The incidence of Bandl's ring and its impact on labor outcomes: a review of the published literature

Abstract

Introduction: Obstructed labor is a serious obstetric emergency that can lead to uterine rupture, and significant maternal and perinatal morbidity and mortality. Bandl first described this condition, of abnormal retraction of the uterus occurring during obstructed labor, characterized by a constriction between the thinned lower uterine segment and the thick, retracted upper uterine portion. To determine the incidence and the maternal and perinatal outcome in pregnancies showing Bandl's ring by reviewing the published literature.

Content: PubMed, Embase and Google Scholar Search searches were made using "Bandl's ring." Papers selected were assessed independently for content, data extraction and analysis. The following parameters were included for the analysis: total number of reported cases, use of ultrasound, fetal position and station, labor augmentation, modality of delivery, indications for cesarean section, neonatal complications.

Summary and outlook: The literature search identified nine articles that met the established inclusion criteria and were deemed eligible for analysis and comparison, encompassing a total of 23 clinical cases. Ultrasound was used 21 % of the cases. The fetal occiput was posterior in 93 % of the cases, augmentation of labor in 39 %, cesarean section was necessary in 95.6 % of cases and there were three cases of severe neonatal complications (13 %). Bandl's ring represents a rare yet clinically significant intrapartum pathology. This study highlights the importance of early recognition and appropriate management of Bandl's ring. Incorporating ultrasound into the assessment of obstructed labor may enhance obstetricians' ability to accurately identify this condition, thereby minimizing the risks associated with delayed or inappropriate intervention.

Keywords: obstructed labor; uterine Bandl’s ring; ultrasound.