9.3.2 Bandl’s ring
Bandl’s ring is the name given to the depression between the upper and lower halves of the uterus, at about the level of the umbilicus. It should not be seen or felt on abdominal examination during a normal labour (Figure 9.2a), but when it becomes visible and/or palpable (Figure 9.2b) Bandl’s ring is a late sign of obstructed labour. Above this ring is the grossly thickened, upper uterine segment which is pulled upwards (retracted) towards the mother’s ribs. Below the Bandl’s ring is the distended (swollen), dangerously thinned, lower uterine segment. The lower abdomen can be further distended by a full bladder and gas in the intestines.
9.3.1 Assessment of clinical signs of obstruction
9.3.3 Evidence from the partograph