Bandl's ring: a comprehensive review

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.