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Article ; Online: Coronavirus Disease 2019 (COVID-19) Vaccination in Pregnancy.

Prabhu, Malavika / Riley, Laura E

2023 Volume 141, Issue 3, Page(s) 473–482

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with significant maternal morbidity and mortality, and its risks can be mitigated with coronavirus disease 2019 (COVID-19) vaccination. Vaccination against ... ...

Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with significant maternal morbidity and mortality, and its risks can be mitigated with coronavirus disease 2019 (COVID-19) vaccination. Vaccination against COVID-19 in pregnancy results in protection against both maternal and neonatal SARS-CoV-2 infection, as well as maternal critical illness. Vaccination during pregnancy is safe, with no documented risks of pregnancy loss, preterm delivery, congenital anomalies, or other adverse perinatal outcomes. For these reasons, COVID-19 vaccination is recommended in pregnancy by the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, as well as other national and international professional organizations. In this review, we will summarize the published literature demonstrating the benefit and safety of these vaccines.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Pregnancy ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Pregnancy Complications, Infectious ; Pregnancy Outcome ; SARS-CoV-2 ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2023-01-16
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000005100
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Article ; Online: Society for Maternal-Fetal Medicine Statement: RhD immune globulin after spontaneous or induced abortion at less than 12 weeks of gestation.

Prabhu, Malavika / Louis, Judette M / Kuller, Jeffrey A

American journal of obstetrics and gynecology

2024

Abstract: Guidelines for the management of first-trimester spontaneous and induced abortion vary in terms of rhesus factor D (RhD) testing and RhD immune globulin (RhIg) administration. These existing guidelines are based on limited data that do not convincingly ... ...

Abstract	Guidelines for the management of first-trimester spontaneous and induced abortion vary in terms of rhesus factor D (RhD) testing and RhD immune globulin (RhIg) administration. These existing guidelines are based on limited data that do not convincingly demonstrate the safety of withholding RhIg for first-trimester abortions or pregnancy losses. Given the adverse fetal and neonatal outcomes associated with RhD alloimmunization, prevention of maternal sensitization is essential in RhD-negative patients who may experience subsequent pregnancies. In care settings in which RhD testing and RhIg administration are logistically and financially feasible and do not hinder access to abortion care, we recommend offering both RhD testing and RhIg administration for spontaneous and induced abortion at <12 weeks of gestation in unsensitized, RhD-negative individuals. Guidelines for RhD testing and RhIg administration in the first trimester must balance the prevention of alloimmunization with the individual- and population-level harms of restricted access to abortion.
Language	English
Publishing date	2024-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2024.02.288
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Article ; Online: Magnesium sulfate prophylaxis for late-postpartum severe hypertension.

Cagino, Kristen / Prabhu, Malavika / Sibai, Baha

American journal of obstetrics and gynecology

2024

Language	English
Publishing date	2024-03-23
Publishing country	United States
Document type	Letter
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2024.03.028
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Article ; Online: Impact of Tobacco and Marijuana on Infertility and Early Reproductive Wastage.

Bortoletto, Pietro / Prabhu, Malavika

Clinical obstetrics and gynecology

2022 Volume 65, Issue 2, Page(s) 360–375

Abstract: Reducing exposure to tobacco and marijuana during preconception and early pregnancy is a critical area of intervention for obstetricians, gynecologists, and other reproductive health care professionals. Beyond the deleterious personal health effects, ... ...

Abstract	Reducing exposure to tobacco and marijuana during preconception and early pregnancy is a critical area of intervention for obstetricians, gynecologists, and other reproductive health care professionals. Beyond the deleterious personal health effects, both substances have been extensively associated with short-term and long-term detrimental effects to gametogenesis, fecundity, as well as tissue level effects in the reproductive tracts. When tobacco and marijuana do not impair the ability to achieve pregnancy, an increasing body of literature suggests either may be associated with increased risk of early pregnancy loss and reproductive wastage. In this review, we will discuss what is known about how tobacco and marijuana affect the male and female reproductive systems and highlight how these consequences may impair attempts at successful conception and pregnancy continuation beyond the first trimester.
MeSH term(s)	Cannabis/adverse effects ; Female ; Fertility ; Gynecology ; Humans ; Infertility/etiology ; Male ; Pregnancy ; Nicotiana
Language	English
Publishing date	2022-02-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000689
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Article ; Online: Challenges in Interpreting the Ob/Gyn Literature: Studies of Screening.

Prabhu, Malavika / Riley, Laura E

Clinical obstetrics and gynecology

2022 Volume 65, Issue 2, Page(s) 244–251

Abstract: Screening tests are critical to patient care. Screening tests must meet ten criteria established by the World Health Organization in order to be considered effective. Common types of studies on screening tests include those that establish test ... ...

