All Publications

  • Impact of a Potential 20-Week Abortion Ban on Likelihood of Completing Required Views in Second-Trimester Fetal Anatomy Ultrasound. American journal of perinatology Henkel, A., Beshar, I., Cahill, E. P., Blumenfeld, Y. J., Chueh, J., Shaw, K. A. 2022


     The aim of this study was to quantify the likelihood of assessing all mandated fetal views during the second-trimester anatomy ultrasound prior to the proposed federal 20-week abortion ban. Retrospective cohort study of a random sample of 1,983 patients undergoing anatomy ultrasound in 2017 at a tertiary referral center. The difference in proportion of incomplete anatomic surveys prior compared with after 20-week gestation was analyzed using X 2 and adjusted logistic regression; difference in mean days elapsed from anomaly diagnosis to termination tested using t-tests and survival analysis. Incomplete views were more likely with initial ultrasound before 20 weeks (adjusted relative risk: 1.70; 95% confidence interval: 1.50-1.94); 43.5% versus 26.1% were incomplete before and after 20 weeks, respectively. Fetal structural anomalies were identified in 6.4% (n = 127/1,983) scans, with 38.0% (n = 49) identified at follow-up after initial scan was incomplete. 22.8% (n = 29) with an anomaly terminated. A complete assessment of fetal views during an anatomy ultrasound prior to 20-week gestation is often not technically feasible. Legislation limiting abortion to this gestational age would greatly impact patient's ability to make informed choices about their pregnancies.· It is often not technically possible to complete anatomy ultrasound prior to 20-week gestation.. · Often, anomalies are missed during early, incomplete anatomy ultrasounds.. · After the diagnosis of a structural anomaly, one in five chose to terminate the pregnancy..

    View details for DOI 10.1055/s-0042-1749138

    View details for PubMedID 35576967

  • Missing strings following immediate postpartum IUD placement. BMJ sexual & reproductive health Henkel, A., Blumenthal, P. D. 2022

    View details for DOI 10.1136/bmjsrh-2021-201400

    View details for PubMedID 35277465

  • Postpartum permanent contraception: updates on policy and access. Current opinion in obstetrics & gynecology Henkel, A., Beshar, I., Goldthwaite, L. M. 2021


    PURPOSE OF REVIEW: To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels.RECENT FINDINGS: Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients.SUMMARY: Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.

    View details for DOI 10.1097/GCO.0000000000000750

    View details for PubMedID 34534995

  • First Trimester Abortion Care in Low- and Middle-Income Countries. Clinical obstetrics and gynecology Henkel, A., Shaw, K. A. 2021; 64 (3): 449-459


    Access to first trimester abortions has increased significantly in the past few decades in low and middle-income countries. Manual vacuum aspiration is now standard of care for procedural abortion and postabortion care. Medication abortion has shifted abortions to being performed earlier in pregnancy and is becoming more widely available with new service delivery strategies to broaden access. Widespread availability of misoprostol has made abortions induced outside of the formal medical sector overall safer. In both legally restrictive and supportive environments, there is increased interested in self-managed abortions as part of a shift towards demedicalizing abortion through task-sharing.

    View details for DOI 10.1097/GRF.0000000000000626

    View details for PubMedID 34323227

  • The impact of the COVID-19 pandemic on postpartum contraception planning AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY MFM Miller, H. E., Henkel, A., Leonard, S. A., Miller, S. E., Tran, L., Bianco, K., Shaw, K. A. 2021; 3 (5)
  • The impact of the COVID-19 pandemic on postpartum contraception planning. American journal of obstetrics & gynecology MFM Miller, H. E., Henkel, A., Leonard, S. A., Miller, S. E., Tran, L., Bianco, K., Shaw, K. A. 2021: 100412

    View details for DOI 10.1016/j.ajogmf.2021.100412

    View details for PubMedID 34058421

  • Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review. Current opinion in obstetrics & gynecology Henkel, A., Goldthwaite, L. M. 2020


    PURPOSE OF REVIEW: To describe common bleeding patterns and treatment strategies to minimize bothersome bleeding in users of progestin-based long-acting reversible contraception (LARC).RECENT FINDINGS: Most levonorgestrel intrauterine device users will establish a favorable bleeding pattern within a year; NSAIDs are the most effective bridge to help with bothersome bleeding during that time period. Early follicular phase insertion and fundal placement are associated with more favorable early bleeding profiles. Recent studies exploring tranexamic acid, mifepristone, and tamoxifen's adjunct role show modest or no benefit. The progestin implant is associated with more persistent unpredictable bleeding disproportionately affecting women with higher etonogestrel serum levels; recent studies indicate that oral contraceptives, ulipristal acetate, and tamoxifen may all provide temporary relief.SUMMARY: Women's healthcare providers can offer patients adjunct medical therapies to minimize bothersome bleeding associated with progestin LARC use, which may result in increased satisfaction and continuation rates of these effective forms of contraception.

