Erica P. Cahill MD

All Publications

• Adding a COX-2 inhibitor improves efficacy of emergency contraception. Lancet (London, England) Cahill, E. P. 2023

  View details for DOI 10.1016/S0140-6736(23)01612-4

  View details for PubMedID 37597526

• Lactational Amenorrhea Method for Postpartum Contraception: a content analysis of YouTube videos. American journal of obstetrics & gynecology MFM Henkel, A., Rice, K. P., Parameshwar, P. S., Cahill, E. P. 2023: 101122

  View details for DOI 10.1016/j.ajogmf.2023.101122

  View details for PubMedID 37549735

• The cost of loss: a secret shopper survey of mortuary disposition of fetal remains AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY MFM Henkel, A., Burns, R. M., Spach, N. C., Cahill, E. P. 2023; 5 (7)

  View details for DOI 10.1016/j.ajogmf.2023.100986

  View details for Web of Science ID 001010572100001

• Cabergoline for Lactation Inhibition After Second-Trimester Abortion or Pregnancy Loss: A Randomized Controlled Trial. Obstetrics and gynecology Henkel, A., Johnson, S. A., Reeves, M. F., Cahill, E. P., Blumenthal, P. D., Shaw, K. A. 2023; 141 (6): 1115-1123

  Abstract

  To assess cabergoline's efficacy at decreasing breast symptoms after second-trimester abortion or pregnancy loss.This was a double-blinded, block-randomized superiority trial comparing cabergoline 1 mg once to placebo for preventing bothersome breast engorgement after second-trimester uterine evacuation. We enrolled pregnant people at 18-28 weeks of gestation who were English- or Spanish-speaking and without contraindication to the study drug. Participants completed a validated, piloted, electronic survey at baseline and at multiple timepoints through 2 weeks postprocedure to assess breast symptoms, side effects, and bother. Our primary outcome was any breast symptoms (a composite of engorgement, milk leakage, tenderness, and need for pain relief) on day 4; we planned to enroll 80 patients to show a 30% difference in breast symptoms (80% power, α=0.049). A subgroup of participants returned for serum prolactin levels.After screening 150 patients from April 2021 to June 2022, we enrolled 73 participants. Baseline demographics were balanced between groups: median gestational age was 21 weeks (range 18-26 weeks), 56.2% of participants were nulliparous, 34.2% self-identified as Hispanic, and 37.0% had public insurance. At baseline, reported breast symptoms were similar between groups. Among 69 participants who returned surveys on day 4, significantly fewer participants receiving cabergoline reported any breast symptoms compared with placebo (27.8% vs 97.0%, P<.001) (primary outcome) and fewer reported significant bother (2.8% vs 33.3%, P=.001) (secondary outcome). These differences persisted through day 14. Reported incidence and severity of bother from side effects were similar between groups: most common were constipation, fatigue, and headache. Serum prolactin levels were similar at baseline. On day 4, mean serum prolactin level was 6.5 ng/mL (SD 2.2) for those who received cabergoline and 18.0 ng/mL (SD 5.9) for placebo (P=.049).Cabergoline is an effective and well-tolerated strategy to prevent breast symptoms after second-trimester abortion or pregnancy loss.ClinicalTrials.gov, NCT04701333.

  View details for DOI 10.1097/AOG.0000000000005190

  View details for PubMedID 37486652

• New Gaps and Urgent Needs in Graduate Medical Education and Training in Abortion. Academic medicine : journal of the Association of American Medical Colleges Beasley, A. D., Olatunde, A., Cahill, E. P., Shaw, K. A. 2023

