bandl

Bandl refers to Bandl's law and Bandl's ring, a concept in obstetrics describing a constriction ring that can form in the uterus during obstructed labor. The phenomenon represents a division between a distended upper uterine segment and a relatively contracted lower segment, connected by a circular constriction known as Bandl's ring. The ring may be felt as a circumferential band at the level of the lower uterine segment and, with ongoing obstruction, can migrate upward as labor progresses. Its appearance signals obstructed labor and a high risk of uterine rupture if delivery is delayed.

Pathophysiology involves differential changes in the uterine segments during obstructed labor. The upper segment becomes markedly distended and labor progresses poorly, while the lower segment remains comparatively contracted. This mismatch can produce a constriction ring at the junction of the two segments. If obstruction persists, the ring can move toward the fundus and may be associated with deterioration of both maternal and fetal condition.

Clinical significance and diagnosis: Bandl's ring is a historical and clinical sign of obstructed labor. It is typically identified during abdominal or pelvic examination, and in modern practice may be supported by imaging if needed. Today, effective management of obstructed labor aims to relieve the obstruction promptly to prevent complications, including uterine rupture.

Management: The presence of Bandl's ring indicates the need for urgent obstetric intervention to deliver the fetus and relieve obstruction. Management is typically expedited delivery, most commonly by cesarean section, with careful monitoring for maternal hemorrhage and signs of uterine rupture. The condition underscores the importance of timely recognition and treatment of dystocia in obstetric care.

See also: obstructed labor, dystocia, uterine rupture, cesarean section.