Evaluation of recurrent miscarriage

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Useful for assessing the morphology of both ovaries.​

Assessing sperm DNA fragmentation in couples with recurrent pregnancy loss can be considered for explanatory purpose.[1]European Society of Human Reproduction and Embryology (ESHRE). Guideline on the management of recurrent pregnancy loss. Feb 2023 [internet publication]. https://www.eshre.eu/Guidelines-and-Legal

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

Most commonly trisomy, polyploidy, or monosomy.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Useful for assessing the morphology of both ovaries.​

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

Commonly Robertsonian translocation. Genetic counseling indicated.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Is useful for assessing the morphology of both ovaries.​

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

The test for lupus anticoagulants is done by either APTT, KCT, or DRVVT, or sometimes 2 of these tests. It is unlikely all 3 tests are used in all laboratories.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Is useful for assessing the morphology of both ovaries.​

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

In a nonpregnant state, measurement of the cervical length has not been proven useful for predicting outcome in a subsequent pregnancy. A cervical length, measured by transvaginal ultrasound scan, of >25 mm in second trimester of pregnancy is associated with a reduced risk of preterm delivery.[97]Crane JM, Hutchens D. Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review. Ultrasound Obstet Gynecol. 2008 May;31(5):579-87. http://www.ncbi.nlm.nih.gov/pubmed/18412093?tool=bestpractice.com

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

Diagnostic in presence of typical symptoms.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Is useful for assessing the morphology of both ovaries.​

Confirms diagnosis of diabetes mellitus.

May be used in addition to confirm diagnosis of diabetes mellitus.

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

Rarely, TSH is low in hypothyroidism or high in hyperthyroidism when they are central in origin.

Often normal in subclinical hypothyroidism.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Is useful for assessing the morphology of both ovaries.​

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation. If tests are abnormal, they need to be repeated to confirm the diagnosis.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Is useful for assessing the morphology of both ovaries.​

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

May be performed to confirm structural abnormality.

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

A diagnosis commonly only involves microscopy for clue cells, clinical symptoms, and an increased vaginal pH. Culture is not always done as is not needed for diagnosis.[Figure caption and citation for the preceding image starts]: Photomicrograph of clue cells: vaginal epithelial cells with a stippled appearance and obscured borders, due to bacteria adhering to their surfaceAdapted from the Public Health Image Library, CDC [Citation ends].

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

Women with PCOS are at risk for abnormal glucose.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

To exclude premature menopause or hypogonadotropic hypogonadism.

To exclude premature menopause or hypogonadotropic hypogonadism.

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.

The exact tests may vary between laboratories but the screen generally includes testing for anticardiolipin antibodies, lupus anticoagulants, and anti-beta-2 glycoprotein-1 antibodies.

Excludes obvious congenital uterine malformations.[28]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline no. 17. Jun 2023 [internet publication]. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17 http://www.ncbi.nlm.nih.gov/pubmed/37334488?tool=bestpractice.com ​ Is useful for assessing the morphology of both ovaries.​

This screen involves a combination of tests, which may vary slightly between different laboratories. It generally includes protein S and protein C assay, activated protein C resistance assay, antithrombin III activity, and tests for factor V Leiden gene mutation and prothrombin G20210A gene mutation.

UK and US guidelines recommend against heritable thrombophilia screening in women with recurrent miscarriage or a history of fetal loss, respectively.[42]Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: a British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18239 http://www.ncbi.nlm.nih.gov/pubmed/35645034?tool=bestpractice.com [43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Targeted assessment for inherited thrombophilia may be considered in specific clinical circumstances (e.g., personal history of VTE).[43]American College of Obstetricians and Gynecologists. Practice bulletin no. 197: inherited thrombophilias in pregnancy. Jul 2018 [internet publication]. https://journals.lww.com/greenjournal/abstract/2018/07000/acog_practice_bulletin_no__197__inherited.55.aspx http://www.ncbi.nlm.nih.gov/pubmed/29939939?tool=bestpractice.com Consult local guidance.