regular, and increasingly close together or when the membranes rupture, whichever comes first. Prior to term, patients should come in if they at all feel like they might be going into preterm labor. Better safe than sorry.

 

[Haemulon]

I have found from a parent's perspective that membranes should rupture at precisely the most inconvenient, undesireable time. Preferably after a long day when you are just finally laying down in bed for that much needed rest. Then BAM! You instead have to take Honey to the hospital and your once planned evening of glorious sleep fades into nothingness ...

From a med-students perspective .... pretty much the same thing. A patient's membranes should rupture and she should come into triage in active labor just after that moment on call in the wee-hours when the busy night has finally grown quiet and you are just about to get the go-ahead for a brief nap.