A simple, life-saving innovation: Using a foley catheter for uterine suction and hemorrhage control

Introduction

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in resource-limited settings.¹ Uterine atony—the inability of the uterus to contract after delivery—is the most common cause. This type of hemorrhage most commonly occurs in the immediate postpartum period but can also happen days to weeks later during uterine involution, or after either a spontaneous or induced abortion.³ While several interventions exist, including uterotonics, balloon tamponade, and surgical techniques, access to specialized devices is often limited and may not always be the most suitable for every situation.⁴

Now, a novel approach using a Foley catheter for uterine suction (FOCUS) is emerging as a simple, effective, and widely accessible solution. Recent publications, including a 2025 report in the American Journal of Obstetrics and Gynecology and a case series in Contraception, demonstrate its success in controlling hemorrhage across different gestational ages and clinical scenarios—even in cases where traditional devices are unsuitable or unavailable.^5,6

The problem: limitations in current hemorrhage management

Standard treatments for PPH include:

• Uterotonics (oxytocin, misoprostol, carboprost, methylergometrine)
• Balloon tamponade (Bakri, Ebb, etc)
• Uterine suction (JADA System)
• Surgical interventions (uterine artery ligation, hysterectomy)

However, challenges persist, as, for example:

• FDA-approved vacuum devices (eg, JADA System) are only approved for immediate postpartum use with a dilated cervix.⁷
• While balloon tamponade applies outward pressure. Vacuum-induced uterine tamponade with suction, however, can enhance physiologic uterine contraction.⁸
• Cost and availability restrict access in low-resource settings.⁹

The solution: FOCUS

The FOCUS technique repurposes a standard Foley catheter—a ubiquitous, low-cost tool—to create a vacuum-induced tamponade. Here’s how it works:

Step-by-step application

1. Clear the uterine cavity of clots or retained tissue.
2. Insert a Foley catheter (size adjusted for uterine volume, eg, 16-24F).
3. Inflate the balloon (eg, 30-35 mL saline) past the internal os to anchor it.
4. Connect to suction, begin at 80 mmHg and increase as needed up to a maximum of 525 mmHg, via standard tubing. (Figure 1)
5. Maintain for 1 to 24 hours, with intravenous antibiotics (azithromycin plus cefazolin for postpartum; doxycycline for post abortion.)^{7, 10, 11}

Why it works

1. Negative pressure promotes uterine contraction.^5,6,8
2. Widely available—Foley catheters are found in nearly all obstetric settings.
3. Versatile—effective in postpartum hemorrhage, postabortion bleeding, and even with müllerian anomalies.

Clinical evidence: Case reports and outcomes

Case 1: Second-trimester dilation and evacuation with coagulopathy⁵

1. Patient: 34-year-old with fetal demise at 18 weeks and dysfibrinogenemia.
2. Bleeding persisted despite evacuation and uterotonics.
3. FOCUS applied: Bleeding controlled, blood loss after use of suction was 50 mL.
4. Outcome: Stable discharge on postoperative day 2.

Case 2: Delayed postpartum hemorrhage after cesarean delivery⁵

1. Patient: 33-year-old postoperative day 6 after prelabor cesarean delivery with severe anemia and retained clots.
2. Failed conventional management (uterotonics, dilatation and curettage).
3. FOCUS applied: Bleeding controlled within minutes, blood loss after use of suction was less than 10 mL.

Key findings from studies

• Rapid hemorrhage control (often within 5 minutes).
• No device failures or complications in reported cases to date.^5,6
• Cost-effective compared with specialized devices.

Table. Why FOCUS Stands Out

Conclusion

The FOCUS technique exemplifies practical innovation—combining 2 routine instruments into a life-saving intervention. As maternal hemorrhage remains a global crisis, this approach could be particularly transformative in low-resource settings, where access to expensive devices is limited.^1,5,6,9 Additionally, FOCUS enables vacuum-induced hemorrhage control, which has proven especially effective not only in traditional PPH⁸ but also in new cases of delayed PPH, cesarean deliveries with a closed cervix, and post-abortion bleeding.

For more details, including videos, multilingual printer-friendly instructions, and a patient registry, visit: www.focuspph.com

Video credit: Animation and instructional video provided by Frank Jackson, DO, clinical assistant professor, University of New England College of Osteopathic Medicine and Maternal-Fetal Medicine Fellow at Northwell Health. Originally published at www.focuspph.com. Shared under a Creative Commons Attribution (CC BY) license.

References

1. Chauke L, Bhoora S, Ngene NC. Postpartum haemorrhage - an insurmountable problem? Case Rep Womens Health. 2023;37:e00482. doi:10.1016/j.crwh.2023.e00482
2. Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage. N Engl J Med. 2021;384(17):1635-1645. doi:10.1056/NEJMra1513247
3. Kerns JL, Brown K, Nippita S, Steinauer J. Society of Family Planning Clinical Recommendation: management of hemorrhage at the time of abortion. Contraception. 2024;129:110292. doi:10.1016/j.contraception.2023.110292
4. Serrano Redonnet C, Gold M, Krolewiecki A, Nhampossa T, Menendez C. Pharmacological innovations in postpartum haemorrhage management: a crucial step to reducing maternal mortality in resource-limited settings. Lancet Glob Health. 2025;13(5):e799-e800. doi:10.1016/S2214-109X(25)00112-3
5. Jackson FI, Stork-Binyamin L, Blitz MJ, Gerber S. Vacuum-induced management of hemorrhage using intrauterine foley catheter: a report of two cases. Contraception. 2025;143:110802. doi:10.1016/j.contraception.2024.110802
6. Jackson FI, Dilena NJ, Abelman SH, Blitz MJ, Gerber S. Hemorrhage management using a Foley catheter for uterine suction. Am J Obstet Gynecol. 2025;233(5):503-504. doi:10.1016/j.ajog.2025.06.061
7. JADA System Vacuum-induced Hemorrhage Control System, instructions for use. 2022. Accessed September 13, 2024. https://www.organon.com/product/usa/pi_circulars/j/jada/jada_system_ifu_blue_seal.pdf
8. D'Alton ME, Rood KM, Smid MC, et al. Intrauterine vacuum-induced hemorrhage-control device for rapid treatment of postpartum hemorrhage. Obstet Gynecol. 2020;136(5):882-891. doi:10.1097/AOG.0000000000004138
9. Aimagambetova G, Bapayeva G, Sakhipova G, Terzic M. Management of postpartum hemorrhage in low- and middle-income countries: emergency need for updated approach due to specific circumstances, resources, and availabilities. J Clin Med. 2024;13(23):7387. doi:10.3390/jcm13237387
10. Achilles SL, Reeves MF; Society of Family Planning. Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102. Contraception. 2011;83(4):295-309. doi:10.1016/j.contraception.2010.11.006
11. Tita ATN, Carlo WA, McClure EM, et al; A-PLUS Trial Group. Azithromycin to prevent sepsis or death in women planning a vaginal birth. N Engl J Med. 2023;388(13):1161-1170. doi:10.1056/NEJMoa2212111