Paracervical Block

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  • First stage of labor
  • Cervical ablation or conization procedures
  • Dilation and curettage

Absolute Contraindications

  • Uteroplacental insufficiency
  • Preexisting fetal distress
  • Nonreassuring fetal heart tracing
  • Delivery appears imminent.
  • Allergy to anesthetic agent
  • Presence of local infection

Relative Contraindications

  • Known coagulopathy or anticoagulated patient
  • 10-mL syringe (with finger rings if available)
  • Iowa trumpet with a 6-inch, 20-gauge needle or a 3-inch needle extender on the end of a syringe with a 1½-inch, 22-gauge needle
  • Anesthesia
  • Sterile gloves
  • Antibacterial solution and sterile gauze pads and sterile ringed forceps
  • Sterile speculum
  • Sterile tenaculum for nongravid cervix
  • Fetal heart monitor (for gravid patient)

Neurovascular Supply of the Cervix

  • The blood supply to the cervix is provided via the cervical branches of the uterine arteries.
  • On the nongravid cervix and in early labor, the cervical nerves are located at 4 and 8 o'clock, but these move anteriorly during progressive dilation.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Continue to monitor the fetal heart rate.
  • It may be necessary to repeat the procedure to maintain anesthesia.
  • Advise the patient to advise you of signs and symptoms of complications.
  • Intrafetal injection
  • Fetal bradycardia
  • Hematoma or infection
  • Neuropathy resulting from hematoma formation or direct sacral plexus trauma
  • Cardiotoxicity or neurotoxicity
  • Allergic reactions (rare)
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