Abstract	Screening tests are critical to patient care. Screening tests must meet ten criteria established by the World Health Organization in order to be considered effective. Common types of studies on screening tests include those that establish test characteristics, such as sensitivity, specificity, positive predictive value, and negative predictive value, as well as cost-effective analyses. In this paper, we review the criteria for effective screening tests, and discuss the strengths and pitfalls of common study designs evaluating screening tests.
MeSH term(s)	Cost-Benefit Analysis ; Humans ; Mass Screening ; Predictive Value of Tests ; Research Design
Language	English
Publishing date	2022-03-31
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000704
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Article ; Online: Is magnesium sulfate therapy warranted in all cases of late postpartum severe hypertension? A suggested approach to a clinical conundrum.

Cagino, Kristen / Prabhu, Malavika / Sibai, Baha

American journal of obstetrics and gynecology

2023 Volume 229, Issue 6, Page(s) 641–646

Abstract: Magnesium sulfate reduces the risk for eclamptic seizures antepartum, intrapartum, and in the immediate postpartum period, however, there are no studies that have evaluated the benefits and risks of magnesium sulfate among women with late postpartum ... ...

Abstract	Magnesium sulfate reduces the risk for eclamptic seizures antepartum, intrapartum, and in the immediate postpartum period, however, there are no studies that have evaluated the benefits and risks of magnesium sulfate among women with late postpartum severe hypertension only. Juxtaposed on this clinical uncertainty is the increased incidence of severe hypertension owing to a rise in pregnancies complicated by advanced maternal age, obesity, chronic hypertension, diabetes, and recent protocols for intensive monitoring of blood pressure in the postpartum period. These factors have led to a significant increase in postpartum presentations for the evaluation and management of severe hypertension, in some cases leading to postpartum readmissions for administration of antihypertensive therapy and magnesium sulfate without data demonstrating clear clinical benefit. Postpartum readmissions can have several negative consequences, including interfering with early bonding with a newborn, breastfeeding, and use of scarce healthcare resources. In addition, magnesium sulfate is associated with risks for serious cardiorespiratory depression and bothersome side effects and can delay determining the optimal antihypertensive regimen, which is typically the most pressing clinical need during postpartum presentations of late-postpartum severe hypertension. Eclampsia that occurs more than 48 hours after delivery is rare (constitutes 16% of all cases of eclampsia) and is most commonly preceded by headaches or other cerebral symptoms. In this commentary, we propose an approach to evaluating and managing patients with late postpartum severe hypertension aimed at identifying those women at highest risk for end-organ injury. We recommend that the short- and long-term focus for all patients with severe hypertension should be the optimal management of blood pressures with a goal of close outpatient monitoring when logistically feasible and clinically appropriate. We suggest reserving magnesium sulfate therapy for the subset of patients with neurologic symptoms who may be at highest risk for an eclamptic seizure.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Humans ; Female ; Magnesium Sulfate/therapeutic use ; Eclampsia/diagnosis ; Pre-Eclampsia ; Antihypertensive Agents/therapeutic use ; Clinical Decision-Making ; Uncertainty ; Postpartum Period ; Seizures/drug therapy ; Seizures/etiology ; Hypertension/drug therapy ; Hypertension/epidemiology
Chemical Substances	Magnesium Sulfate (7487-88-9) ; Antihypertensive Agents
Language	English
Publishing date	2023-07-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2023.07.021
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Article ; Online: Society of Family Planning Clinical Recommendation: Medication abortion between 14 0/7 and 27 6/7 weeks of gestation: Jointly developed with the Society for Maternal-Fetal Medicine.

Zwerling, Blake / Edelman, Alison / Jackson, Anwar / Burke, Anne / Prabhu, Malavika

American journal of obstetrics and gynecology

2023

Abstract: The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7 and 27 6/7 weeks of gestation, with a focus on mifepristone-misoprostol and misoprostol-only ... ...

Abstract	The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7 and 27 6/7 weeks of gestation, with a focus on mifepristone-misoprostol and misoprostol-only regimens. We systematically reviewed PubMed articles published between 2008 and 2022 and reviewed reference lists of included articles to identify additional publications. See Search Strategy for more details. Several randomized trials of medication abortion between 14 0/7 and 27 6/7 weeks of gestation demonstrate that mifepristone 200 mg orally before misoprostol increases effectiveness (complete abortion at 24 or 48 hours) compared to misoprostol only. Studies continue to evaluate different doses, routes, and dosing intervals for misoprostol. If mifepristone is unavailable, several misoprostol regimens with individual doses of at least 200 mcg or more are effective. Adjunctive osmotic dilators are of limited benefit. It is important to individualize care, with consideration to reducing misoprostol dose in low-resource settings or at 24 0/7 weeks of gestation or later (or equivalent uterine size). Misoprostol in the setting of two or more previous cesarean sections is associated with increased risk of uterine rupture compared to one or none, but risk remains low. Most contraceptives can be started during or immediately following abortion. Appropriately trained and credentialed advanced practice clinicians can provide medication abortion between 14 0/7 and 27 6/7 weeks of gestation with appropriate backup within the confines of local regulations and licensure.
Language	English
Publishing date	2023-10-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2023.09.097
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Article ; Online: Society of Family Planning Clinical Recommendation: Medication abortion between 14 0/7 and 27 6/7 weeks of gestation.

