These antibodies cause placental thrombosis and have emerged as well-established risks for second and third trimester pregnancy loss.25 Work-up of thrombophilia is, therefore, recommended in women with a pregnancy loss after 20 weeks' gestation.
In patients who have had a pregnancy loss before 20 weeks, there is insufficient evidence to recommend for or against such a work-up after the loss.
For information about the SORT evidence rating system, see page 1262 or = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
For more severe anomalies (e.g., complete septate uterus), surgical repair may be the only realistic option for a woman to carry her pregnancy to viability.
Hysteroscopic metroplasty for septate uterus is associated with favorable pregnancy outcomes.220 A decision regarding surgical procedures should be made in consultation with an obstetrician.
A thorough history and physical examination should include inquiries about previous pregnancy loss.
Laboratory tests may identify treatable etiologies. Although there is limited evidence that specific interventions improve outcomes, management of contributing maternal factors (e.g., smoking, substance abuse) is essential.
Preventive measures, including vaccination and folic acid supplementation, are recommended regardless of risk.