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Reproductive History

Topics

    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.

    Questions to ask:

  • 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:
      • Start with a thorough history including pregnancy history as well as medical history and physical.
      • Evaluate for parent karyotype abnormalities.
      • Assess for presence of uterine anomalies (sonohysterogram).
      • Consider assessing for antiphospholipid syndrome.
      • Assess thyroid function.
      • Assess for diabetes, hyperprolactinemia, thrombophilia if indicated based on history and physical.
  • History of ectopic pregnancy

    • Discuss recurrence risk, symptoms of ectopic pregnancy, and importance of early ultrasound to confirm location of pregnancy.
  • 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.
  • History of second-trimester pregnancy loss

    • Assess for risk factors for cervical insufficiency.
    • Counsel regarding possible interventions such as cerclage if indicated.
  • History of cervical surgery (LEEP/Cone Biopsy)

    • Discuss possible increased risk of preterm delivery.
    • Counsel regarding need to assess cervical length during pregnancy.
  • 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.
  • 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.
  • 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).
  • 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).
  • 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).
  • 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.
  • 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.
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