Bandl's ring: a comprehensive review
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20260213Keywords:
Bandl's ring, Pathological retraction ring, Obstructed labor, Dystocia, Uterine rupture, Parturition, Maternal morbidity, Perinatal mortality, Intrapartum complicationsAbstract
Bandl's ring is a pathological retraction ring marking the junction between an overstretched upper uterine segment and a thickened, contracted lower segment. It is a critical sign of obstructed labor and imminent uterine rupture. It arises from failure of normal uterine retraction, often due to cephalopelvic disproportion, malpresentation, or macrosomia. Clinically, a late and ominous oblique abdominal groove may be palpable. Diagnosis is primarily clinical, supported by ultrasound showing distorted anatomy and fetal compromise. Immediate cesarean delivery is the definitive and urgent management. Uterine stimulation or instrumental vaginal delivery are absolutely contraindicated. Any delay risks uterine rupture, severe hemorrhage, fetal asphyxia, perinatal death, and maternal morbidity, including hysterectomy. Prevention relies on vigilant labor monitoring and timely intervention for dystocia. Prompt recognition and expedited surgical delivery are essential to prevent catastrophic outcomes.
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Friedman EA, Cohen WR. The active phase of labor. Am J Obstet Gynecol. 2023;228:S1037-49. DOI: https://doi.org/10.1016/j.ajog.2021.12.269
Kissler K, Hurt KJ. The pathophysiology of labor dystocia: theme with variations. Reprod Sci. 2023;30:729-42. DOI: https://doi.org/10.1007/s43032-022-01018-6
Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210:179-93. DOI: https://doi.org/10.1016/j.ajog.2014.01.026
Gupta R, Nageeb EM, Minhas I, Dang N, Mock SA, Rivera J, et al. Emergent cesarean section in a Bandl’s ring patient: an obstetrics and gynecology simulation scenario. Cureus. 2018;10:e3800. DOI: https://doi.org/10.7759/cureus.3800
Lauria, MR, Barthold, JC, Zimmerman, RA, Turrentine, MA. Pathologic uterine ring associated with fetal head trauma and subsequent cerebral palsy. Obstet Gynecol. 2007;109:495-7. DOI: https://doi.org/10.1097/01.AOG.0000231678.01757.73
Turrentine MA, Andres RL. Recurrent Bandl’s ring as an etiology for failed vaginal birth after cesarean section. Am J Perinatol. 1994;11:65-6. DOI: https://doi.org/10.1055/s-2007-994539
Turrentine MA, Andres RL. Modern analysis of pathologic uterine rings. South Med J. 1997;90:40-2. DOI: https://doi.org/10.1097/00007611-199701000-00009
Kaye CH. Constriction ring dystocia. Can Med Assoc J. 1974;10:535-8. DOI: https://doi.org/10.1097/00006254-197410000-00004
Jeanty P, Johns R, Boehm F. Uterine ring and fetal demise. J Ultrasound Med. 1989;8:635-8. DOI: https://doi.org/10.7863/jum.1989.8.11.635
Buhimschi CS, Buhimschi IA, Weiner CP. Ultrasonographic observation of Bandl’s contraction ring. Int J Gynaecol Obstet. 2004;86:35-6. DOI: https://doi.org/10.1016/j.ijgo.2003.12.007
Tinelli A, Di Renzo GC, Malvasi A. The intrapartum ultrasonographic detection of the Bandl ring as a marker of dystocia. Int J Gynaecol Obstet. 2015;131:310-1. DOI: https://doi.org/10.1016/j.ijgo.2015.06.030
Mappa I, Malvasi A, Rizzo G. Ultrasonographic visualization of uterine Bandl’s ring in a case with obstructed labor. Am J Obstet Gynecol. 2025;03:23.
Suzuki S, Kondoa S. Intrapartum diagnosis of idiopathic constriction ring dystocia. J Clin Gynecol Obstet. 2015;4:314-5. DOI: https://doi.org/10.14740/jcgo380e
Braune W. Die Lage des Uterus une Foetus am Ende der Schwangerschaft: nach durchschnitten an gefrornen cadavern. Leipzig: Verlag con Veit & Comp. 1872.
Bandl L. Über Das Verhalten Des Uterus Und Cervix in Der Schwangerschaft Und Während Der Geburt: nach Klinischen Beobachtungen Und Anatomischen Untersuchungen. Enke. 1876.
Rudoplh L. Constriction ring dystocia. J Am Med Assoc. 1937;108:532-8. DOI: https://doi.org/10.1001/jama.1937.02780070016005
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