BANDL’S RING RETRACTION RING CONSTRACTION RING PATHOPHYSIOLOGY A contraction ring is a hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent. The ring usually appears during the second stage of Labor and can be palpated as a horizontal indentation across the abdomen. It is a warning sign that severe dysfunctional labor is occurring as it is formed by excessive retraction of the upper uterine segment; the uterine myometrium is much thicker above than below the ring. PREDISPOSING FACTORS CAUSES • • • • Prolonged labor Dystocia Uncoordinated contraction Obstetric manipulation Malpresentation and malposition Premature rupture of membrane Premature attempt of instrumental delivery Intrauterine manipulations under light anesthesia • Improper use of oxytocin • • • • SIGNS & SYMPTOMS DIAGNOSTIC TESTS Contraction rings often can be identified by ULTRASOUND. • The uterus upper segment is tonically contracted with no relaxation and the wall becomes thicker, lower segment becomes distended and thinned out. • Uterus is tense and tender • Ring is felt as a groove placed obliquely • Vagina lower segment is very much pressed by the forcibly driven presenting part TREATMENTS/MANAGEMENT Administration of IV MORPHINE SULFATE or the inhalation of AMYL NITRITE may relieve a retraction ring. A TOCOLYTIC can also be administered to halt contractions. DEFINITIVE TREATMENT DESTRUCTIVE SURGERY if fetus is dead CESARIAN SECTION is fetus is alive NURSING CARE • • BANDL’S RING • • Explain to the patient about retraction ring causes, predisposing factors, and signs and symptoms. Inform the patient about the necessary test she needs to undergo to confirm the diagnosis. Administer drugs such as morphine sulfate, amyl nitrite, and tocolytic as needed and prescribe by the physician. Educate the patient about her medications and the different treatment she may undergo. RETRACTION RING PATHOPHYSIOLOGY A contraction ring is a hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent. The ring usually appears during the second stage of Labor and can be palpated as a horizontal indentation across the abdomen. It is a warning sign that severe dysfunctional labor is occurring as it is formed by excessive retraction of the upper uterine segment; the uterine myometrium is much thicker above than below the ring. PREDISPOSING CAUSES • • • • Prolonged labor Dystocia Uncoordinated contraction Obstetric manipulation DIAGNOSTIC TESTS Contraction rings often can be identified by ULTRASOUND. FACTORS Malpresentation and malposition Premature rupture of membrane Premature attempt of instrumental delivery Intrauterine manipulations under light anesthesia • Improper use of oxytocin • • • • SIGNS & SYMPTOMS • The uterus upper segment is tonically contracted with no relaxation and the wall becomes thicker, lower segment becomes distended and thinned out. • Uterus is tense and tender • Ring is felt as a groove placed obliquely • Vagina lower segment is very much pressed by the forcibly driven presenting part TREATMENTS/MANAGEMENT Administration of IV MORPHINE SULFATE or the inhalation of AMYL NITRITE may relieve a retraction ring. A TOCOLYTIC can also be administered to halt contractions. DEFINITIVE TREATMENT DESTRUCTIVE SURGERY if fetus is dead CESARIAN SECTION is fetus is alive NURSING CARE RETRACTION RING INCOMPETENT CERVIX Incompetent cervix is a condition that refers to the inability of the cervix to hold the fetus any longer until term because it has dilated prematurely. PATHOPHYSIOLOGY • When the fetus reaches its 20th week, it starts to become heavy and gain fats. • The mother’s cervix is weak, and it could not hold the fetus’ weight anymore as it slowly starts to dilate. • This would cause the appearance of a show, a pink-tinged vaginal discharge. • Then, the membranes would rupture and amniotic fluid would be discharged. • Uterine contractions would start followed by a short labor, then the birth of the fetus. PREDISPOSING FACTORS • Increased maternal age • Congenital structural defects • Trauma to the cervix PRECIPITATING FACTORS • Abnormally formed cervix or uterus • Experienced a premature birth or miscarriage in the second trimester of pregnancy • Injured the cervix or uterus during previous pregnancy or childbirth. • Cervical surgery in the past • Exposure to diethylstilbestrol SIGNS AND SYMPTOMS Sensation of pelvic pressure Backache Abdominal cramps Change in vaginal discharge Light vaginal bleeding/spotting Braxton-Hicks-like contractions • • • • • • COMPLICATION • Miscarriage • Premature birth DIAGNOSTIC TEST Ultrasound. This is the only test that the physician could order if an incompetent cervix is already suspected. TREATMENT OR MANAGEMENT Medical Management Medical management by the physician would include any medications that could hinder dilation of the cervix. Surgical procedures immediately enforced to prevent compromising pregnancy. Surgical Management not the are the • • McDonald’s Cervical Cerclage Shirodkar Cervical Cerclage NURSING CARE • • • • Determine any factors that further contribute to the anxiety of the woman so it could be avoided. Monitor vital signs to determine any physical responses of the patient that could affect her condition. Convey empathy and establish a therapeutic relationship to encourage client to express her feelings. Provide accurate information about the situation to help client back into reality. INCOMPETENT CERVIX Incompetent cervix is a condition that refers to the inability of the cervix to hold the fetus any longer until term because it has dilated prematurely. PATHOPHYSIOLOGY • When the fetus reaches its 20th week, it starts to become heavy and gain fats. • The mother’s cervix is