Diffusenortheast

The first two weeks of July were the Earth’s hottest on human record, and people across the country continue to suffer from lingering, suffocating heat waves. The US Centers for Disease Control and Prevention has issued repeated warnings and tips about recognizing and preventing heat-related illnesses, like heat stroke, heat exhaustion, and heat cramps.

But one heat-related illness that people do not always recognize is heat rash.

“Heat rash can indicate that your exposure to excessive heat could lead to other serious heat-related issues, if not addressed,” says Dr. Abigail Waldman, a dermatologist with Harvard-affiliated Brigham and Women’s Hospital. "While heat rash is not dangerous in itself, sustained exposure to high heat can lead to heat exhaustion and heat stroke, so it's important to note any early signs that your body is struggling with the heat.”

What are the signs of heat rash?

Heat rash is also known as miliaria or prickly heat. It is caused when ducts from eccrine sweat glands that lead to the skin's surface are blocked or inflamed.

Eccrine sweat glands help your body maintain a steady temperature. When your internal temperature rises, these glands release water that rises to the surface of your skin through tiny ducts. There, it quickly evaporates, cooling your skin and the blood beneath.

However, sweat ducts may get blocked when you sweat excessively in hot temperatures, particularly if skin folds or tight-fitting clothes hinder their function.

Sweat is then trapped beneath the skin. This triggers inflammation, which leads to the appearance of small, itchy red bumps, similar to tiny pimples or blisters. In people with darker skin tones, these small, itchy bumps may not appear red, but will look slightly darker than surrounding skin.

Where and when is heat rash likely to occur?

Heat rash can appear on the neck, scalp, chest, groin, or elbow creases.

“Heat rash can occur any time the body sweats, so it is common in hot, humid climates, during hospitalizations, from fever, and during exercise,” says Dr. Waldman.

Heat rash also can occur in newborns, as their eccrine sweat glands are not fully developed. In newborns, heat rash looks like very thin blisters or water drops widely distributed on the face, trunk, arms, and legs. Call your pediatrician for advice if you notice a rash like this.

How can you treat heat rash?

Heat rash in adults is easy to treat with home remedies. “The techniques to relieve symptoms also can help prevent heat rash for adults and babies,” says Dr. Waldman.

• Cool down. The first step is to get out of the heat and cool and dry your skin. Use a fan or air conditioner, take a cool shower, or apply cool compresses to the affected areas. It's important to know that some people are more vulnerable to heat, and to make plans to help stay safe when temperatures are dangerously high.
• Prevent irritation. To prevent skin irritation, avoid wearing clothes made from synthetic materials, which can trap heat. (While dry-fit clothing helps to wicks away moisture from the skin, it often can be too tight fitting.) Instead, wear light, loose-fitting cotton clothing that allows airflow over your skin. If a heat rash occurs around your groin area, avoid wearing undergarments until it clears up.
• Try anti-itch products. Use an over-the-counter topical corticosteroid cream or calamine lotion for itching. However, avoid baby powder, oily or greasy moisturizers, and sunscreen, as they can further block sweat ducts.

Heat rash typically goes away within one to two days once you cool down your body. More severe heat rashes can last a week or longer. See your doctor (or follow up with your pediatrician) if a heat rash has not cleared up after a week. Also seek immediate care if you experience pain, intense itching, or the rash appears infected.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Brittany Jordan-Arthur was at loggerheads with her 7-year-old daughter one recent morning. The little girl simply did not want to head out the door to summer camp, finding any and all excuses to hang back.

But instead of expressing exasperation or annoyance — knowing that would make her daughter dig in her heels even more — Jordan-Arthur, a psychologist at Harvard-affiliated McLean Hospital, decided to use a valuable communication technique: validation. Like many skills, the more you practice validation, the easier it becomes to apply when it’s most needed. Here’s what to know and do.

What is validation?

An approach that can help people feel heard and understood, validation is especially useful when navigating emotionally charged situations. Validating someone shows you understand their feelings and point of view, even when you disagree. It establishes trust, helping the other person feel supported and open to discussing solutions.

