Bandel's Ring: What Is It And How Might It Affect My Labor?

I had a classical cesarean because of a Bandel's ring. Before delivery, there was no indication that the shape of my uterus was abnormal, and no indication was given that I might need a cesarean. I'd like to know more about this condition.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Let me begin by giving some background information about labor itself. During normal labor, the uterus can be divided into two distinct parts. The upper segment actively contracts and becomes thicker as labor advances. The lower portion (with the cervix) becomes thinner as labor progresses and is relatively passive compared to the actively contracting upper segment. The two segments can be differentiated during a contraction; the upper portion is firm and hard and the lower one is softer. The junction between these two is called the physiological ring.

A Bandel's (retraction) ring develops from the physiological ring and is often -- but not always -- the result of an obstructed labor. Sometimes it can actually be seen as an abdominal indentation, signifying impending rupture of the lower uterine segment. If this should happen, death of the fetus ensues and maternal death is imminent, if nothing is done.

Immediate cesarean birth is usually carried out if this ring is seen, but usually the length of labor has been prolonged and caesarean birth is indicated anyway. CPD, or cephalopelvic disproportion, is the prime cause for an obstructed labor but, occasionally, it could be due to malposition, malpresentation, obstetric manipulations, twins, maternal fatigue and failed forceps delivery. The shape of the uterus can be normal, but this condition develops in late labor.

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