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

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