And that’s precisely what happened in Jordan-Arthur’s stalemate with her daughter.

“I just sat with her and said, ‘You really don’t want to go.’ It was a great example of saying, ‘I hear you,’ and ultimately I didn’t tell her she had to go or why — she came to that conclusion herself,” Jordan-Arthur says. “We walked out the door without all the need for explanations.”

Many try validation but don’t succeed

Validation is fundamental to a type of talk therapy called dialectical behavior therapy (DBT), which is geared toward people who experience emotions very intensely. Many people use some aspects of validation in everyday communications with family members, friends, and colleagues, but usually fall short, Jordan-Arthur says. How?

“They jump into problem-solving, saying something validating, but then immediately tell the person what they should have done or what they should do next,” she says. “They don’t let that validation sink in. It’s like putting on anti-itch cream and then immediately washing it off.”

How can you offer validation?

Jordan-Arthur shares these pointers for validating another person:

• Give them your full attention.
• Make eye contact and nod appropriately, saying “uh huh” while showing your interest.
• Reflect what you’ve heard by restating their message, such as, “It sounds like you feel worse about this situation today than yesterday.”
• Verbalize the unspoken, such as, “I hear that you feel you can’t get anything done because of this obstacle,” or “It sounds like you’re frustrated.”
• Give it time to work! Be sure to let the validation sink in before attempting to problem- solve.

Does validation condone troubling behavior?

Validation isn’t the same as condoning someone’s bad or frustrating behavior, Jordan-Arthur notes. It’s not akin to reassuring them when reassurance isn’t appropriate.

“You may be afraid you’re going to communicate that you approve of their behavior or agree with their actions or choices,” she says. “But if you slow down and validate how someone feels in the moment, before a poor decision is made, validating accomplishes exactly the opposite.”

Try this phrasing instead:

• “I hear that this is important to you.”
• “I can see how this has been so upsetting/difficult/scary for you.”

How can you validate teens?

Validating teenagers isn’t dissimilar from the tactics Jordan-Arthur used with her 7-year-old — the problems just tend to be bigger. For example, teens often feel stuck with teachers they don’t like or complain that teachers seem overly harsh.

“Parents have lots of urges to say, ‘Oh, the teacher isn’t that bad’ or ‘I’m sure they mean well,’ defending the teacher and his or her perspective,” Jordan-Arthur says. “The odds are, by the time a kid is a teen, they also have that skill, but it’s going to take them a moment to get there.”

Here’s what to say instead:

• “I hear that you don’t feel respected.”
• “It’s so hard to feel helpless.”
• “It’s difficult to feel your teacher has control over how well you do in class.”

“You can validate their feelings even if you feel the teacher is being respectful,” Jordan-Arthur adds.

How can you validate adults?

Validating other adults in your professional or personal life involves much the same approach. With a colleague who’s feeling undervalued at the office, for instance, try saying, “It makes total sense that you’re feeling really frustrated. I know how important your work is to you.”

If you’re arguing with a spouse or partner, you can believe them as being genuine, Jordan-Arthur says, despite a difference of opinion. Try saying, “I can tell that this issue feels really important to you and you want me to pay attention to what you’re saying.”

It’s also wise to pay attention to the other person’s body language during heated moments. After validating them — but before offering a potential solution to a problem — look for clues that they’re calming down, such as breathing and gesturing more slowly.

“I encourage people to count to 10 in their heads, because we still tend to jump the gun and not wait for the other person to feel that validation,” she says. “If we do that, they’ll often move past the idea that ‘this person wronged me’ and start solving the problem on their own.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

RSV, or respiratory syncytial virus, is a common virus that just causes cold symptoms for most people. But for very young babies, and for babies and young children with certain health problems, it can be very dangerous. A new immune-boosting therapy may help.

What complications can RSV cause?

RSV is the leading cause of bronchiolitis and pneumonia in children under a year. It can cause life-threatening problems with breathing, especially in children with heart or lung disease.

