Prophylactic Intravenous Calcium Gluconate to Decrease Blood Loss at Time of Cesarean Delivery in Pregnant Patients at High Risk for Uterine Atony

This study is FDA IND exempt

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:

• > 4 Prior deliveries
• General anesthesia
• Multifetal gestation
• Polyhydramnios diagnosed by ultrasound within 2 weeks
• Macrosomia ≥ 4000gms; estimated fetal weight by palpation or by ultrasound
• Fibroid uterus, defined as: Multiple ≥ 2cm intramural
• Any history of prior Primary postpartum hemorrhage (PPH)
• Platelets < 100,000 (but >50,000
• Placenta Previa
• 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

• Vitamin D
• Vitamin A
• Thiazide Diuretics
• Calcipotriene
• 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