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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

Paracervical block

TABLE P-1 Indications and precautions for paracervical block



• Dilatation and curettage

• Manual vacuum aspiration

• Make sure there are no known allergies to lignocaine or related drugs

• Do not inject into a vessel

• Maternal complications are rare but may include haematoma

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.

  • With the tenaculum or ring forceps on the cervix vertically (one tooth in the external os, the other on the face of the cervix), use slight traction and movement to help identify the area between the smooth cervical epithelium and the vaginal tissue. This is the site for insertion of the needle around the cervix.

  • Insert the needle just under the epithelium.

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.

  • Inject 2 mL of lignocaine solution just under the epithelium, not deeper than 3 mm, at 3, 5, 7 and 9 o’clock (Fig P-1). Optional injection sites are at 2 and 10 o’clock. When correctly placed, a swelling and blanching of the tissue can be noted.  Anaesthetize early to provide sufficient time for effect. 

  • At the conclusion of the set of injections, wait 2 minutes and then pinch the cervix with forceps. If the woman feels the pinch, wait 2 more minutes and then retest.

Anaesthetize early to provide sufficient time for effect. 


Figure P-1

 Paracervical block injection sites



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Clinical principles

Rapid initial assessment

Talking with women and their families

Emotional and psychological support


General care principles

Clinical use of blood, blood products and replacement fluids

Antibiotic therapy

Anaesthesia and analgesia

Operative care principles

Normal Labour and childbirth

Newborn care principles

Provider and community linkages



Vaginal bleeding in early pregnancy

Vaginal bleeding in later pregnancy and labour

Vaginal bleeding after childbirth

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure

Unsatisfactory progress of Labour

Malpositions and malpresentations

Shoulder dystocia

Labour with an overdistended uterus

Labour with a scarred uterus

Fetal distress in Labour

Prolapsed cord

Fever during pregnancy and labour

Fever after childbirth

Abdominal pain in early pregnancy

Abdominal pain in later pregnancy and after childbirth

Difficulty in breathing

Loss of fetal movements

Prelabour rupture of membranes

Immediate newborn conditions or problems


Paracervical block

Pudendal block

Local anaesthesia for caesaran section

Spinal (subarachnoid) anaesthesia


External version

Induction and augmentation of labour

Vacuum extraction

Forceps delivery

Caesarean section


Craniotomy and craniocentesis

Dilatation and curettage

Manual vacuum aspiration

Culdocentesis and colpotomy


Manual removal of placenta

Repair of cervical tears

Repair of vaginal and perinetal tears

Correcting uterine inversion

Repair of ruptured uterus

Uterine and utero-ovarian artery ligation

Postpartum hysterectomy

Salpingectomy for ectopic pregnancuy



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