Which medications work against RSV?

There aren't any medications that treat RSV effectively. To prevent the illness, a medication called palivizumab (Synagis) can be given as a monthly shot to high-risk infants during RSV season. (While RSV is not always seasonal, many cases occur between late fall and early spring.)

But insurance companies only cover this medication for certain patients, using strict criteria. Its cost and the fact that it has to be given monthly have been barriers to its use.

How can the new RSV shot help?

This year, a new shot could make a big difference. It is called nirsevimab (Beyfortus). Like palivizumab, it is an antibody treatment — but unlike palivizumab, it will be available to all babies under 8 months of age, not just high-risk infants. Here's what to know:

• This is not a vaccine. Vaccines prod the body to make antibodies that help protect against an infection, while this shot works by giving the antibodies directly.
• These antibodies can prevent or lessen the severity of an RSV infection.
• Because the body isn't making its own antibodies the shot does wear off, but the good news is that just one shot can last five months. If given right at the beginning of RSV season, this essentially provides protection for the whole season.

Who can receive the new RSV shot?

One dose of nirsevimab is recommended for all babies under the age of 8 months as close to the start of RSV season as possible. Newborns can get it before they leave the birth hospital, and it can be given along with routine vaccinations.

The new shot is also recommended for children 8 to 19 months with conditions that put them at high risk of becoming very sick if they get RSV. These include

• prematurity
• chronic lung disease
• congenital heart disease
• weakened immune system
• cystic fibrosis
• neuromuscular disorders, or other disorders that make it hard for babies to swallow and clear mucus.

Infants and toddlers who get nirsevimab do not need to get monthly shots of palivizumab as well.

Because this is brand new, there may be some challenges with getting it to all the infants and toddlers that are eligible. Talk to your doctor if your baby or toddler would be eligible this season.

For more information, check out the press releases from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

While the FDA rules for blood donation were revised twice in the last decade, one group — men who have sex with men (MSM) — continued to be turned away from donating. Now new, evidence-based FDA rules embraced by the American Red Cross will focus on individual risk rather than groupwide restrictions.

Medical experts consider the new rules safe based on extensive evidence. Let’s review the changes here.

The new blood donation rules: One set of questions

The May 2023 FDA guidelines recommend asking every potential blood donor the same screening questions. These questions ask about behavior that raises risk for HIV, which can be spread through a transfusion.

Blood donation is then allowed, or not, based on personal risk factors for HIV and other blood-borne diseases.

Questions for potential blood donors

Screening questions focus on the risk of recent HIV infection, which is more likely to be missed by routine testing than a longstanding infection.

The screening questions ask everyone — regardless of gender, sex, or sexual orientation — whether in the past three months they have

• had a new sexual partner and engaged in anal sex
• had more than one sexual partner and engaged in anal sex
• taken medicines to prevent HIV infection (such as pre-exposure prophylaxis, or PrEP)
• exchanged sex for pay or drugs, or used nonprescription injection drugs
• had sex with someone who has previously tested positive for HIV infection
• had sex with someone who exchanged sex for pay or drugs
• had sex with someone who used nonprescription injection drugs.

When is a waiting period recommended before giving blood?

• Answering no to all of these screening questions suggests a person has a low risk of having a recently acquired HIV infection. No waiting period is necessary.
• Answering yes to any of these screening questions raises concern that a potential donor might have an HIV infection. A three-month delay before giving blood is advised.

Does a waiting period before giving blood apply in other situations?

Yes:

• A three-month delay before giving blood is recommended after a blood transfusion; treatment for gonorrhea or syphilis; or after most body piercings or tattoos not done with single-use equipment. These are not new rules.
• A waiting period before giving blood is recommended for people who take medicines to prevent HIV infection, called PrEP (pre-exposure prophylaxis). PrEP might cause a test for HIV to be negative even if infection is present. The new guidelines recommend delaying blood donation until three months after the last use of PrEP pills, or a two-year delay after a person receives long-acting, injected PrEP.