  Abstract

  Abortion is essential health care, and abortion training and education are essential at all levels of medical education. Among the most common procedures performed in obstetrics and gynecology (OB/GYN), abortion is a core competency for OB/GYN residency programs. For nearly 50 years, the procedure was federally protected by the U.S. Supreme Court's January 22, 1973, Roe v Wade decision. On June 24, 2022, amidst increasing state restrictions limiting abortion access, the Court's decision on Dobbs v Jackson Women's Health Organization effectively reversed Roe. As a result, immediate bans on abortion went into effect across the country, removing access to abortion for millions of people and newly limiting training and education in this core competency for many medical residents. As of June 2022, nearly half of U.S. OB/GYN residency programs and more than 40% of residents are located in states that have banned or are likely to ban abortion. In states where abortion is restricted or illegal, states must adapt quickly to ensure their residents meet training requirements. This adaptation may include developing and leveraging relationships with programs in states where access is protected, depending on simulation, and placing greater emphasis on education and training in pregnancy loss management and postabortion care. None of these is a comprehensive solution and even all together, they are insufficient to train residents and medical students. Ultimately, many future physicians will not receive the training they need to provide full reproductive health care to their pregnant patients. Legal and other systems of support are needed to ensure that current and future physicians can provide compassionate, evidence-based reproductive health care, including essential abortion care.

  View details for DOI 10.1097/ACM.0000000000005154

  View details for PubMedID 36656271

• The ongoing crisis of abortion care education and training in the United States. Current opinion in obstetrics & gynecology Cahill, E. P., Meza, P. K. 2022; 34 (6): 373-378

  Abstract

  PURPOSE OF REVIEW: The Dobbs vs Jackson case (Dobbs) decided by the Supreme Court of the United States (SCOTUS) in 2022 rescinded the constitutional right to abortion care, resulting in immediate state bans and severe restrictions on abortion care in almost half of the states at the time of submission. This article reviews the current state of abortion education and training as well as available curricula and programmes to support continued training.RECENT FINDINGS: Prior to Dobbs, a national residency-level training programme, the Ryan Residency Training Program, has helped expand abortion care training in residency programs nationally, yet there remained many barriers to incorporating this training into practice, including practice and hospital restrictions. New state restrictions now additionally constrain almost half of all the Ob-Gyn residency programmes. Medical students benefit from education on options counselling and values exploration.SUMMARY: Abortion care education and training is in crisis. Almost half of the Ob-Gyn residents are training in states that have banned or severely restricted abortion care. This threatens to create a workforce without critical early pregnancy management knowledge and skills. Residents are more likely to provide abortion care when they have scheduled routine training. Medical students can apply options counselling and values exploration knowledge broadly. Online education resources provide some patchwork solutions to continue abortion care education and training in this heavily restrictive landscape.

  View details for DOI 10.1097/GCO.0000000000000825

  View details for PubMedID 36342010

• 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

  Abstract

   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

• The Cost of Loss: A Secret-Shopper Survey of Mortuary Disposition of Fetal Remains Burns, R., Henkel, A., Cahill, E. LIPPINCOTT WILLIAMS & WILKINS. 2022: 53S

  View details for Web of Science ID 000811070700179

• Potential candidate for oral pericoital contraception: evaluating ulipristal acetate plus cyclo-oxygenase-2 inhibitor for ovulation disruption. BMJ sexual & reproductive health Cahill, E. P., Lerma, K., Shaw, K. A., Blumenthal, P. D. 2022

  Abstract

  BACKGROUND: There remains considerable global unmet contraceptive need, with almost 200million women reporting desire to limit or space childbearing without contraceptive use. Researchers have documented worldwide interest in an oral, on-demand contraceptive option were it available. Candidates for use include ulipristal acetate (UA), levonorgestrel and cyclo-oxygenase-2 (COX-2) inhibitors alone or in combination.METHODS: We performed an exploratory, prospective study of matched menstrual cycles: one baseline cycle and one treatment cycle of UA 30mg plus meloxicam 30mg just prior to ovulation. The primary outcome was ovulation disruption, defined as unruptured dominant follicle for 5days. Secondary outcomes included comparing cycle length, endometrial stripe thickness, and side effects.RESULTS: Nine participants completed all study procedures in both cycles. Ovulatory disruption occurred in 66.7% (n=6) of treatment cycles and all but one demonstrated features of ovulatory dysfunction. Cycle length (mean±SD) was longer in the treatment cycle (31.9±4.0 vs 28.6±3.5 days, p<0.01). Secondary outcomes did not differ between the two cycles.CONCLUSIONS: UA plus the COX-2 inhibitor meloxicam disrupts ovulation at peak luteal surge and is a promising candidate for evaluation as a pericoital oral contraceptive.TRIAL REGISTRATION NUMBER: NCT03354117.

