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Intravenous Calcium to Decrease Blood Loss During Intrapartum Cesarean Delivery: A Randomized Controlled Trial.

Jessica R Ansari1, Alla Yarmosh, Guillermina Michel

  • 1Department of Anesthesiology, Perioperative and Pain Medicine, the Department of Obstetrics and Gynecology, the Quantitative Sciences Unit, Department of Medicine, and the Department of Pediatrics, Stanford University, Stanford, California.

Obstetrics and Gynecology
|November 2, 2023
PubMed
Summary
This summary is machine-generated.

Prophylactic intravenous calcium chloride did not significantly reduce blood loss during cesarean delivery in the main study. However, it significantly reduced blood loss in a subgroup analysis, suggesting potential for postpartum hemorrhage treatment.

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Pharmacology

Background:

  • Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality.
  • Uterine atony is a common cause of PPH, particularly during cesarean delivery.
  • Effective prophylactic strategies to reduce blood loss during cesarean delivery are needed.

Purpose of the Study:

  • To evaluate the efficacy of prophylactic intravenous calcium chloride in reducing blood loss from uterine atony during intrapartum cesarean delivery.
  • To assess the safety and effectiveness of calcium chloride compared to placebo.

Main Methods:

  • A single-center, block-randomized, placebo-controlled, double-blind superiority trial was conducted.
  • 120 parturients undergoing intrapartum cesarean delivery after oxytocin exposure received either 1 g of intravenous calcium chloride or saline placebo after cord clamping.
  • Quantitative blood loss was the primary outcome, with a planned subgroup analysis excluding nonatonic bleeding.

Main Results:

  • The primary analysis showed no statistically significant difference in median blood loss between the calcium chloride (840 mL) and placebo (1,051 mL) groups.
  • In the planned subgroup analysis excluding nonatonic bleeding, calcium chloride significantly reduced quantitative blood loss by 356 mL (95% CI 159-515).
  • Adverse event rates were similar between groups.

Conclusions:

  • Prophylactic intravenous calcium chloride did not significantly reduce blood loss in the overall cesarean delivery population.
  • Calcium chloride demonstrated a significant reduction in blood loss in the subgroup analysis, suggesting a potential role in managing PPH.
  • Further research is warranted to explore calcium chloride as a novel treatment for PPH.