Department of Reproductive Health and Research (RHR), World Health Organization
Managing Complications in Pregnancy and Childbirth
A guide for midwives and doctors
Section 3 - Procedures
TABLE P-1 Indications and precautions for paracervical block
Note: With incomplete abortion, a ring (sponge) forceps is preferable as it is less likely than the tenaculum to tear the cervix with traction and does not require the use of lignocaine for placement.
Tip: Some practitioners have suggested the following step to divert the woman’s attention from the insertion of the needle: Place the tip of the needle just over the site selected for insertion and ask the woman to cough. This will “pop” the needle just under the surface of the tissue.
Note: Aspirate (pull back on the plunger) to be sure that no vessel has been penetrated. If blood is returned in the syringe with aspiration, remove the needle. Recheck the position carefully and try again. Never inject if blood is aspirated. The woman can suffer convulsions and death if IV injection of lignocaine occurs.
Anaesthetize early to provide sufficient time for effect.
Paracervical block injection sites
Rapid initial assessment