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A constriction of the junction between the thinned lower uterine segment and the thick
retracted upper uterine segment caused by obstructed labor; a sign of impending
rupture of the uterus. Also called Bandl's ring.
A constriction located at the junction of the thinned lower uterine segment with the
thick retracted upper uterine segment, resulting from obstructed labour; this is one of
the classic signs of threatened rupture of the uterus.
Bandl’s Ring
Posted on November 3, 2009 by Kathy
Our miracle baby was born c-sec after more than 24hrs of VBAC-ing labor. His heart
rate de-celled enough times that we decided to get him out, after I was stuck at 9/5
cm’s for many, many hrs with no progress!
As it turned out, i had an obstructed labor…and a Bandel’s Ring, so baby was never
coming out vaginally. So, now I am concerned for the next baby (prob a yr from now).
Should I attempt another VBAC? How do I find out if I have a true Bandels Ring? What
are things I can do to prevent this from happening?
What is “Bandl’s Ring”? There are two types of uterine muscles, one to help the cervix
dilate and the other to help push the baby out. At their juncture, rarely (usually during
a prolonged and/or obstructed labor) a ring develops around a “depression” in the
fetus, usually over the neck. [Click here to see a picture of a woman's abdomen,
showing the stark outlines of the baby's body, due to a Bandl's Ring. Sometimes when
this happens, even a birth by C-section is difficult, because the ring prevents the birth
of the shoulders and the rest of the body. Usually, the uterus will greatly constrict,
which disrupts placental blood flow, and therefore oxygen flow, to the fetus. Bandl's
Ring was named after the doctor who first identified it.
One source said that a T incision was indicated for Bandl's Ring. Since a T incision is
usually (if not always) a contraindication to a VBAC, it seems pretty certain that it is
not always necessary. One mother said that she had a Bandl's Ring but still had a
vaginal birth, and someone else responding to the comment questioned whether she
really had a "true" Bandl's Ring, since she actually had a vaginal birth. In the old days,
and currently in areas of the world without access to medical care, Bandl's Ring
frequently results in high perinatal mortality (many times the baby is stillborn, or dies
of birth injuries soon after birth) and also maternal mortality and morbidity. Uterine
rupture will likely occur after a Bandl's Ring develops, because the lower uterine
segment is just stretched so thin, and subsequent contractions stress it even more. In
the old days, it was sometimes necessary to dismember the fetus (who was usually
dead, due to lack of oxygen); and even then, sometimes the woman died or suffered
debilitating injuries to her internal organs.
One of the frustrating elements in doing the search was a paucity of materials on
Bandl's Ring, especially recent materials -- many of the Google Scholar results were
case studies from the 1960s and before; including at least one from 1891 (yes, not
1981, but 1891, right before an article debating chloroform and ether). This article
from 1961 (click on the pdf to read the article) included many alternate names: ring of
Bandl, contraction of the ring of Bandl, contraction ring dystocia of White, retraction
ring dystocia of Pride, simple contraction or retraction ring, uterine contraction ring, or
constriction ring of Rudolph. Then it launches into a discussion of what different
doctors have differentiated between the various names (and perhaps various types) of
ring.
Johnson also commented that the terminology and assumptions used in reference to
pathologic rings are bewildering, and he, too, emphasized the difference between the
rings of obstructed and nonbstructed labor, although he referred to both as
contraction rings.
"Bewildering" is correct. I tried to find information on Bandl's Ring, Bandel's Ring, and
"uterine constriction ring," and got precious little information. On one message board,
someone identifying herself as a midwife said that once a woman develops a Bandl's
Ring, it will always happen again, and the woman will always need C-sections. But on
another board, a doctor said that since the woman asking the question was being
offered a VBAC, then that was proof that a vaginal birth was still a possibility.
The blogger at Abundant B'earth wrote the following for a "complications project,"
which is a nice summary (and is more informative than Google Scholar turned out to
be!):
Si/sx: ["symptoms"]
-Hypertonic contractions
-presenting part driven/jammed
-mother experiences severe pain and excited or restless emotions
-maternal pulse, temperature rise
-palpable, taut round ligaments; may also be visible
-Baby entirely or almost entirely in lower uterine segment.
-ring felt as transverse ridge, as high up as umbilicus or potentially even higher
Differential Diagnosis: May appear to be constriction ring. (see chart Frye p. 1043)
Complications/Sequelae:
-rupture of the lower segment, maternal hemorrhage
-placental abruption
-maternal exhaustion, inertia, and arrest of contractions
-uteroplacental insufficiency with resultant fetal hypoxia and distress.
-maternal fistula, lacerations more likely
So, I don’t know how common it is. I don’t know what the rate of recurrence is. It
seems that uterine fatigue is the chief cause of it (although there are other factors —
for instance, fetal malposition may cause obstructed labor which may lead to uterine
fatigue due to a lengthy labor), which makes me think that perhaps red raspberry leaf
tea may help to prevent it. I don’t think there are any contraindications to this tea in
the third trimester, although some people think it might increase the risk of
miscarriage in the first trimester. This website says, “Red Raspberry leaf does not start
labor or promote contractions. It is NOT an emmenagogue or oxytocic herb. What it
does is help strengthen the pelvic and uterine muscles so that once labor does start
the muscles will be more efficient.” So, this may help in general to prevent uterine
fatigue. Chiropractic adjustments and optimal fetal positioning may help to prevent
fetal malposition (along with the mother being upright and mobile during labor, if she
desires). Cephalopelvic Disproportion (CPD) is over-diagnosed, but it may occasionally
happen even in well-nourished mothers. [In developing countries, many women have
malformed pelvises due to poor nutrition in childhood and adolescence, and many
cultures have child-brides which leads to many still-developing adolescents giving
birth to children, so the incidence of true CPD is higher there.]