  View details for DOI 10.1136/bmjsrh-2021-201446

  View details for PubMedID 35470225

• Trauma-informed abortion care. Current opinion in obstetrics & gynecology Cahill, E. P., Doyle, A. 2021; 33 (6): 453-457

  Abstract

  PURPOSE OF REVIEW: People seeking reproductive care experience trauma on many levels including personal, structural, in medical care, and in barriers to care. This article reviews key aspects of a Trauma-Informed Care approach in abortion and reproductive healthcare.RECENT FINDINGS: Experiences of trauma are common and compounding, including systemic trauma, such as racism, sexism, and transphobia. Reproductive healthcare itself traumatizes and re-traumatizes. Trauma Informed Care (TIC) approach to individual abortion care includes maximize patient safety, choice, and privacy. TIC approach to systemic abortion care includes dismantling barriers to care and stigma.SUMMARY: The experience of trauma is prevalent, often unrecognized and can be multifactorial, especially for those seeking abortion and contraception care. Reproductive care can create situations or power dynamics that reactivate a trauma experience. History of trauma influences a person's health, relationships, experience, and use of reproductive healthcare, as well as trust in reproductive health recommendations. Laws restricting access to abortion and reproductive health add another layer of trauma and disproportionately affect marginalized groups. Guidelines for Trauma Informed Abortion Care recognize the complexity of trauma in reproductive health experiences and seek to promote safety, empowerment, and healing on individual and systemic levels.

  View details for DOI 10.1097/GCO.0000000000000749

  View details for PubMedID 34747881

• Socioeconomic Differences Persist in Use of Permanent versus Long-Acting Reversible Contraception: An Analysis of the National Survey for Family Growth, 2006-2010 versus 2015-2017. Contraception Beshar, I., So, J., Chelvakumar, M., Cahill, E. P., Shaw, K. A., Shaw, J. G. 2020

  Abstract

  OBJECTIVE: Permanent contraception has historically been more prevalent among non-White women with lower education and income. Given increasing popularity of long-acting reversible contraception (LARC), we examine changing sociodemographic patterns of permanent contraception and LARC.STUDY DESIGN: We performed a descriptive analysis of the National Survey of Family Growth (NSFG) from 2006-2017, with multivariable analyses of the 2006-2010 and 2015-2017 cohorts. Using multinomial logistic regression, we investigate predictors of contraceptive category (permanent contraception versus LARC, lower-efficacy contraception versus LARC) in reproductive-aged women.RESULTS: 8,161 respondents were included in two distinct but analogous regression analyses: 1) the most recent survey cohort, 2015-2017, and 2) the cohort a decade prior, 2006-2010. Over this period, the prevalence of LARC increased nearly three-fold (6.2% to 16.7%), while permanent contraception use trended downwards (22% to 18.6%). Yet, in adjusted models, we observed little change in the sociodemographic predictors of permanent contraception: from the early to recent cohort, use of permanent contraception (versus LARC) remained less likely among college graduates (multinomial odds ratio (OR) 0.45[95% CI 0.21, 0.97]) and Hispanic women (OR 0.41[0.21, 0.82]). In addition, high income (>$74,999) and metropolitan residence came to predict less use (OR 0.33[0.13, 0.84] and 0.47[0.23, 0.97]). Multiparity, advanced age (over ≥35), and marital status remained strong predictors of permanent contraception.CONCLUSION: Although use of LARC nearly equals that of permanent contraception in the most recent NSFG survey, socioeconomic differences persist. Continued effort is needed to detect and address structural barriers to accessing the most effective forms of contraception for women.IMPLICATIONS: Comparing 2006-2010 to 2015-2017, reliance on female permanent contraception decreased while LARC use increased, making prevalence more similar. However, significant socioeconomic differences persist in who chooses permanent contraception, with urban, educated, higher-income women more likely to use LARC. Ongoing efforts are needed to understand and reduce economic barriers to LARC.

