Overview

This research study is being done to learn what effect a single dose of calcium gluconate will have on blood loss at the time of cesarean delivery in pregnancy patients at high risk for uterine atony.

Eligibility

Inclusion Criteria:

• English speaking
• Viable Intrauterine Pregnancy, Gestational Age ≥24 weeks
• Labor Converted to Cesarean Delivery at High Risk for Atonic Bleeding Defined as: Any exposure to oxytocin infusion for labor augmentation or induction prior to cesarean delivery
• Or Scheduled Cesarean Delivery at High Risk for Atonic Bleeding Defined as scheduled Cesarean-Section (CS) plus any one of:
  1. > 4 Prior deliveries
  2. General anesthesia
  3. Multifetal gestation
  4. Polyhydramnios diagnosed by ultrasound within 2 weeks
  5. Macrosomia ≥ 4000gms; estimated fetal weight by palpation or by ultrasound
  6. Fibroid uterus, defined as: Multiple ≥ 2cm intramural
  7. Any history of prior Primary postpartum hemorrhage (PPH)
  8. Platelets < 100,000 (but >50,000
  9. Placenta Previa
  10. Body Mass Index (BMI) ≥ 40

Exclusion Criteria:

• Non-English speaking
• Antenatal suspicion for placenta accreta spectrum
• History of allergic reaction to Calcium Gluconate
• Patients with hypertensive disorder of pregnancy receiving Magnesium Sulfate for seizure prophylaxis
• Underlying Renal Disease defined as Cr>1.0
• Known underlying cardiac condition
• Cardiac glycosides (Digoxin) within two weeks for maternal or fetal indication
• Treatment with a calcium channel blocker medication within 24 hours of screening
• Hypertensive disorder necessitating intravenous antihypertensive medication within 24 hours of screening
• Emergent case where study participation could impede care (judgement of obstetrician or anesthesiologist)
• Known hypercalcemia
• Concurrent use of any drugs that may cause hypercalcemia including
  1. Vitamin D
  2. Vitamin A
  3. Thiazide Diuretics
  4. Calcipotriene
  5. Teriparatide
• Ceftriaxone within 48 hours of screening
• Total Parenteral Nutrition (TPN) within 48 hours of screening
• Known Coagulopathy International Normalized Ratio (INR) ≥ 1.5
• Vaginal delivery