Erica Cahill, MD

View details for Web of Science ID 000554572900348

Abstract

PURPOSE OF REVIEW: To review the current state of self-managed or self-induced abortion in the United States and the emerging legal, political, and research questions surrounding this issue.RECENT FINDINGS: With the exponential rise of restrictive antiabortion laws in the United States, it has become increasingly difficult to access safe and legal abortion services. One response to this hostile environment for reproductive care access is an increased interest in methods of self-induced or self-managed abortions, primarily by medications sourced outside the medical setting. Medication abortion is established as a safe and effective method of ending a pregnancy. Compared with clinic-based care, the two most pressing concerns regarding the safety of self-managed abortion are that people seeking abortion will incorrectly self-identifying as appropriate candidates and that they will not know or be able to access medical care if needed. There is therefore an increasing need for medical providers to learn about and researchers to evaluate the incidence, safety and efficacy of self-management of abortion. Simultaneously, reproductive law experts must continue to develop and educate on the legal frameworks to protect and decriminalize people seeking self-managed abortion as well as their care providers.SUMMARY: Emerging research suggests that abortion outside the medical setting, or self-managed abortion, is an overall safe and effective way to end a pregnancy. However, significant legal barriers and stigma remain. The safest environment for self-managed abortion (SMA) is one where accurate information is available, medical care is accessible when needed, and all methods of abortion remain legal.

View details for DOI 10.1097/GCO.0000000000000585

View details for PubMedID 31693568

View details for Web of Science ID 000473810000080

Abstract

Misoprostol as an Adjunct to Overnight Osmotic Dilators Prior to Second Trimester Dilation and Evacuation: A Systematic Review and Meta-Analysis. Cahill EP, Henkel AG, Shaw JG, Shaw KA OBJECTIVE: To understand effect of adjunct misoprostol with overnight osmotic dilators for dilation and evacuation for cervical preparation after 16 weeks gestation on procedure time and dilation, complication rate, and side effects.We searched PubMed, ClinicalTrials.gov, POPLINE, and the Cochrane Controlled Trials Register using search terms for second trimester, abortion, misoprostol, dilators and reviewed reference lists of published reports. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean and standard deviation (SD) and pooled binary outcomes were compared with two sample t-test or chi-square respectively.Among 84 articles identified, three met inclusion criteria of randomized controlled trials comparing adjunct misoprostol to placebo with overnight osmotic dilators prior to second trimester abortion with 457 total subjects at 16-24 weeks gestation (misoprostol n=228; placebo n=229). In the meta-analysis, misoprostol as compared to placebo did not significantly decrease mean procedure times (8.5 + 4.6 vs 9.6 + 5.8 minutes, p=0.78) or need for manual dilation (18% vs 28%, p=0.23). There was no difference in total complications (p=0.61), major complications (hemorrhage, uterine perforation, hospitalization, p=0.44), or cervical lacerations (p=0.87).Current limited evidence suggests that use of adjunctive misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation. Further research is needed to determine if adjunctive misoprostol affects major complications and blood loss.Adjunctive misoprostol does not affect procedure time or need for manual dilation in mid to late second trimester abortion. Further research is needed to determine the effect of adjunctive misoprostol on major complications and blood loss.

View details for DOI 10.1016/j.contraception.2019.09.005

View details for PubMedID 31811840

Abstract

The immediate postpartum period is a critical moment for contraceptive access and an opportunity to initiate long acting reversible contraception, including insertion of an intrauterine device (IUD). The use of the IUD in the postpartum period is a safe practice with few contraindications and many benefits. While an IUD placed during the postpartum period is more likely to expel compared to one placed at the postpartum visit, women initiating IUDs at the time of delivery are also more likely to continue to use an IUD compared to women planning to follow up for an interval IUD insertion. This review will focus on the most recent clinical and programmatic updates on postpartum IUD practice. We discuss postpartum IUD expulsion and continuation, eligibility criteria and contraindications, safety in regards to breastfeeding, and barriers to access. Our aim is to summarize evidence related to postpartum IUDs and encourage those involved in the health care system to remove barriers to this worthwhile practice.

View details for PubMedID 30031750

Abstract

To review updates in how abortion care is depicted and analysed though various media outlets: news, television, film, and social media.A surge in recent media-related abortion research has recognized several notable and emerging themes: abortion in the news media is often inappropriately sourced and politically motivated; abortion portrayal in US film and television is frequently misrepresented; and social media has a new and significant role in abortion advocacy.The portrayal of abortion onscreen, in the news, and online through social media has a significant impact on cultural, personal, and political beliefs in the United States. This is an emerging field of research with wide spread potential impact across several arenas: medicine, policy, public health.

View details for PubMedID 28915157