Authors: Abiramia TL, et al.
International Journal of Obstetric Anesthesia 63, 2025.
This randomized, placebo-controlled trial evaluated whether intravenous calcium gluconate can improve uterine tone and reduce postpartum hemorrhage during intrapartum cesarean delivery with spinal anesthesia. A total of 367 women were randomized to receive either calcium gluconate 1 g or placebo after umbilical cord clamping.
Uterine tone, assessed by obstetricians using an 11-point scale, did not differ significantly between groups. However, calcium administration led to important secondary benefits. Mean postpartum blood loss was reduced by approximately 55 mL in the calcium group compared to placebo. The need for additional uterotonics was also nearly halved (21.7% vs. 42.4%). Blood transfusion and vasopressor use were similar between groups.
What You Should Know:
Prophylactic intravenous calcium gluconate did not improve uterine tone scores, but it meaningfully reduced blood loss and the need for second-line uterotonics in cesarean delivery patients. These findings suggest calcium may have a role in optimizing hemorrhage management, even though tone assessment was unaffected.
Clinical Relevance:
For anesthesiologists and obstetric teams, calcium gluconate represents a low-cost, widely available adjunct that may help reduce bleeding and minimize reliance on additional uterotonic drugs during intrapartum cesarean deliveries. While not a substitute for standard prophylaxis, it may provide a valuable tool in postpartum hemorrhage prevention strategies.
Thank you to the International Journal of Obstetric Anesthesia for allowing us to use this article.