Effect of prophylactic intravenous calcium gluconate on uterine atony during intrapartum cesarean delivery with spinal anesthesia: a placebo controlled, randomized clinical trial
An erratum to this article was published (Int J Obstet Anesth, Feb 2026 ↗)
Authors' conclusion
Intravenous calcium gluconate (1 g) did not improve uterine tone, evaluated by the obstetricians with a numeric rating score, during intrapartum cesarean delivery with spinal anesthesia, though it significantly reduced additional uterotonics administration.
Study context
- Population
- Patients undergoing intrapartum cesarean delivery with spinal anesthesia
- Participants
- 367 patients
- Comparison
- Calcium vs Placebo
- Calciumn = 183
- Placebon = 184reference
- Primary endpoint
- Uterine tone, assessed five times by the obstetrician on an 11-point verbal numeric rating score (0 = completely atonic; 10 = fully contracted)
Methodological detailsprospective, placebo-controlled, two-arm, blinded
- Prospective
- Placebo-controlled
- Two-arm
- Blinded
Primary result
As reported in the abstract
Increase in uterine tone score from baseline
Calcium
2.67
mean · SD 0.97
Placebo
2.79
mean · SD 0.98
P = 0.11
Secondary outcomes
Mean, mL
| Outcome | Calcium | Placebo | Mean difference (mL) (95% CI) | P value | |
|---|---|---|---|---|---|
| Postpartum blood lossSignificantly lower in the calcium group | 526.0 (SD 155.2) | 581.5 (SD 148.9) | 55.6 (24.3–86.8) | P = 0.001 | |
| −50050100Difference, mL (linear scale) |
| Outcome | Calcium | Placebo | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Additional uterotonic administration | 21.7% | 42.39% | 0.51 (0.37–0.71) | P = 0.001 | |
| 0.20.5125Relative risk (log scale) |
Median
| Outcome | Calcium | Placebo | P value |
|---|---|---|---|
| Uterine tone score 10 min after end of study drug infusion · 10 minutes after the end of study drug infusion | 8 (range 6–10) | 8 (range 4–10) | P = 0.002 |
Transfusion and vasopressor requirements
- Comparable between groups
Original publication
Effect of prophylactic intravenous calcium gluconate on uterine atony during intrapartum cesarean delivery with spinal anesthesia: a placebo controlled, randomized clinical trial. Int J Obstet Anesth. Published 5 June 2025. doi:10.
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