Calcium Supplementation and Uterine Atony: Simple Solution to a Big Problem

Authors

  • Umairah yaqub Department of Obs & Gynae, Pak Emirates Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Uzma Saleem Department of Obs & Gynae, Combined Military Hospital Kharian /National University of Medical Sciences (NUMS) Pakistan
  • Shagufta Parveen Department of Obs & Gynae, Combined Military Hospital Sialkot /National University of Medical Sciences (NUMS) Pakistan
  • Sumaira Khan Department of Obs & Gynae, Combined Military Hospital Rawalpindi /National University of Medical Sciences (NUMS) Pakistan
  • Adiba Akhtar Khalil Department of Obs & Gynae ,NUST School of Health Sciences Islamabad Pakistan
  • Syed Ali Mazhar Rizvi Department ofAnesthesiology, Pak Emirates Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i1.11986

Keywords:

Calcium chloride, cesarean section, spontaneous vaginal delivery, post-partum hemorrhage and uterine atony

Abstract

Objective: To compare the frequency of uterine atony in laboring women who are given prophylactic Calcium Chloride versus laboring women who did not receive it.

Study design:  Quasi-experimental study

Place and duration of study: Pakistan Emirates Military Hospital Rawalpindi, Pakistan from Oct 2023 to Mar 2024.

Methodology: After getting approval of hospitals ethical committee, eighty-two gravid women at term, who were at the risk of development of uterine atony were recruited. The study participants were then divided into two groups. 41 patients were placed in Group-A, while 41 patients were placed in Group-C. The patients in Group-C were given one gram of Calcium Chloride (10ml of 10% Calcium Chloride solution) along with Oxytocin (10 international units) after cord clamping while Group-A patients were only given Oxytocin (10 international units) after cord clamping. The frequency of uterine atony was taken as the primary outcome.

 Results: The uterine atony was present in 7(17.1%) Group-C patients in which supplemental calcium was administered, however 34(82.9%) patients did not develop uterine atony in contrast to Group-A where 15(38.5%) patients developed uterine atony, and twenty-four (61.5%) patients did not develop atony with p- value of less than 0.05.

 Conclusion: The Intravenous administration of Calcium Chloride can prevent uterine atony during delivery in patients at risk of developing post-partum hemorrhage.

Downloads

References

Lam V, Vinh T. Risk factors of postpartum hemorrhage due to uterine atony: a retrospective cohort study. Tạp chí Phụ sản. 2023; 21(1): 9-15. https://doi: 10.46755/vjog.2023.1.1544

Liew-Spilger A, Sorg N, Brenner T, Langford J, Berquist M, Mark N ,et al. Viscoelastic hemostatic assays for postpartum hemorrhage. J Clin Med. 2021; 10(17): 3946.

https;//doi 10.3390/jcm10173946

Belfort MA, Lockwood C, Barss V. Overview of postpartum hemorrhage. UpToDate. Ed. 2018.

Lan Y, Xu A, Lu X, Zhou Y, Wang J, Hua Y, et al. Risk factors for postpartum hemorrhage in twin pregnancies with cesarean section. Front Med 2024; 10:1301807.

https://doi: 10.3389/fmed.2023.1301807.

Drew T, Carvalho J. Pharmacologic Prevention and Treatment of Postpartum Hemorrhage. Current Anesthesiology Reports. 2021; 11:37-47. https://doi.org/10.1007/s40140-021-00444-7

Dorairajan G. (Ed.) Management of Normal and High-Risk Labour during Childbirth Ed. 1. CRC Press: (2022). https://doi.org/10.1201/9781003034360

Fan G, Cui Y, Gollasch M, Kassmann M. Elementary calcium signaling in arterial smooth muscle. Channels 2019;13(1):505-519.https://doi: 10.1080/19336950.2019.1688910.

Hart B, Noble V. Calcium and quinine in labor and post-partum hemorrhage. Eur J Pharm Med Res 2019; 6(10): 53-58.

