Prophylactic Intravenous Calcium Gluconate to Decrease Blood Loss at Time of Cesarean Delivery in Pregnant Patients at High Risk for Uterine Atony

Inclusion Criteria:

* English speaking
* Viable Intrauterine Pregnancy, Gestational Age ≥24 weeks
* Labor Converted to Cesarean Delivery at High Risk for Atonic Bleeding Defined as: Any exposure to oxytocin infusion for labor augmentation or induction prior to cesarean delivery
* Or Scheduled Cesarean Delivery at High Risk for Atonic Bleeding Defined as scheduled Cesarean-Section (CS) plus any one of:

  1. \> 4 Prior deliveries
  2. General anesthesia
  3. Multifetal gestation
  4. Polyhydramnios diagnosed by ultrasound within 2 weeks
  5. Macrosomia ≥ 4000gms; estimated fetal weight by palpation or by ultrasound
  6. Fibroid uterus, defined as: Multiple ≥ 2cm intramural
  7. Any history of prior Primary postpartum hemorrhage (PPH)
  8. Platelets \< 100,000 (but \>50,000
  9. Placenta Previa
  10. Body Mass Index (BMI) ≥ 40

Exclusion Criteria:

* Non-English speaking
* Antenatal suspicion for placenta accreta spectrum
* History of allergic reaction to Calcium Gluconate
* Patients with hypertensive disorder of pregnancy receiving Magnesium Sulfate for seizure prophylaxis
* Underlying Renal Disease defined as Cr\>1.0
* Known underlying cardiac condition
* Cardiac glycosides (Digoxin) within two weeks for maternal or fetal indication
* Treatment with a calcium channel blocker medication within 24 hours of screening
* Hypertensive disorder necessitating intravenous antihypertensive medication within 24 hours of screening
* Emergent case where study participation could impede care (judgement of obstetrician or anesthesiologist)
* Known hypercalcemia
* Concurrent use of any drugs that may cause hypercalcemia including

  1. Vitamin D
  2. Vitamin A
  3. Thiazide Diuretics
  4. Calcipotriene
  5. Teriparatide
* Ceftriaxone within 48 hours of screening
* Total Parenteral Nutrition (TPN) within 48 hours of screening
* Known Coagulopathy International Normalized Ratio (INR) ≥ 1.5
* Vaginal delivery