A Study: To Consider IV Calcium Chloride in Preventing Uteri
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Women at high risk for uterine atony during cesarean delivery greatly benefited from IV calcium chloride administration for reducing significant postpartum hemorrhage.

Postpartum hemorrhage is a leading cause of maternal mortality, with uterine atony causing 70% to 80% of the bleeding cases. Extra calcium is an effective, inexpensive and well-tolerated intervention to improve uterine contraction, thus reducing blood loss during labor and cesarean delivery. The pilot study, comprised of 40 women with mostly normal or slightly lower-than-normal calcium levels. All study patients had two risk factors for uterine atony: augmentation of labor with oxytocin, history of postpartum hemorrhage, polyhydramnios, or women with previous multiple gestations.

Patients were randomized to either 1 g of calcium chloride or placebo, as a 10-minute infusion started after umbilical cord clamping. Use of secondary uterotonic agents was unaltered. Uterine atony was defined as the occurrence of any of the following: requirements for a second-line uterotonic, Bakri balloon, B-lynch procedure, hysterectomy, or an estimated blood loss greater than 1,000 mL. Only 20% of women who received calcium chloride developed uterine atony. In calcium-treated patients, the calcium level rose from a baseline of 1.18 mmol/L to a peak level in the 1.5- to 1.6 over 10 minutes. However, the study found no significant difference in estimated blood loss between the two groups.

The calcium chloride infusion also was well tolerated, with no difference in any side effects such as nausea, changes in blood pressure, or injection site discomfort with reported complications. It could make a significant difference for women with postpartum hemorrhage, without any downside.

Source: https://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/08-20/Consider-IV-Calcium-Chloride-To-Prevent-Uterine-Atony
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