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No one goes to Hank's for spreadsheets. They go for a darn good pizza. Lately though, the shop's been quiet. So Hank decides to bring back the $1 slice. He asks copilot in Microsoft Excel to look at his sales and costs and help him see if he can afford it. Copilot shows Hank where the money's going and which little extras make the dollar slice work. Now Hanks has a line out the door. Hank makes the pizza, Copilot handles the spreadsheets. Learn more@m365copilot.com Work foreign. So I'm about to date myself a little bit. But that's okay. I'm okay with that. But back in the day when cartoons were only available on Saturday morning, at least the good ones were. And I'm not talking about the new fancy computer 3D animation crap. I'm talking about the hand drawn real artist cartoons. Back in the day, on Saturday morning there used to be something called Schoolhouse Rock. Anybody? Anybody? This used to teach little messages, little things of history to kids in a cartoon. And one of the Schoolhouse Rocks was Mother Necessity. Man, I remember it. I remember it like I was yesterday. It was Mother necessity with her good intentions. Where would this country be with without her invention? Where would this country be without her invention? So it went through the entire thing of like the cotton gin and Thomas Edison and it went through all of these things. Great innovators. Why? Because necessity is the mother of invention. That was Mother Necessity from Schoolhouse Rock. Michael, come on, one more time. Old school Mother necessity with her good intentions. Where would this country be without her invention? Wow, listen to the quality of that, y'. All. That is some 40 ish years old. All right, Mother Necessity. Because where would we be without her inventions, y'? All? Necessity is the mother of good evil, innovation, good intention and good design. That is what we're talking about today. We're going to talk about DIY PPH tools. Now if you follow my insta, which you should, I had posted a little a picture and a little reel of a buddy of mine. His name is Frank. We're going to get into him in just a minute because he published something in this line. All right, so Frank Jackson published the DIY option for postpartum hemorrhage. Hey, if your place can't get a Jada, because I get it, it's, it's a little expensive. And tamponade by a balloon seems kind of counterintuitive because the uterus does contraction in order to stop bleeding and the balloon Kind of pushes out and prevents that. I get that. So, Frank Jackson, Good man, Frank. Keep up the great work. He sent me this message about, hey, there's this new publication out there, which is what we're gonna cover here. Talking about what I've been trying to say and create here in a low cost, every unit has this, these tools to help save a patient's life from postpartum hemorrhage. Uterine hemorrhage sucks. It sucks when it's a second trimester birth. It sucks when it's a third trimester birth. And one of the issues, guys, with something like a Bakri or a Jada, is that if you have a mid pregnancy loss. All right, so let's say, you know, whatever, 18 weeks, 22 weeks, you have a birth. It's hard to get a bakery into a balloon that's not fully term. Okay, I've tried it. I'm telling you, it's hard to do or to get enough volume in there where it's kind of meaningful. And same thing with Jada. Okay? So because of that, wouldn't it be nice? And this was where Frank comes in with his publication. We'll get into that in a minute. And others, by the way, and others, if you could just put in like a simple Foley or a suction tube connected to wall suction and, and diy. Baby diy. If you can contract the uterus and it works, that would be awesome. It's cheap, it's readily available. We can get on top of this without people saying, do you really need a Jada? Well, are you sure you need a Jada? Because everyone's worried about cost, for heaven's sakes. So this is where we get things like Focus, Stut and ucavit. I didn't make up those. Those are all terms. They're all acronyms for things that we use. Focus. Focus. That is Frank's deal. That is Focus catheter. It's Foley catheter for uterine suction. That's Focus Foley catheter for uterine suction. Then we have Stut. S T U T, that is suction tubing for uterine tamponade. Y' all with me? S T U T. And what we're going to talk about here is this brand new publication from April 2026 called UCAVIT. UCAVIT, I.e. urological catheter, vacuum induced tamponade. You pick a flavor. They're all trying to do the same things that are low cost, readily available. And guys, here's what we're trying to do get on top of postpartum bleeding, whether it's at a C section, because this also works at a C section or at a vaginal delivery. This is a big deal. Okay. Also got another buddy who helped create a drape at C section that you can actually see through. So you don't have any concealed bleeding around or under the patient or think she's all dry up on top and