Who cannot donate blood?

Anyone who has had a confirmed positive test for HIV infection or has taken medicines to treat HIV infection is permanently banned from donating blood. This rule is not new.

Why were previous rules more restrictive?

In 1983, soon after the HIV epidemic began in the US, researchers recognized that blood transfusions could spread the infection from blood donor to recipient. US guidelines banned men who had sex with men from giving blood. A lifetime prohibition was intended to limit the spread of HIV.

At that time, HIV and AIDS were more common in certain groups, not only among MSM, but also among people from Haiti and sub-Saharan Africa, and people with hemophilia. This led to blood donation bans for some of these people, as well.

A lot has changed in the world of HIV in the last several decades, especially the development of highly accurate testing and highly effective prevention and treatment. Still, the rules regarding blood donation were slow to change.

The ban from the 1980s for MSM remained in place until 2015. At that time, rules were changed to allow MSM to donate only if they attested to having had no sex with a man for 12 months. In 2020, the period of sexual abstinence was reduced, this time to three months.

Why are the blood donation guideline changes important?

• Removing unnecessary restrictions that apply only to certain groups is a step forward in reducing discrimination and stigma for people who wish to donate blood but were turned away in the past.
• The critical shortage in our blood supply has worsened since the start of the COVID-19 pandemic. These revised rules are expected to significantly boost the number of blood donors.

The bottom line

Science and hard evidence should drive policy regarding blood donation as much as possible. Guidelines should not unnecessarily burden any particular group. These new guidelines represent progress in that regard.

Of course, these changes will be closely monitored to make sure the blood supply remains safe. My guess is that they’ll endure. And it wouldn’t surprise me if there is additional lifting of restrictions in the future.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

If the first goal of a drug advertisement is to grab your attention, this ad for Entyvio (vedolizumab) works.

You see a young woman getting into her car, sitting in her work cubicle, sitting in a restaurant, and finally in the waiting room of her doctor’s office. But she’s not sitting on the seat of the car or on a chair; in every scene, she’s sitting on the lid of a toilet.

Strange, right?

Why all the toilets?

The voiceover provides a clue: “When you live with moderate or severe Crohn’s disease or ulcerative colitis, your day can be full of reminders of your condition. Never knowing, always wondering.” And there’s another hint: the woman keeps grimacing and clutching her belly.

But these clues may not be enough. What’s never explained in this ad is that abdominal pain and sudden diarrhea are among the most common symptoms of Crohn’s disease and ulcerative colitis, conditions known collectively as inflammatory bowel disease (IBD). The “never knowing, always wondering” refers to the way people with these conditions often have unpredictable bouts of diarrhea and an urgent need to get to a restroom. And that’s why there are toilets everywhere.

What does this ad get right?

The ad provides useful information about:

• How this treatment works. Crohn’s disease and ulcerative colitis are two forms of IBD that cause inflammation of the intestinal tract. Given as an infusion every two months, vedolizumab works by blocking cells involved in that inflammation. The ad uses visually appealing animations and graphics to get these points across.
• Side effects. The FDA requires every drug ad to describe common and potentially serious side effects. For vedolizumab, possible side effects include infusion reactions, allergic reactions, liver problems, and an increased susceptibility to infection. The ad highlights an infection called PML, noting that it’s “a rare, serious, potentially fatal brain infection.”
• Benefits. The voiceover states that “in clinical trials, Entyvio helped many people achieve long-term relief and remission.”

What else do you need to know?

As with most drug ads, this ad doesn’t provide all the information that’s important to know about this medication, especially if you’re a person with IBD for whom this drug might be helpful.

For starters, the ad never explains that diarrhea and abdominal pain are among the most common symptoms of Crohn’s disease and ulcerative colitis. And while the ad focuses on frequent diarrhea, it never mentions more serious complications, such as

• bleeding, fistulas (abnormal connections between the intestines and other parts of the body), perforation of the bowel, and bowel blockage 
• an increased risk of colorectal cancer
• inflammation in other parts of the body, including joints and eyes.

