Trick of the trade: Foley catheter for DUB

Your next patient has heavy dysfunctional uterine bleeding (DUB). She is tachycardic and pre-syncopal.

While you establish an IV, resuscitate her, and wait for the gynaecology team to arrive, is there any trick you can use to stem the bleeding?

Trick of the trade: 
Foley catheter insertion into the uterus for DUB

The obstetricians sometimes use a Bakri balloon (Bakri postpartum balloon, Cook Medical) for postpartum bleeding. This balloon will take 250-500 cc of fluid. In the ED, a regular Foley catheter can be used.

Step 1: 
Regular speculum exam. Remove clots.

Step 2: 
Feed Foley catheter through the os by curved or straight forceps held close to the os.

Step 3: 
When the catheter is in a few centimetres through the os (endometrial cavity is usually 6 - 8 cm deep), inflate the Foley balloon with 30-80 cc of water.

The balloon will hopefully tamponade the endometrium that it contacts and prevent further blood loss. 

Illustration by Simon Yiu

Thanks to Dr. Jamie Kroft for this great tip!

Reference Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG: An International Journal of Obstetrics & Gynaecology. 2009;116(6):748–757.

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