Labor, Labor Active Dilated Cm, Labor Complication, Labor Delivery, Labor Duration, Labor Dystocia, Uterine Contraction
Conditions
Keywords
calcium carbonate, labor, vaginal delivery, cesarean delivery
Brief summary
The goal of this clinical trial is to learn if oral calcium carbonate can improve uterine contractions and labor outcomes in term pregnancies. It will also evaluate the safety of calcium carbonate when used during labor. The main questions it aims to answer are: Does oral calcium carbonate increase uterine contraction strength? Does it lead to shorter labor duration or higher vaginal delivery rates? What side effects or complications, if any, occur with calcium carbonate use during labor? Researchers will compare oral calcium carbonate to no treatment to see if it helps improve labor efficiency and reduce cesarean delivery rates. Participants will: Be randomly assigned to receive either 2,000 mg of oral calcium carbonate or no intervention Undergo monitoring with an intrauterine pressure catheter to measure contraction strength Be observed for two hours without oxytocin to assess calcium's direct effect on contractions Have data collected on labor progression, delivery outcomes, and neonatal health
Detailed description
In the United States, nearly one-third of deliveries are performed via cesarean section, with labor dystocia remaining a leading indication. Labor dystocia may result from a variety of maternal and fetal factors, including malposition, cephalopelvic disproportion, or ineffective uterine contractions. When contractions are inadequate, the standard intervention is intravenous oxytocin. However, prolonged or high-dose oxytocin administration can lead to receptor desensitization, reducing its effectiveness and increasing the risk of postpartum hemorrhage. Calcium plays a key role in myometrial contractility by facilitating calcium influx through L-type channels in myometrial cells, which triggers intracellular calcium release and action potentials. During labor, upregulation of calcium channels enhances the uterus's responsiveness to contractile stimuli. Elevated serum calcium levels have been associated with stronger and more effective contractions. Adjunctive intravenous calcium administration with oxytocin has been shown to improve labor outcomes, including higher rates of vaginal delivery within 24 hours of induction and reduce blood loss in cesarean deliveries. However, the potential role of oral calcium supplementation in enhancing labor progression has not been evaluated in clinical trials. Given its physiological relevance, accessibility, and low-risk profile, oral calcium may represent a simple adjunct to improve labor efficiency and reduce cesarean rates. This study aims to evaluate the impact of oral calcium carbonate supplementation during labor on uterine contractility and clinical outcomes. The investigators hypothesize that calcium carbonate administered intrapartum will enhance uterine contractions, resulting in higher vaginal delivery rates, shorter time to delivery, and reduced blood loss.
Interventions
DRUGCalcium carbonate
2,000 mg PO calcium carbonate as a single dose
Sponsors
Arrowhead Regional Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants in the intervention group received a single oral dose of 2,000 mg calcium carbonate, consisting of four over-the-counter antacid tablets. This dose is well below the recommended daily maximum of 8,000 mg. The control group received no medication. Common side effects of calcium carbonate include constipation, bloating, and abdominal discomfort, while serious side effects such as hypercalcemia are rare.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Had an intrauterine pressure catheter in place * Term gestation, greater than or equal to 37 weeks of gestation * Singleton pregnancy * Cephalic presentation * \> 18 years of age
Exclusion criteria
* incarceration * multiple gestation * active illicit drug use * abnormal clinical pelvimetry * Suspected fetal macrosomia defined as estimated fetal weight ≥4250 grams * intrauterine growth restriction * abnormal placentation * prior cesarean delivery * maternal history of arrhythmia * hyperparathyroidism * heart failure * renal or hepatic failure * nephrolithiasis * receipt of medications known to affect uterine contractility-such as magnesium sulfate, terbutaline, or recent misoprostol in the last four hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Uterine contraction strength | Two hours after receiving the study medication or, for control participants, two hours after enrollment. | Recording Montevideo units every 30 minutes for 2 hours |
| Contraction Frequency | Two hours after receiving the study medication or, for control participants, two hours after enrollment. | Recording the number of contractions in a ten-minute period for 2 hours |
| Peak strength | Two hours after receiving the study medication or, for control participants, two hours after enrollment. | Recording the max pressure generated during a contraction using an intrauterine pressure catheter during the 2-hour study period |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pitocin dose | Calculated at the time of delivery | Record the maximum dose of Pitocin used during labor |
| Duration of the first stage of labor | Calculated at the time of delivery | Record the length of the first stage of labor from 6 cm to 10 cm dilation |
| Neonatal outcomes | at the time of discharge (assessed up to 5 days) | Determine which babies were admitted to neonatal intensive care unit (NICU) and had a low 5- minute APGAR score |
| Postpartum hemorrhage | at the time of discharge (assessed up to 5 days) | Determine which patients had a blood loss of greater than or equal to 1000 mL |
| Duration of the second stage of labor | Calculated at the time of delivery | Record the time from 10 cm to delivery of the baby |
| Mode of delivery | Calculated at the time of delivery | Determine whether or not patient had a spontaneous vaginal bleeding, operative vaginal delivery, or cesarean delivery |
Countries
United States
Outcome results
None listed