Abdelgayed SM, Bakry AM, Faheem AS. The Relation between serum calcium levels and Atonic postpartum Hemorrhage. Eygpt J Med Res 2023 ; 4(4): 50-62.

https://doi.org/10.21608/ejmr.2023.186552.1315

Farber MK, Schultz R, Lugo L, Liu X, Huang C, Tsen LC. The effect of co-administration of intravenous Calcium Chloride and oxytocin on maternal hemodynamics and uterine tone following cesarean delivery: a double-blinded, randomized, placebo-controlled trial. Int J Obstet Anesthesiol. 2015; 24(3): 217-224.

https://doi: 10.1016/j.ijoa.2015.03.007

Ansari J, Kalariya N, Carvalho B, Flood P, Guo N, Riley E. Calcium Chloride for the prevention of uterine atony during cesarean delivery: a pilot randomized controlled trial and pharmacokinetic study. J Clin Anesthisol 2022 ;80:110796.

https://doi.org/10.1016/j.jclinane.2022.110796

Joseph N, Worrell N, Collins J, Schmidt M, Sobers G, Hutchins K, et al. Implementation of a postpartum hemorrhage safety bundle at an urban safety-net hospital. American J Perineonatology Rep 2020; 10(03): e255-e261.

https://doi.org/10.1055/s-0040-1714713

Bláha J, Bartošová T. Epidemiology and definition of PPH worldwide. Best Pract Res Clin Anaesthesiol 2022; 36(3-4): 325-339. https://doi.org/10.1016/j.bpa.2022.11.001

Premalahta H, Krishnegowda R. Prospective study of association of uterine atonicity and serum calcium levels. Int J Reproductio Contaception Obstet Gynecol 2016 ; 5(7): 2221-2224. https://doi.org/10.18203/2320-1770.ijrcog20162097

Pehlivanoğlu B, Bayrak S, Doğan M. A close look at the contraction and relaxation of the myometrium; the role of calcium. J Turk Ger Gynecol Assoc 2013; 14(4): 230-234. https://doi.org/10.5152/jtgga.2013.67763

Andretta A, Schieferdecker M, Petterle R. Relations between serum magnesium and calcium levels and body composition and metabolic parameters in women with fibromyalgia. Adv Rheumatol 2020; 60(18).

https://doi.org/10.1186/s42358-020-0122-4

Pergialiotis V, Bellos I, Constantinou T, Voskos A, Papapanagiotou A, Loutradis D, et al. Magnesium sulfate and risk of postpartum uterine atony and hemorrhage: A meta-analysis. Eur J Obstet Gynecol 2021; 256:158-64.

https://doi.org/10.1016/j.ejogrb.2020.11.005

Oguaka V, Adinma J, Okafor C, Udigwe G, Adinma O, Edet M. Serum calcium in primary postpartum haemorrhage. Eur J Pharm Med Res 2019; 6(10): 53-58.

Khan S, Saeed M, Mustafa G, Durrani HD. Uterine Atony;: Association Of Low Serum Vitamin D. Professional Med J 2014; 21(06): 1117-1121.

https://doi.org/10.29309/TPMJ/2014.21.06.2672

Abd El-Samie M, Abd El-Hamid A, El-Ashmawy A, Ahmed B. Calcium in the management of atonic postpartum hemorrhage. Eygption J Hosp Med 2017; 68(2): 1162-1168.

https://doi.org/10.12816/0039044

Downloads

Published

28-02-2025

Issue

Section

Original Articles

How to Cite

1.
yaqub U, Saleem U, Parveen S, Khan S, Khalil AA, Rizvi SAM. Calcium Supplementation and Uterine Atony: Simple Solution to a Big Problem. Pak Armed Forces Med J [Internet]. 2025 Feb. 28 [cited 2025 Apr. 25];75(1):147-51. Available from: https://pafmj.org/PAFMJ/article/view/11986