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History of recurrent pregnancy loss
- Recurrent pregnancy loss is the occurrence of 3 or more consecutive losses of a clinically recognized pregnancy prior to the 20th week of gestation.
- Try to identify underlying cause of losses:
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History of preterm birth
- Assess reason for preterm birth (spontaneous, medically indicated delivery, etc.).
- Discuss recurrence risk, assess for remediable causes.
- Counsel patient that she may be a candidate for progesterone therapy to reduce the risk of recurrent spontaneous preterm birth.
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History of second-trimester pregnancy loss
- Assess for risk factors for cervical insufficiency.
- Counsel regarding possible interventions such as cerclage if indicated.
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History of cervical surgery (LEEP/Cone Biopsy)
- Discuss possible increased risk of preterm delivery.
- Counsel regarding need to assess cervical length during pregnancy.
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Known uterine anomaly (fibroids, septum or other congenital anomaly)
- Discuss risk of pregnancy loss and malpresentation.
- Consider sonohysterogram and assessment for renal abnormalities and referral to specialist for possible surgical intervention.
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History of cesarean delivery
- Counsel patient that a longer pregnancy interval (at least 12-18 months) after a cesarean delivery reduces the risk of scar rupture during pregnancy, especially if considering attempted vaginal delivery.
- Counsel regarding possible modes of delivery for next pregnancy so that patient is aware of options.
- Encourage patient to obtain operative report to confirm prior low-transverse cesarean section.
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History of placental abruption
- Counsel regarding recurrence risk.
- Address risk factors that can be modified before the next pregnancy (e.g. cocaine use, tobacco use).
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History of intrauterine fetal demise/stillbirth
- Evaluate the cause of the previous stillbirth if a work-up was not done at the time.
- Offer patient referral for counseling about possible increased risk of adverse pregnancy outcomes with future pregnancies.
- Address risk factors that can be modified before the next pregnancy (e.g., tobacco cessation or weight loss).
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History of pregnancy induced hypertensive disorders
- Discuss recurrence risk.
- Assess for modifiable risk factors for preeclampsia such as hypertension, renal disease, obesity, insulin resistance, and diabetes and encourage management of the condition(s).
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History of gestational diabetes
- Consider testing for preexisting diabetes or pre-diabetes in asymptomatic women.
- Counsel overweight and obese patients to work toward a normal BMI prior to pregnancy.
- Refer for nutrition counseling and weight management programs as needed.
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History of thrombosis
- Take a thorough history of prior thrombosis.
- Refer to hematologist and/or maternal fetal medicine specialist to discuss risk of clotting in pregnancy.
The goal of taking a thorough reproductive history is to identify factors that may increase risk during a future pregnancy and actions that may mitigate these risks.