there's blood coming out of the vagina. That's prospective medical. These are visionaries to try to get the job done, to try to get on top of postpartum hemorrhage. All right, so we have talked about Frank's work before on the Foley catheter for uterine suction. And in this episode, we're gonna talk about Ucavit Urological Catheter Vacuum Induced tamponade. This is a brand new publication. We're going to get into this. We're going to touch a little bit about Frank, Dr. Jackson's Gray Journal publication just from last year, 2025 and others. There's some work out of South Africa that has published this, even going back to 2020. But that was a very small, you know, kind of like a feasibility study. And those authors are still at it. We're going to get into that as well. So I'm very happy to cover this because anything that is birthed out of necessity, I'm all in. Especially when the aim is reduction in patient morbidity. This is coming out of the gray journal. This is not even officially out yet. It's ahead of print. This is vacuum induced tamponade using urological catheters for postpartum hemorrhage. I love it. Frank, you've got something. You're onto something here. All these people are looking at the same thing because you all have the same vision here. Why? Because, Mother Necessity is a good place to start. Come on now. Where would this country be without her invention? I love that stuff. Mother Necessity. All right, I think I've set it up enough. We will be right back. Podcast Family. I'm happy to share information from one of our corporate sponsors, Perspective Medical. In a C section, every second counts, especially when managing postpartum hemorrhage. But traditional surgical draping often hides the very signs that we need to see concealed bleeding around or under the patient. Introducing the OBGYN Physician Designed Hemorrhage View C Section Drape. It's designed to provide clear and direct visualization of the patient to allow assessment of any concealed bleeding. Now you can Recognize hemorrhage earlier and monitor bleeding in real time without compromising the sterile field. Whether you're placing a uterine balloon or administering uterotonics or assisting in a second stage C section, you now have clear visualization. You need to act fast. So let's be proactive, not reactive, in the recognition and management of hemorrhage. Visit perspectivemedical.org to learn more about the Hemorrhage View C section drape or to request a trial option. This is Dr. Chapma's OBGYN no Spin podcast. Girl. Winter is so last season and now spring's got you looking at pictures of tank tops with hungry eyes. Your algorithm is feeding you cutoffs. You're thirsty for the sun on your shoulders that perfect hang on the patio. Sundress. Those sandals you can wear all day and all night. And you've had enough of shopping from your couch. Done. Hoping it looks anything like the picture when you tear open that envelope. It's time for a little in person spring treat. It's time for a trip to Ross. Work your magic. My goodness. Now I have Mother necessity with her good. And boom, boom. Come on. Now you. You know you're going to be doing a C section and in the middle of closing that hysterotomy, it's just going to blurt out, oh, yeah, where would this country be without her invention? All right, stop, stop, stop, stop, stop. So it's cute and it taught a story that. Let's be done with that. Let's not do that again, Michael. We're done. All right, so. So where are we? Oh, yeah. PPH sucks. That's the lesson. Pph. Peripartum bleeding sucks. And yes, we've got FDA approved things. Guys. Bakri been around. It's in the ACOG bulletin. Sure, why not? But it really doesn't make a lot of anatomical and physiological sense. We're giving all these medications to try to contract the uterus. Meanwhile, we got this big ass balloon, about 500 ML's worth, pushing out. I'm not against Bakri. Please don't send me a message. Medical affairs for cook and bakery. I mean, please don't send me a message. I get plenty of those. I'm just saying, hey, yes, it's got a role, yes, it's got data, but it's not really anatomically correct or functionally correct because we're trying to make the uterus go the opposite way. We're trying to make it contract down. All right, so that brings us to Frank Jackson New York. And although there's been others, I'm going to give him a little props because direct communication with him, I think he's a good guy and he came up with his idea, his little version of this, his flavor of the pie is focus. Foley catheter for uterine suction. He published this in November 2025 in the gray Journal. Good for you, Frank. This was a novel technique using a Foley catheter attached to wall suction. We're going to get into this new publication from this year, which is April 2026, as well as others. My point is this guys, three quick points before we get into this data. Number one, you gots to do what you gots to do to get on top of a problem. Two, think outside the box. So if you say, man, I'm