Bad Obstetric History

Prepared and reviewed by the PrepElephant Academic Review Team

First published 15 Oct 2026 · Spot an error?

Reference basis: Williams Obstetrics; ESHRE Guideline on Recurrent Pregnancy Loss

On this page

Direct answer
What you must remember
A targeted workup before the next pregnancy
Where the exam tries to catch you
Frequently asked questions
Related topics

Direct answer

Bad obstetric history is a record of adverse pregnancy outcomes, such as recurrent miscarriage, stillbirth, early neonatal death or preterm delivery. Its clinical value lies in finding a treatable cause, such as antiphospholipid syndrome, a septate uterus, a parental chromosomal translocation or an endocrine disorder, before the next pregnancy. Many cases remain unexplained, but a structured workup still guides targeted care.

What you must remember

Recurrent miscarriage: commonly defined as two or more consecutive losses, as in ESHRE guidance, though some guidelines use three, so local protocols should be followed.
Commonest early cause: fetal chromosomal abnormality, which accounts for most first-trimester losses.
Antiphospholipid syndrome: lupus anticoagulant, anticardiolipin and anti-beta-2-glycoprotein I antibodies, a treatable cause managed with low-dose aspirin and heparin.
Uterine causes: septate uterus, the commonest congenital uterine anomaly linked to loss, plus cervical incompetence and intrauterine adhesions.
Endocrine and metabolic causes: uncontrolled diabetes, thyroid disease, prolactin excess and polycystic ovary syndrome.
Parental karyotype: a balanced translocation in either partner, detected by karyotyping both partners.
Unexplained losses: a large share of cases have no identified cause, and counselling should say so honestly.

A targeted workup before the next pregnancy

A woman with two or more losses needs an evaluation that looks for treatable causes rather than a generic battery of tests. The steps below follow a sensible order.

Take a full history: record the number, gestation and timing of each loss, and note any stillbirth, preterm birth or neonatal death.
Karyotype the couple: send karyotypes of both partners, since a balanced translocation can cause recurrent losses.
Screen for antiphospholipid syndrome: test lupus anticoagulant, anticardiolipin and anti-beta-2-glycoprotein I antibodies, repeating any positive result after about 12 weeks.
Image the uterus: use three-dimensional ultrasound or hysteroscopy to look for a septum, fibroid or intrauterine adhesions, and treat a septum surgically where indicated.
Check endocrine and metabolic status: assess thyroid function, glycaemic control and prolactin, and optimise any abnormality before conception.
Plan the next pregnancy: consider low-dose aspirin, heparin where indicated, progesterone for a previous spontaneous preterm birth and cerclage for cervical incompetence, with early scans to monitor growth.

Where the exam tries to catch you

The examiner looks for systematic thinking and avoidance of the reflex diagnosis.

Trap: Labelling every loss as unexplained without testing. Correct: Antiphospholipid syndrome and anatomical causes are treatable, so testing comes before accepting an unexplained diagnosis.
Trap: Starting heparin in every woman with recurrent loss. Correct: Heparin with aspirin is targeted to confirmed antiphospholipid syndrome or thrombophilia, not given empirically to all.
Trap: Confusing a bicornuate uterus with a septate uterus. Correct: A septate uterus has a normal external fundal contour with an internal septum, whereas a bicornuate uterus shows an external indentation, and it is the septum that is usually resected.

Frequently asked questions

How is recurrent pregnancy loss defined?

Recurrent pregnancy loss is usually defined as two or more consecutive pregnancy losses, though some guidelines use three. Investigation is generally offered after the second loss, and local guidance should be followed for the threshold.

Which antibodies are tested in suspected antiphospholipid syndrome?

Lupus anticoagulant, anticardiolipin antibodies and anti-beta-2-glycoprotein I antibodies are tested in suspected antiphospholipid syndrome. A positive result is repeated after about 12 weeks to confirm that it persists.

What is the most common cause of first-trimester miscarriage?

Fetal chromosomal abnormality is the most common cause of first-trimester miscarriage. Parental karyotyping is mainly useful when losses recur, since it can detect a balanced translocation.

Which uterine anomaly linked to recurrent miscarriage can be treated surgically?

A septate uterus is the commonest uterine anomaly linked to recurrent miscarriage, and it can be treated by hysteroscopic septum resection. It is diagnosed by three-dimensional ultrasound or hysteroscopy, and the external fundal contour helps separate it from a bicornuate uterus.