  View details for DOI 10.1016/j.contraception.2020.12.008

  View details for PubMedID 33359509

• Advances in contraception research and development. Current opinion in obstetrics & gynecology Cahill, E. P., Kaur, S. 2020

  Abstract

  PURPOSE OF REVIEW: In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years including new medications, and technologies.RECENT FINDINGS: Contraception must be discussed within the context of individual goals and context. New contraceptive options approved by the FDA in the past two years include a year-long vaginal ring, a progestin-only pill that is as effective as combined oral contraceptive pills, a new hormonal patch and a vaginal gel that may also help prevent sexually transmitted infections.There are still areas of contraceptive research that are very much unknown including biomarkers of contraceptive efficacy or side effects, how individuals or groups metabolize contraception, initiation around reproductive life events or the discontinuation of other methods.SUMMARY: There have been many new contraceptives developed over the past few years to address challenges of existing contraception and create new methods; yet, there remain many unanswered questions in contraceptive research. Contraceptive technology has far-reaching consequences, and independent of technology itself, represents a great opportunity for truly personalized medicine.

  View details for DOI 10.1097/GCO.0000000000000666

  View details for PubMedID 32969852

• Sociodemographic Trends in Long Acting Reversible Contraception vs. Female Sterilization, 2006-2017 Beshar, I. B., Chelvakumar, M., So, J., Cahill, E. P., Shaw, K. A., Shaw, J. G. LIPPINCOTT WILLIAMS & WILKINS. 2020: 100S

  View details for Web of Science ID 000554572900348

• Self-managed abortion. Current opinion in obstetrics & gynecology Conti, J., Cahill, E. P. 2019; 31 (6): 435–40

  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

• 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

  View details for Web of Science ID 000473810000080

• 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

  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

• Pericoital contraception. Current opinion in obstetrics & gynecology Cahill, E. P., Blumenthal, P. D. 2018; 30 (6): 400–406

  Abstract

  PURPOSE OF REVIEW: To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception.RECENT FINDINGS: Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data.SUMMARY: Repeat pericoital dosing of 1.5-mg LNG is approximately as effective as other on-demand contraceptive methods and is overall very safe. The most common side effect is irregular bleeding. Repeat on-demand ulipristal acetate or meloxicam/other cyclo-oxygenase-2 inhibitors have potential as an on-demand option either alone or in combination but have not been evaluated for contraceptive efficacy in a large-scale study. Given the high unmet need for contraception, even among women with access to available options, there is a distinct need for options that address needs of women who are interested in an on-demand option. On-demand oral contraception has the potential to expand the convenience of contraceptive options and overall contraceptive use.

  View details for PubMedID 30399016

• Pericoital contraception CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Cahill, E. P., Blumenthal, P. D. 2018; 30 (6): 400-406

  View details for DOI 10.1097/GCO.0000000000000491

  View details for Web of Science ID 000455903200010

• Postpartum intrauterine devices: clinical and programmatic review AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Goldthwaite, L. M., Cahill, E. P., Voedisch, A. J., Blumenthal, P. D. 2018; 219 (3): 235–41

  View details for DOI 10.1016/j.ajog.2018.07.013

  View details for Web of Science ID 000443000400003

• Postpartum intrauterine devices: Clinical and programmatic review. American journal of obstetrics and gynecology Goldthwaite, L. M., Cahill, E. P., Voedisch, A. J., Blumenthal, P. D. 2018

  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

• Abortion in the media. Current opinion in obstetrics & gynecology Conti, J. A., Cahill, E. n. 2017; 29 (6): 427–30

  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