tired of finding blood concealed under the patient at C section, then get a clear drape like the prospective medical drape. If you're tired of saying I'm tired of not having Bacri or Jada cause they're cost prohibited, whatever, make your own. Do this as a quality improvement project, try to do something here. I'm gonna give you some steps here that have already been published like by Frank's description as well as his new publication from the Gray Journal from April of 2026. There's very clear instructions on how to do this in a low cost method. Number three, come up with your own thing. Be insightful, have a vision and try to get on top of some problem in our next episode, I think, or one or two upcoming episodes. Depends. I always bump topics. But I'm going to give you another QI project of what a resident, what a medical student even can do in your ED in the emergency department to help gynecological and obstetrical patients. Well, mainly obstetrical, but I'll get into that a little later. There's a lot of rooms for improvement here and this DIY tools for PPH is one of the things that we can improve. So November 2025, back to Frank's publication because I digressed there for a little bit. As Dr. Jackson stated, quote, the suction pressure may be increased to a maximum of 525mg if needed to control bleeding. Now this is using a 24 French, a latex regular old 30cc balloon. Stick that into the uterus, connect that to wall suction and typically remain in place for like an hour and of course no longer than 24 hours. That's very atypical because these things stop bleeding Very quickly. Now, in Dr. Jackson's and Frank's description, in those patients who are postpartum, they did give some antibiotic coverage because it's kind of a foreign body. And I have a separate episode on that. Are antibiotics recommended with Bakri? And while there's no formal societal guidance, it is definitely reasonable. And it's got some evidence because you're putting pressure with Bacchary on the walls so you can get a little bit of ischemia. And it's a foreign body. And she delivered all those risk factors for infection. So let's not make things worse. So there is some data for antibiotic prophylaxis coverage. And so in Dr. Jackson's publication, he gave 500 milligrams of Zithromax and then 2 grams of Ancef IV just to try to COVID infection. All right? And if IV antibiotics weren't available, he gave 2 grams oral Zithromax, and that's the end of that. Okay, now that makes anatomical and functional sense. These things should work because negative pressure from the suction can help facilitate uterine wall opposition and stimulate. What we're trying to do is make the uterine contract. That seems to be a little bit better, at least in theory, than passive balloon distension. I've. Again, I want to be very clear. I have no beef or problem with the back reissue. Okay, now, the current guidance guys from ACOG does recommend intrauterine balloon tamponade when uterotonics or bimanual exam fails. And it does note that while, quote, multiple Foley catheters were historically used, commercial devices are now preferred, end quote. Well, my question is, why is that? Because it's standardized. Sure, that makes sense. Because you have one way of doing it. Sure, that makes sense. That goes back to it being standardized. However, the cost effectiveness models definitely does have a valid point here to at least attempt a DIY approach. All right, so the Jackson technique is a return to using simple Foley catheters with the idea of contracting this thing down, which bleeding typically happens, you know, within the first five minutes or so. So you win with a cheap method there. Okay, now, so that is the. The publication from Dr. Jackson. And again, I think I highlighted that on the. On our instareel. But he is not. Just to be clear, he is not the only one that has looked at this and published this. Others have other varieties. As I mentioned in the intro, there's different acronyms for this. And Even back in 2025, just last year, there was actually a randomized trial so Frank's publication wasn't a randomized trial. It was a small cohort. But there is an rct, a randomized trial from South Africa that compared suction tube uterine tamponade. That's stut. Suction tube uterine tamponade stut versus traditional balloon tamponade. Okay, now remember, none of this is in the ACOG guidance because this came after that. All right, so ACOGs practice bulletin on a postpartum hemorrhage. This is way before the 2025 randomized trial from South Africa saying that, hey, maybe stut as suction tubing uterine tamponade could work as well as balloon tamponade. Well, what did they find? They found, yeah, it actually had less pain and had some better outcomes, with 27% versus 54% experiencing blood loss greater than 1,000 MLS or requiring additional intervention like laparotomy. In other words, about half with a relative risk of 0.49. Half using the suction tubing method required other things, whereas the others required other