Paracervical block is associated with the danger of?

AIIMS Bhatinda NO - 2019

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

A paracervical block is a regional anesthetic technique used for pain relief during the first stage of labor, where a local anesthetic is injected into the tissue next to the cervix.
The most significant and worrisome complication of this procedure is fetal bradycardia (a dangerously slow fetal heart rate).
This occurs in about 15% of cases and is believed to result from the anesthetic causing vasospasm (constriction) of the nearby uterine arteries, which reduces blood flow to the fetus.
The bradycardia typically develops within 10 minutes of the block and can last for up to 30 minutes, posing a risk of fetal distress.

Option A: A paracervical block is intended to manage labor pain and is not primarily associated with inhibiting or stopping uterine contractions.
Option C: This procedure does not typically cause increased blood loss. While any injection carries a minor risk of hematoma, significant hemorrhage is not a recognized complication.
Option D: Atony of the uterus is the failure of the uterus to contract effectively after childbirth, leading to postpartum hemorrhage. It is not a complication of a paracervical block administered during labor.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Regional Anesthesia in Labor as background academic context rather than a clinical decision trigger.
Continuous electronic fetal heart rate monitoring is mandatory after administering a paracervical block to allow for immediate detection of fetal bradycardia.
If fetal bradycardia occurs, nursing interventions include changing the mother's position (e.g., to the left side) to improve uterine blood flow, administering oxygen, and notifying the provider immediately.
Due to the significant risk of fetal bradycardia, many institutions have limited the use of paracervical blocks in favor of other methods like epidural analgesia.

How to Approach the Question

Identify the core subject of the question: the dangers of a 'paracervical block'.
Recall the purpose and anatomical location of this procedure. It's a local anesthetic injection near the cervix for labor pain.
Consider the anatomy involved. The injection is near the uterine arteries, which supply blood to the placenta and fetus.
Evaluate each option based on this anatomical and physiological context.
Eliminate options that are not directly related. 'Inhibition of labor', 'increased blood loss', and 'atony of uterus' are not primary, well-known complications of this specific block.
Recognize that interference with uterine artery blood flow would directly impact the fetus, making 'fetal bradycardia' the most plausible and clinically recognized danger.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 62-84