الفهرس 
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Abstract
7.Summary
Postpartum hemorrhage (PPH), a predominant cause of obstetric hemorrhage is an emergency that may follow vaginal or caesarean delivery. Obstetric hemorrhage is a major cause of maternal morbidity, and one of the five major causes of maternal mortality in both high and low income countries. There is a strong evidence to believe that the rate of PPH is increasing worldwide. The main reason for this increase is the growing frequency of uterine atony .
Optimum levels of calcium are very important for contraction of uterine muscle. Low levels of serum calcium result in poor contraction. It has been shown that myometrial contraction can be augmented by increasing calcium levels within the body or by optimizing physiological calcium levels in the setting of augmented prolonged labour, which is at a higher risk of weak uterine contraction and PPH.
The aim of this study was to study the correlation between serum calcium levels and uterine atony and primary postpartum hemorrhage.
Our study was carried out at Beni Suef University Hospital from (July 2021 till November 2021). The study population recruited when they were admitted for delivery, they were asked to participate in the study after been evaluated to ensure fulfilling inclusion and exclusion criteria.
The study will consist of 180 women:
All participants will be subjected to:
Full history takingincluding Personal, past, family and surgical history, Previous medical treatment.
Obstetric history (parity, methods of previous deliveries) Carefulphysical examination to ensure fulfilling both inclusion and exclusion criteria, including: general abdominal and pelvic examination.
Trans-abdominal ultrasonography: The ultrasound equipment used will be (Toshiba Xario 200) with 6 - 9 MHz. To ensure date of pregnancy, viability and any abnormalities.
Laboratory investigations: will include : Routine investigations including: kidney function, liver function, random blood sugar and complete blood picture.
Following the delivery of the baby, third stage of labour will be “actively managed” with 10 I.U of intramuscular oxytocin given within 1 minute of the delivery, delivery of the placenta by controlled cord traction. The fetal birth weight and route of delivery will be recorded. The participants will be monitored for the following 24 hours for evidence of primary PPH.
In both the groups, PPH is defined asthe loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby. In women with lower body mass (e.g. less than 60 kg), a lower level of blood loss may be clinically significant
The estimation is made by the usual routine clinical visual assessment, number of soaked pads, DROP of haemoglobin level and blood transfusion given, if any.
Features of uterine atony are loss of tone of uterine muscle OR failure of the myometrium to contract after the delivery of the placenta associated with the bleeding from the placental site.
In This study includes 180 females with a minimum age 18 yrs., and a maximum age of 40 yrs. The mean age of the studied females was 27.33 ± 4,78.
It was found that there was no statistical significance of the age between patients with normal and low calcium level with p-value 0.76 .
It was found that there was no ststistical significance of the parity between patientswith normal and low ca levelwith p-value 0.811 .
It was found that serum calcium level in cases with PPH was lower than cases with no PPH wih P-value 0.001.
It was found that serum Hb level in cases with PPH were lower than cases with no PPH .
It was found that there was no statistical significance of the fetal outcome and neonatal complication between patients with normal and low calcium level with P value 0.234 .
It was found that 43 cases with PPH required no blood transfusion and 7 cases with PPH required blood transfusion and signifcantlly associated at p-value0.001.
Our result revealed that low calcium level is strongly associated with uterine atony, hence is a risk factor for uterine atony. Therefore we suggest all patients admitted in labor should be estimated serum calcium and those with serum calcium less than 8 mg% may be administered IV calcium gluconate in second stage or before LSCS, to prevent PPH and to decrease maternal morbidity and mortality.