interventions. So 27% with stuff versus 54% with the balloon. Okay, so they found, yeah, this actually potentially has some benefit. And this was out of the Official Journal of Figo. Again, this was 2025. The title was A Randomized Clinical Feasibility Trial of Suction Tube Uterine Tamponade vs. Uterine Balloon Tamponade for the Treatment of Refractory Postpartum Hemorrhage. Again, South Africa. All right, so we'll post all of this, all of these references. We're going to do rapid fire here, of course, on our show notes, but I'm just making the point here that Jackson had a great idea and it's working. Everybody's got a Foley. This was with a suction tube. Okay, fine. So same similar concept. The point is you can DIY this yourself. Now, these authors from South Africa that we just covered, this RCT that was just published last year, this was not their first go around, right? They've been in this neighborhood before. Because those Same authors in 2020, y', all, six years ago, they published a very, very small number, three cases in BJOG. Okay? So in the British Journal of Exceptional Gynecology, these authors did this to try it out. They're like, hey, let's try this novel suction tube approach to uterine tamponade for patients who are failing medical therapy. And they reported three cases, BJOG 2020. So you go from that to a publication in 2025 when they did an RCT. Good for them. Y' all follow this. Is this not exciting to you? I know it's kind of geeky that I get worked up about this, but man, this is how you change the game. This is how you. This is how you come up with new things. All right? And again, I've got no beef with Jada, no beef with Bakri, but you gotta have a big uterine cavity for those things to work. Jada is no small device if you've never had held a Jada. It's a good like Harry Potter wand. All right, guys in not long ago, a couple of days ago or last week, I don't know, one or two weeks ago, I posted our new medical students that were doing their boot camp immersion, you know, kind of trying to make them functional when they get on the ward so they don't look like a deer in a headlight. And One of my 30 or med students was holding a jade, and I'm like, what is that? He's like, oh, this is a jade device. It's used for, you know, uterine collapse or postpartum hemorrhage. And you kind of see it's kind of a big device. Not mocking that, not minimizing, you know, the importance of it. It does work, you know, according to the parole study, but not all cavities. You can get that thing in there, right? So my point is you can pretty much get a foley with a 30cc balloon and a lot more people, especially with preterm deliveries and, or especially in those, you know, mid second trimester losses. So all to say that brings us to April 2026 in the gray Journal with vacuum induced tamponade using urological catheters for postpartum hemorrhage. This was not an rct, so I don't want to give any false illusions. It's not level one, it is retrospective, but nonetheless, it still gives good data. All right, now this was out of Zurich. I've been to Zurich a couple of times. Phenomenal place, super cool. I really advise, chop out travel recommendations, get yourself to Zurich. Now. As stated in this April 2026 publication quote, over an eight month period, we applied Ucavit. I just like that. Ucavit. Okay, so that's urological catheter, vacuum induced tamponade. You cavet. It's like a new, you know, pop group. It's Ucavit. All right, you know what? It's kind of guys, just to let you know, I'm doing this at 8pm Central Time. I got home, it's been a long day. I Lectured to medical students. I was on call this morning, so my brain's kind of done and I am on my six, six cup of coffee. Anyway, what did I have to do? What did it have to do with anything? I've totally lost Michael after over an eight year period. We applied UCAVIT in 20. Thank you. In 20 women with severe postpartum hemorrhage, mainly due to uterine atony, following unsuccessful first line medical therapy. Right, so it's not like we're just gonna stick this in women. They've gotta do the traditional things. Uterine massage, give them uterotonics, give them txa, and then if none of that works, quote, as an intermediate step before proceeding to more invasive cervical management. In other words, these patients went through the list, they went through uterotonics, txa, uterine massage, emptied the bladder, and blood loss was still happening. They did do a qbl, not an EBL as is preferred and standard. So that's good. And these weren't big numbers, right? So let me just get it. These aren't big numbers. They had an N of 22. 