Zwerling, Blake / Edelman, Alison / Jackson, Anwar / Burke, Anne / Prabhu, Malavika

Contraception

2023 , Page(s) 110143

Abstract: Objective: The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7-27 6/7 weeks of gestation, with focus on mifepristone-misoprostol and misoprostol- ...

Abstract	Objective: The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7-27 6/7 weeks of gestation, with focus on mifepristone-misoprostol and misoprostol-only regimens. Methods: We systematically reviewed PubMed articles published between 2008 and 2022 and reviewed reference lists of included articles to identify additional publications. See Search Strategy for more details. Results/conclusions: Several randomized trials of medication abortion between 14 0/7-27 6/7 weeks of gestation demonstrate that mifepristone 200 mg orally before misoprostol increases effectiveness (complete abortion at 24 or 48 hours) compared to misoprostol only. Studies continue to evaluate different doses, routes, and dosing intervals for misoprostol. If mifepristone is unavailable, several misoprostol regimens with individual doses of at least 200 mcg or more are effective. Adjunctive osmotic dilators are of limited benefit. It is important to individualize care, with consideration to reducing misoprostol dose in low resources settings or at 24 0/7 weeks of gestation or later (or equivalent uterine size). Misoprostol in the setting of two or more previous cesarean sections is associated with increased risk of uterine rupture compared to one or none, but risk remains low. Most contraceptives can be started during or immediately following abortion. Appropriately trained and credentialed advanced practice clinicians can provide medication abortion between 14 0/7-27 6/7 weeks of gestation with appropriate backup within the confines of local regulations and licensure.
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80106-9
ISSN	1879-0518 ; 0010-7824
ISSN (online)	1879-0518
ISSN	0010-7824
DOI	10.1016/j.contraception.2023.110143
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Article ; Online: Association between programmed frozen embryo transfer and hypertensive disorders of pregnancy.

Bortoletto, Pietro / Prabhu, Malavika / Baker, Valerie L

Fertility and sterility

2022 Volume 118, Issue 5, Page(s) 839–848

Abstract: Dissociation of embryo transfer from the ovarian stimulation cycle has afforded patients increased flexibility for genetic testing and fertility preservation. Although frozen embryo transfer (FET) has largely been demonstrated to be safe and effective ... ...

Abstract	Dissociation of embryo transfer from the ovarian stimulation cycle has afforded patients increased flexibility for genetic testing and fertility preservation. Although frozen embryo transfer (FET) has largely been demonstrated to be safe and effective compared with fresh transfer, programmed FET cycles, where a corpus luteum is absent, have come under increasing scrutiny. In observational trials, programmed FET protocols appear to be associated with an increased risk of ineffective decidualization and impaired placental function. Together with the appropriate preexisting risk factors, this additive risk may potentiate hypertensive disorders of pregnancy later in gestation. Efforts to understand the reasons for this apparent risk may afford us opportunities to better individualize the FET cycle type offered to patients with cryopreserved embryos. Randomized controlled trials will help us to understand whether the apparent risk is due to patient factors, which influence protocol choice, or a characteristic of the protocol itself, such as the absence of the corpus luteum or suboptimal replacement of estradiol and progesterone.
MeSH term(s)	Humans ; Female ; Pregnancy ; Progesterone ; Hypertension, Pregnancy-Induced/diagnosis ; Hypertension, Pregnancy-Induced/epidemiology ; Hypertension, Pregnancy-Induced/therapy ; Placenta ; Embryo Transfer/adverse effects ; Embryo Transfer/methods ; Estradiol
Chemical Substances	Progesterone (4G7DS2Q64Y) ; Estradiol (4TI98Z838E)
Language	English
Publishing date	2022-09-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80133-1
ISSN	1556-5653 ; 0015-0282
ISSN (online)	1556-5653
ISSN	0015-0282
DOI	10.1016/j.fertnstert.2022.07.025
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Article ; Online: Self-monitoring of Blood Pressure During Pregnancy.

Prabhu, Malavika / Malha, Line / Riley, Laura E

JAMA

2022 Volume 327, Issue 17, Page(s) 1651–1652

MeSH term(s)	Blood Pressure/physiology ; Blood Pressure Determination ; Blood Pressure Monitoring, Ambulatory/methods ; Female ; Humans ; Hypertension/diagnosis ; Hypertension, Pregnancy-Induced/diagnosis ; Pregnancy ; Self Care ; Self-Testing ; Vital Signs
Language	English
Publishing date	2022-03-30
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2022.2802
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