The ad also omits:

• Explaining how moderate to severe Crohn’s and ulcerative colitis is defined. Generally, it would include people with either condition who have large areas of intestinal inflammation, deep ulcers in the walls of the intestines, or who have had surgery; and those who haven’t responded to other standard treatments.
• Other ways to treat Crohn’s disease or ulcerative colitis. Steroids, azathioprine, infliximab, ustekinumab, risankizumab, and other drugs are also options to treat these disorders. 
• The high cost of this drug (up to $52,000/year). For some, health insurance may cover much of this cost, and a discount program is mentioned at the end of the ad (though eligibility details are not provided). Still, for many people with IBD, the cost of expensive drugs like Entyvio is a major barrier to receiving optimal care.

Also troubling is the way the ad skims over two important points:

• Little information is provided about PML. The ad doesn’t even say what the letters stand for: progressive multifocal leukoencephalopathy. PML is a virus that can infect the brain, often causing death or severe neurologic disease.
• What benefits does the drug deliver? Only one sentence speaks confidently about benefits, and no details are provided. How often people do taking this drug have at least some relief from their symptoms? How often do they experience remission of symptoms? And how long do these improvements last?

The bottom line

The ad ends with the young woman driving home after her doctor’s visit. She’s sitting on a regular seat for the first time. She glances at the rearview mirror and smiles at the toilet that’s been relegated to the back of the car. The message is clear: she’s better now and doesn’t have to worry about having to rush to the toilet since her doctor prescribed vedolizumab.

Of course, it doesn’t always work out this way in real life. Then again, drug ads aren’t intended to show real life. They’re intended to promote a product. That’s a good reason to maintain a healthy dose of skepticism about drug ads, and to rely instead on your doctor and other unbiased sources for your health information, such as the National Institutes of Health websites.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Your face plays an outsized role in your interactions with the world. It’s usually the first thing a person notices when they look at you. It’s home to the eyes, nose, and mouth, vital body parts that allow you to eat, drink, and communicate. But our facial features are also engineered for their own self-protection — and help protect our bodies in many surprising ways.

My brief career as a cowpoke

I learned how the human face is designed for self-protection while whipping around a lasso I’d been given as a birthday gift. At 8, I’d seen enough cowboy movies to think I knew how use it, at least until the rope struck me across my face. Within seconds a raised red streak ran across my forehead, eyebrow, and cheek. But it skipped my eye.

Once sure I was okay, my mom pointed out that being set back and surrounded by my eye socket bones had protected my eye from damage.

I learned two important lessons that day. First, facial anatomy is remarkably good at protecting itself. Second, using a lasso is harder than it looks.

How do your eyes help protect your body?

Our eyes help keep us safe by feeding detailed information about our surroundings to the brain. Having two eyes pointing ahead (rather than just one) allows for depth perception and a wider field of vision.

What’s more:

• Eyebrows help guide debris, sweat, rainwater, or other substances that find their way onto your forehead away from your eyes. They also communicate emotions, as is obvious if you compare the positions of a person’s eyebrows when they are angry, surprised, or fearful.
• Eyelashes act as guards at the front of the eyes, preventing dust, sweat, and other irritants from making it into the eye. And because lashes are sensitive to touch, they can also provide an alert when something is near the eye.
• The cornea protects your eyes from what may be harmful in the environment while allowing light to pass through to reach nerves at the back of the eye. The cornea is perfectly suited for these tasks: its tough outer coating shields the front of the eye, but is clear so that light can pass through it.

How does your nose help protect your body?

The nose that allows us to smell flowers, bread baking, and other pleasant scents also serves as an alarm system: if there’s a gas leak or if food has spoiled, a good sense of smell can be lifesaving. It also warms and humidifies air passing through. That’s important because cold, dry air can be irritating to the lungs.