0. Now, don't send me a message. This is published in a good journal, all right? It's a very good journal. And even though it's an end of 20, guys, it's adding to the bucket of data that's gone before it and will continue to come after it, all right? So thankfully, PPH is not very common. That's why it takes a long time to get these. And this is something that is high, high reward with low risk. Okay? So I'm all for it at an end of 20. Great for them. That's better than nothing. And the short of it is, this worked. Now, of the 20, got to be realistic, 16 cases were primary atonic PPH. Four cases had mixed etiology, meaning they had a little like a retained placenta as well as acne. That was the issue. And we're not talking about lax, we're talking about uterine causes. So 16, just acne. And then the four remaining had both from acne and a little bit of placental fragments as a cause of bleeding. Okay, so here's how the authors describe this thing. So here we go, guys, we're almost done. Under aseptic conditions, insert the deflated three way catheter into a uterine cavity. After vaginal delivery, the catheter is passed transvaginally through the cervix into the uterus. And during C section, the catheter can be placed directly into the uterus through the uterine opening before closing. The hysterotomy. We get this. We've all done this. The catheter's distal end then goes out to the cervix and the vagina by the assistant. Maintain intrauterine vacuum for at least one hour while closely observing vaginal bleeding. Once the bleeding has stopped for an hour, the suction is turned off, but the catheter is left in place. After observing another interval, typically an additional hour with no re bleeding, you can deflate the balloon and gently remove the catheter. The total indwelling time is typically two to three hours. Y' all get this. This is pretty quick. The question is, before we wrap this up, did this joker work? Okay, did this little suction thing, this urinary catheter, this is a Foley, guys, into the uterus of this end of twin. Did it work? Yeah, I mean, it worked pretty well. 85%, that's 17, 85% had their hemorrhage immediately controlled with Ucavit alone, y'. All. It said immediately, so that's pretty good. Why? Because it contracted it down. You gotta crank that up to wall. Suction brings it down. Very nice quote. Without needing surgical other intervention. In three cases, Ucavit was insufficient. Two involved uterine malformations. All right? That prevented effective uterine collapse. These patients ultimately required uterine artery embolization. I'm reading directly from the new publication. The third case had stabilized with Ucavit, but an embolization was performed electively to further reduce the risk of re bleeding. Okay, I know that's pretty. That's pretty intense. We don't really do that here in the U.S. but, hey, good for you. They wanted to really get on top of it. They went and threw some embolization. So while three patients needed other things, one was kind of empiric, one was kind of. The patient said, do what you got to do. I don't want to go through this again. Totally understandable. So two real kind of failures and then one kind of an elective other procedure to make sure it didn't happen again. Those are pretty good odds. Okay. As they say, no patient required a hysterectomy, and there was no device related complications. Further, we observed no uterine or cervical injuries from the catheter, no apparent air embolization or cardiovascular issues from the vacuum, and no cases of infection or unusual allergic reactions. End quote. Guys, we're reading from the April 2026 new publication on Ucavit. All right? From the Gray Journal. Last thing their tweetable Statement of this new publication. Quote, A simple urological catheter with intrauterine vacuum that rapidly contracts the uterus and stops the bleeding is a promising low cost and easy to use device for women with atonic postpartum hemorrhage. End quote. Love it, love it, love it. Thinking outside the box, We've got to get on top of postpartum bleeding, guys. As I told the medical students in our new boot camp, PPH should scare you. PPH should scare you. These things can go south very, very quickly. And you absolutely have to get on top of this thing because the rate of bleeding from this is just so rapid that we just got to be careful. Okay? So this is a big deal. So I'm glad for these people with these visions. Look, I just report this stuff. I don't have that creativity. I don't know, kind of creative on social media, but you know what I mean, Those come up with these things. The focus. You cave it. The stut. The transparent drapet section. Good for you all. You're trying to change the game, and I applaud you. Michaels, we get ready to wrap this up. Let's hear it one more time. Come on. Oh, yeah. Where would this country be without her invention? Oh, boy. Thank you all. Schoolhouse Rock. That was old school. Podcast family, as always, we're thankful for you. We're glad you're part of our podcast community. Frank. Dr. Jackson, congrats. Congrats on. On your work. Keep it up. I know you're doing more things to get things in print. I applaud you. Keep it up. You are changing the game, Podcast family. We're thankful for you. We'll see you on the next episode of the OB GYN Clinical Pearls, no spin Podcast Michael. Let's be done here, brother. Let's take it home.