Efficacy of Prophylactic Intravenous Calcium Gluconate for the Prevention of Severe Postpartum Hemorrhage during Vaginal Delivery

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 699–710

DOI: 10.46882/2026/IJOG/000539

Original Research Article

Title: Efficacy of Prophylactic Intravenous Calcium Gluconate for the Prevention of Severe Postpartum Hemorrhage during Vaginal Delivery

Names of Authors: Oluwaseun A. Adebayo¹, Aminat Z. Yusuf¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria

Abstract:
Uterine atony remains the principal driver of postpartum hemorrhage (PPH). Calcium ions play an essential role in myometrial contractility, regulating the efficacy of endogenously produced or exogenously administered oxytocin. This double-blind, placebo-controlled randomized clinical trial investigated whether prophylactic intravenous calcium gluconate lowers intrapartum blood loss during vaginal deliveries in women at high risk for uterine atony. Three hundred and sixty women presenting with risk factors (prolonged labor, macrosomia, or polyhydramnios) were randomized to receive either 1 g of intravenous calcium gluconate (n = 180) or a matching 0.9% saline placebo (n = 180) slowly over 10 minutes concurrently with standard active management of the third stage of labor. The primary outcome was measured as the total calculated blood loss within 2 hours postpartum. The mean calculated blood loss was significantly reduced in the calcium gluconate group compared to the placebo cohort (342.5 ± 92.4 mL vs. 485.6 ± 124.8 mL, p < 0.001). The incidence of severe PPH (blood loss ≥ 1,000 mL) was lower in the intervention arm (1.7% vs. 6.1%, p = 0.028). Furthermore, the requirement for rescue second-line uterotonics (such as misoprostol or ergometrine) was significantly lower in the calcium arm (3.3% vs. 11.1%, p = 0.004). Prophylactic administration of calcium gluconate enhances myometrial baseline contractility and limits blood loss during high-risk vaginal deliveries without introducing adverse maternal hemodynamic alterations.

Keywords: Postpartum Hemorrhage; Calcium Gluconate; Uterine Atony; Vaginal Delivery; Myometrial Contractility; Uterotonics.

Manuscript Timeline: Received: July 25, 2026; Revised: August 20, 2026; Accepted: September 03, 2026; Published: September 07, 2026.

Citation: Adebayo OA, Yusuf AZ. Efficacy of Prophylactic Intravenous Calcium Gluconate for the Prevention of Severe Postpartum Hemorrhage during Vaginal Delivery. International Journal of Obstetrics and Gynecology. 2026; 14(9): 699–710.

Subscribe to read the full article: https://mail.internationalscholarsjournals.org/subscribe-to-read