Additionally:

• Nose hairs help filter larger particles, such as dust or soot, from the air.
• The nasal liningteams with immune cells ready to attack toxic particles from the air, viruses, or other intruders. It also produces protective mucus that can trap small particles and keep nasal passages from drying out.
• Sneezing expels small particles, such as microorganisms or chemical irritants, out through the nose.

How does your mouth help protect your body?

Eating, drinking, and speaking are among the most important functions of the mouth, but there are other ways it’s protective:

• A tight seal forms when you close your mouth. That’s helpful, because otherwise we’d have a hard time swimming — or even just walking around — and might be constantly swallowing bugs (among other challenges)
• Coughing allows you to expel unwanted particles or organisms through your mouth.
• Saliva contains antibodies to attack infectious organisms before these travel further into the body.
• The mucous membranes that line the inside of the mouth allow for the sensation of taste. That’s important for quality of life, and for avoiding eating something toxic. And the mucous membranes host key immune cells, serving as a first-line immune barrier against viruses and other infectious organisms.

The evolution of the human face

How is it that the human face developed to protect its host in so many ways?

As is so often the case with the human body, you can thank evolution. Over thousands of years, evolutionary pressure ensured that features favoring survival were preserved in our genetic makeup.

This includes facial anatomy: each element of your face is there for a reason, from its shape, form and function to its various attachments and orifices. Even features that humans consider attractive (such as symmetry, youthfulness, or familiarity) are partly due to evolutionary pressure: these features help attract mates, and therefore may increase the chances of passing on genes to offspring.

The bottom line

Remarkable features of the human face serve to protect itself and its host. Unlike communication and social interactivity, these features are less well known and probably underappreciated.

So, the next time you look at yourself in the mirror, go ahead: Check how good you look. Or for signs of aging. Or for lettuce in your teeth. But whatever you’re searching for, remember: there’s a lot more to the appearance of your face than how you look.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

When you first learned the facts about pregnancy — from a parent, perhaps, or a friend — you probably didn’t learn that up to one in three ends in a miscarriage.

What causes miscarriage? How is it treated? And why is appropriate health care for miscarriage under scrutiny — and in some parts of the US, getting harder to find?

What is miscarriage?

Many people who come to us for care are excited and hopeful about building their families. It’s devastating when a hoped-for pregnancy ends early.

Miscarriage is a catch-all term for a pregnancy loss before 20 weeks, counting from the first day of the last menstrual period. Miscarriage happens in as many as one in three pregnancies, although the risk gradually decreases as pregnancy progresses. By 20 weeks, it occurs in fewer than one in 100 pregnancies.

What causes miscarriage?

Usually, there is no obvious or single cause for miscarriage. Some factors raise risk, such as:

• Pregnancy at older ages. Chromosome abnormalities are a common cause of pregnancy loss. As people age, this risk rises.
• Autoimmune disorders. While many pregnant people with autoimmune disorders like lupus or Sjogren’s syndrome have successful pregnancies, their risk for pregnancy loss is higher.
• Certain illnesses. Diabetes or thyroid disease, if poorly controlled, can raise risk.
• Certain conditions in the uterus. Uterine fibroids, polyps, or malformations may contribute to miscarriage.
• Previous miscarriages. Having a miscarriage slightly increases risk for miscarriage in the next pregnancy. For instance, if a pregnant person’s risk of miscarriage is one in 10, it may increase to 1.5 in 10 after their first miscarriage, and four in 10 after having three miscarriages.
• Certain medicines. A developing pregnancy may be harmed by certain medicines. It’s safest to plan pregnancy and receive pre-pregnancy counseling if you have a chronic illness or condition.

How is miscarriage diagnosed?

Before ultrasounds in early pregnancy became widely available, many miscarriages were diagnosed based on symptoms like bleeding and cramping. Now, people may be diagnosed with a miscarriage or early pregnancy loss on a routine ultrasound before they notice any symptoms.

How is miscarriage treated?

