In some cases, oral calcium carbonate is given in combination with a 1-hour “pit break” or turning off IV oxytocin in other cases, it is used with maternal position changes. In our experience with such social group forums, we have observed that the topic of administering oral calcium carbonate tablets (eg, Tums) to address labor dystocia is commonly discussed among group members. labor and delivery nurses, midwives, and physicians. One example, “Labor and Delivery Nurses Rock!!,” is a large private group on Facebook connecting approximately 64,500 U.S. To solve problems with little traditional scientific evidence, physicians and nurses sometimes consult other clinicians, and social media groups in which health care professionals can ask questions and share suggestions have formed in specific specialties. 4 The American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine criteria for labor arrest is diagnosed when all three of the following are present: 1) The cervix is dilated 6 cm or greater 2) Membranes are ruptured and 3) There is no cervical change after at least 4 hours with adequate uterine activity or at least 6 hours of oxytocin administration with inadequate uterine activity. There are limited current standard prevention methods for labor dystocia other than amniotomy, oxytocin administration, and accurate diagnosis of labor arrest. Labor dystocia may occur for several reasons, including a large or malpositioned fetus, pelvic structure, inadequate contractions, or maternal factors such as illness or medications.Ĭlinicians use a variety of interventions to treat and prevent labor dystocia, including intravenous (IV) oxytocin and maternal position changes aimed at changing pelvic dimensions and repositioning the fetus. 3 Labor dystocia is a broad term commonly used to describe prolonged, slow, or arrested labor. 3 Labor dystocia is responsible for one-third of all cesarean sections, 50% of which are primary cesarean sections. The most common indication for a cesarean section is labor dystocia. 2 While cesarean sections can be a life-saving intervention, the current rise in the cesarean section rate has not resulted in improved maternal or neonatal morbidity or mortality. In the United States, cesarean sections increased by 31% from 1976 to 2019 1 approximately 30% of all U.S. Studies reporting the potential effectiveness of calcium gluconate and sodium bicarbonate in preventing labor dystocia offer background, safety information, and rationale for a future randomized control trial to evaluate the ability of calcium carbonate to prevent labor dystocia and reduce rates of cesarean section. To answer how calcium and carbonate physiologically contribute to myometrium contractility, we conducted a literature search of English-language peer-reviewed articles, with no year limitation, consisting of the keywords “calcium,” “calcium carbonate,” “calcium gluconate,” “pregnancy,” “hemorrhage,” and variations of “smooth muscle contractility” and “uterine contractions.” Though no overt evidence on calcium carbonate’s ability to prevent labor dystocia was identified relevant information was found regarding smooth muscle contractility, calcium’s influence on uterine muscle contractility, and carbonate’s potential impact on reducing amniotic fluid lactate levels to restore uterine contractility during labor. The goal of this narrative review was to provide a synopsis of pertinent literature on calcium use in obstetrics to explore the potential benefit of calcium carbonate as a simple and low-cost intervention for prevention or treatment of labor dystocia. Anecdotally, there are attestations from clinicians of calcium carbonate being used successfully for laboring people experiencing labor dystocia.
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