    View details for DOI 10.1097/GCO.0000000000000664

    View details for PubMedID 32889971

  • Evaluation of shorter mifepristone to misoprostol intervals for second trimester medical abortion: a retrospective cohort study. Contraception Henkel, A., Lerma, K., Blumenthal, P. D., Shaw, K. A. 2020


    OBJECTIVES: To assess shorter mifepristone-misoprostol intervals compared to current guidelines for second trimester medical abortion on total abortion time (mifepristone to fetal expulsion) and induction time (first misoprostol to fetal expulsion).METHODS: This retrospective cohort study included women who elected for a second trimester medical abortion with mifepristone and misoprostol at an academic tertiary medical center in the United States from January 2008 to June 2018. We abstracted times of mifepristone administration, first dose of misoprostol, and fetal expulsion from the medical record. We assessed outcomes based on the shorter intervals <12 hours and 12 to 24 hours compared to the guideline mifepristone-misoprostol interval (24-48 hours).RESULTS: The study population included eighty-nine women, 47, 28, and 14 women in the <12 hour, 12-24 hour, guideline (24-48 hour) groups, respectively. The cohort had a median gestational age of 220/7 weeks (range: 150/7-270/7) and parity of 1 (range: 0-5) with no differences observed between groups. Total abortion times were 20.7 hours (range: 3.7-46.9), 30.6 hours (16.7-48.0), and 42.8 hours (32.7-62.6), respectively (p<0.001). Induction times were 12.9 hours (range: 1.2-36.6), 11.7 hours (2.0-35.2), and 9.3 hours (5.3-16.5), respectively. Fetal expulsion within 12 hours of first misoprostol dose occurred in 22 (47%), 14 (50%), and 9 (64%), respectively (p=0.52).CONCLUSIONS: Shorter mifepristone-misoprostol intervals (less than 24 hours) significantly decrease the total abortion time while maintaining a clinically similar induction time.IMPLICATIONS: Shortening the mifepristone-misoprostol interval in second trimester medical abortion significantly decreases the total abortion time which may be preferable to some women or health systems. (Words: 25).

    View details for DOI 10.1016/j.contraception.2020.06.009

    View details for PubMedID 32592800

  • Postplacental intra-abdominal placement of levonorgestrel 52mg intrauterine system: a case report. Contraception Peterson, S. F., Henkel, A., Ganti, A., Blumenthal, P. D. 2020


    This case of an intra-abdominal levonorgestrel 52mg intrauterine system found three weeks after manual postplacental placement demonstrates the importance of proper insertion technique and ascertainment of fundal placement. Ultrasound guidance can be considered if fundal placement is uncertain. Short interval follow up should be recommended to confirm proper placement.

    View details for DOI 10.1016/j.contraception.2020.01.015

    View details for PubMedID 32081642

  • Preeclampsia Treatment in SARS-CoV-2. American journal of obstetrics & gynecology MFM Joudi, N. n., Henkel, A. n., Lock, W. S., Lyell, D. n. 2020: 100146

    View details for DOI 10.1016/j.ajogmf.2020.100146

    View details for PubMedID 32838258

    View details for PubMedCentralID PMC7237374

  • Barriers to Completing Second-trimester Antenatal Screening: A Retrospective Cohort Study Beshar, I., Henkel, A., Cahill, E., Josh, Y., Shaw, K. LIPPINCOTT WILLIAMS & WILKINS. 2019: 25S
  • Connect the Dots-March 2019. Obstetrics and gynecology Coney, T., Henkel, A., Plisko, A. M., Chescheir, N. C. 2019; 133 (3): 579-581

    View details for DOI 10.1097/AOG.0000000000003151

    View details for PubMedID 30741819

  • Misoprostol as an Adjunct to Overnight Osmotic Dilators Prior to Second Trimester Dilation and Evacuation: A Systematic Review and Meta-Analysis. Contraception Cahill, E. P., Henkel, A. n., Shaw, J. G., Shaw, K. A. 2019


    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,, 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

  • Advances in the management of early pregnancy loss CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Henkel, A., Shaw, K. A. 2018; 30 (6): 419–24
  • Advances in the management of early pregnancy loss. Current opinion in obstetrics & gynecology Henkel, A., Shaw, K. A. 2018


    PURPOSE OF REVIEW: To describe recent advances in management of early pregnancy loss.RECENT FINDINGS: Addition of mifepristone to current protocols for medical management of miscarriage increases effectiveness of a single dose of misoprostol and significantly reduces subsequent aspiration procedures. Women with an incomplete evacuation after medical management may be treated expectantly with similar rates of complete expulsion compared with surgical management at 6 weeks. As cytogenetic analysis improves, analysis of products of conception can be performed whether collected after surgical or medical management and is an efficient strategy in starting a recurrent pregnancy loss work-up. For those seeking pregnancy after miscarriage, conception immediately following an early pregnancy loss is not associated with increased risk of subsequent miscarriage. However, recent studies suggest that the original intendedness of the pregnancy resulting in miscarriage does not predict future reproductive goals of the woman, so family planning should be discussed at the time of miscarriage.SUMMARY: Miscarriage is a common experience among reproductive-aged women and advances in medical management and modern-day aspiration techniques make the use of the sharp curette obsolete.

    View details for PubMedID 30299321