Being able to choose the next step in treatment may help emotionally. When there are no complications and the miscarriage occurs during the first trimester (up to 13 weeks of pregnancy), the options are:

Take no action. Passing blood and pregnancy tissue often occurs at home naturally, without need for medications or a procedure. Within a week, 25% to 50% will pass pregnancy tissue; more than 80% of those who experience bleeding as a sign of miscarriage will pass the pregnancy tissue within two weeks.

What to know: This can be a safe option for some people, but not all. For example, heavy bleeding would not be safe for a person who has anemia (lower than normal red blood cell counts).

Take medication. The most effective option uses two medicines: mifepristone is taken first, followed by misoprostol. Using only misoprostol is a less effective option. The two-step combination is 90% successful in helping the body pass pregnancy tissue; taking misoprostol alone is 70% to 80% successful in doing so.

What to know: Bleeding and cramping typically start a few hours after taking misoprostol. If bleeding does not start, or there is pregnancy tissue still left in the uterus, a surgical procedure may be necessary: this happens in about one in 10 people using both medicines and one in four people who use only misoprostol.

Use a procedure. During dilation and curettage (D&C), the cervix is dilated (widened) so that instruments can be inserted into the uterus to remove the pregnancy tissue. This procedure is nearly 99% successful.

What to know: If someone is having life-threatening bleeding or has signs of infection, this is the safest option. This procedure is typically done in an operating room or surgery center. In some instances, it is offered in a doctor’s office.

If you have a miscarriage during the second trimester of pregnancy (after 13 weeks), discuss the safest and best plan with your doctor. Generally, second trimester miscarriages will require a procedure and cannot be managed at home.

Red flags: When to ask for help during a miscarriage

During the first 13 weeks of pregnancy: Contact your health care provider or go to the emergency department immediately if you experience

• heavy bleeding combined with dizziness, lightheadedness, or feeling faint
• fever above 100.4° F
• severe abdominal pain not relieved by over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Please note: ibuprofen is not recommended during pregnancy, but is safe to take if a miscarriage has been diagnosed.

After 13 weeks of pregnancy: Contact your health care provider or go to the emergency department immediately if you experience

• any symptoms listed above
• leakage of fluid (possibly your water may have broken)
• severe abdominal or back pain (similar to contractions).

How is care for miscarriages changing?

Unfortunately, political interference has had significant impact on safe, effective miscarriage care:

• Some states have banned a procedure used to treat second trimester miscarriage. Called dilation and evacuation (D&E), this removes pregnancy tissue through the cervix without making any incisions. A D&E can be lifesaving in instances when heavy bleeding or infection is complicating a miscarriage.
• Federal and state lawsuits, or laws banning or seeking to ban mifepristone for abortion care, directly limit access to a safe, effective drug approved for miscarriage care. This could affect miscarriage care nationwide.
• Many laws and lawsuits that interfere with miscarriage care offer an exception to save the life of a pregnant patient. However, miscarriage complications may develop unexpectedly and worsen quickly, making it hard to ensure that people will receive prompt care in life-threatening situations.
• States that ban or restrict abortion are less likely to have doctors trained to perform a full range of miscarriage care procedures. What’s more, clinicians in training, such as resident physicians and medical students, may never learn how to perform a potentially lifesaving procedure.

Ultimately, legislation or court rulings that ban or restrict abortion care will decrease the ability of doctors and nurses to provide the highest quality miscarriage care. We can help by asking our lawmakers not to pass laws that prevent people from being able to get reproductive health care, such as restricting medications and procedures for abortion and miscarriage care.

About the Authors

Sara Neill, MD, MPH, Contributor

Dr. Sara Neill is a physician-researcher in the department of obstetrics & gynecology at Beth Israel Deaconess Medical Center and Harvard Medical School. She completed a fellowship in complex family planning at Brigham and Women's Hospital, and … See Full Bio View all posts by Sara Neill, MD, MPH

Scott Shainker, DO, MS, Contributor

Scott Shainker, D.O, M.S., is a maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center (BIDMC). He is also a member of the faculty in the Department of Obstetrics, … See Full Bio View all posts by Scott Shainker, DO, MS