weak, and it could not hold the fetus’ weight anymore as it slowly starts to dilate. • This would cause the appearance of a show, a pink-tinged vaginal discharge. • Then, the membranes would rupture, and amniotic fluid would be discharged. • Uterine contractions would start followed by a short labor, then the birth of the fetus. PREDISPOSING FACTORS SIGNS AND SYMPTOMS • Cervical trauma • Race • Congenital conditions PRECIPITATING FACTORS • Abnormally formed cervix or uterus • Experienced a premature birth or miscarriage in the second trimester of pregnancy • Injured the cervix or uterus during previous pregnancy or childbirth. • Cervical surgery in the past • Exposure to diethylstilbestrol • • • • • • Sensation of pelvic pressure Backache Abdominal cramps Change in vaginal discharge Light vaginal bleeding/spotting Braxton-Hicks-like contractions COMPLICATION • Miscarriage • Premature birth DIAGNOSTIC TEST Ultrasound. This is the only test that the physician could order if an incompetent cervix is already suspected. TREATMENT OR MANAGEMENT Medical Management Medical management by the physician would not include any medications that could hinder the dilation of the cervix. Surgical procedures are immediately enforced to prevent compromising the pregnancy. Surgical Management • McDonald’s Cervical Cerclage • Shirodkar Cervical Cerclage NURSING CARE • • • • Determine any factors that further contribute to the anxiety of the woman so it could be avoided. Monitor vital signs to determine any physical responses of the patient that could affect her condition. Convey empathy and establish a therapeutic relationship to encourage client to express her feelings. Provide accurate information about the situation to help client back into reality. INCOMPETENT CERVIX Incompetent cervix is a condition that refers to the inability of the cervix to hold the fetus any longer until term because it has dilated prematurely. PATHOPHYSIOLOGY • When the fetus reaches its 20th week, it starts to become heavy and gain fats. • The mother’s cervix is weak, and it could not hold the fetus’ weight anymore as it slowly starts to dilate. • This would cause the appearance of a show, a pink-tinged vaginal discharge. • Then, the membranes would rupture, and amniotic fluid would be discharged. • Uterine contractions would start followed by a short labor, then the birth of the fetus. PREDISPOSING FACTORS SIGNS AND SYMPTOMS • Cervical trauma • Race • Congenital conditions PRECIPITATING FACTORS • Abnormally formed cervix or uterus • Experienced a premature birth or miscarriage in the second trimester of pregnancy • Injured the cervix or uterus during previous pregnancy or childbirth. • Cervical surgery in the past • Exposure to diethylstilbestrol • • • • • • Sensation of pelvic pressure Backache Abdominal cramps Change in vaginal discharge Light vaginal bleeding/spotting Braxton-Hicks-like contractions COMPLICATION • Miscarriage • Premature birth DIAGNOSTIC TEST Ultrasound. This is the only test that the physician could order if an incompetent cervix is already suspected. TREATMENT OR MANAGEMENT Medical Management Medical management by the physician would not include any medications that could hinder the dilation of the cervix. Surgical procedures are immediately enforced to prevent compromising the pregnancy. Surgical Management • McDonald’s Cervical Cerclage • Shirodkar Cervical Cerclage NURSING CARE • • • • Determine any factors that further contribute to the anxiety of the woman so it could be avoided. Monitor vital signs to determine any physical responses of the patient that could affect her condition. Convey empathy and establish a therapeutic relationship to encourage client to express her feelings. Provide accurate information about the situation to help client back into reality. BANDL’S RING RETRACTION RING CONTRACTION RING PATHOPHYSIOLOGY A contraction ring is a hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent. The ring usually appears during the second stage of Labor and can be palpated as a horizontal indentation across the abdomen. It is a warning sign that severe dysfunctional labor is occurring as it is formed by excessive retraction of the upper uterine segment; the uterine myometrium is much thicker above than below the ring. PREDISPOSING FACTORS CAUSES • • • • Prolonged labor Dystocia Uncoordinated contraction Obstetric manipulation SIGNS & SYMPTOMS DIAGNOSTIC TESTS Contraction rings often can be identified by ULTRASOUND. Malpresentation and malposition Premature rupture of membrane Premature attempt of instrumental delivery Intrauterine manipulations under light anesthesia • Improper use of oxytocin • • • • • The upper segment of the uterus is tonically contracted with no relaxation, and the wall becomes thicker, the lower segment becomes distended and thinned out. • Uterus is tense and tender • Ring is felt as a groove placed obliquely • Vagina lower segment is very much pressed by the forcibly driven presenting part TREATMENTS/MANAGEMENT Administration of IV MORPHINE SULFATE or the inhalation of AMYL NITRITE may relieve a retraction ring. A TOCOLYTIC can also be administered to halt contractions. DEFINITIVE TREATMENT • DESTRUCTIVE SURGERY if fetus is dead • CESARIAN SECTION is fetus is alive NURSING CARE • • BANDL’S RING • • Explain to the patient about retraction ring causes, predisposing factors, and signs and symptoms. Inform the patient about the necessary test she needs to undergo to confirm the diagnosis. Administer drugs such as morphine sulfate, amyl nitrite, and tocolytic as needed and prescribe by the physician. Educate the patient about her medications and the different treatment she may undergo.
