From the Guidelines
A bad obstetric history (BOH) is defined as a woman's past pregnancy experiences that include high-risk features such as recurrent first trimester or late miscarriages, gestational diabetes, hypertension, pre-eclampsia, placental insufficiency, abruption, intrauterine growth restriction (IUGR), stillbirth, preterm birth, or history of thrombophilia, particularly anti-phospholipid antibodies. This definition is based on the most recent evidence from a 2021 study published in the American Journal of Hematology 1. According to this study, a careful obstetric history should identify these high-risk features to inform a risk-adapted therapeutic strategy.
Key components of a bad obstetric history include:
- Recurrent first trimester or late miscarriages
- Gestational diabetes
- Hypertension
- Pre-eclampsia
- Placental insufficiency
- Abruption
- Intrauterine growth restriction (IUGR)
- Stillbirth
- Preterm birth
- History of thrombophilia, particularly anti-phospholipid antibodies
The significance of identifying BOH is that it helps healthcare providers assess risks for future pregnancies and implement appropriate preventive measures, such as stringent glycemic control, optimal management of hypertension, and prophylactic interventions like low-dose aspirin or heparin therapy, as recommended in the study 1. Women with BOH require comprehensive preconception counseling and close monitoring during pregnancy to improve outcomes in subsequent pregnancies.
From the Research
Definition of Bad Obstetric History (BOH)
- Bad obstetric history (BOH) refers to a history of adverse outcomes in previous pregnancies, which can include unexplained stillbirth, neonatal death, three or more consecutive abortions, and other complications 2.
- BOH is a significant concern in clinical practice, as it can increase the risk of perinatal mortality and other adverse outcomes in subsequent pregnancies 2, 3.
- The definition of BOH may vary, but it generally includes a history of previous pregnancy losses, stillbirths, or other complications that can affect the outcome of future pregnancies 2, 4.
Risk Factors Associated with BOH
- Studies have identified several risk factors associated with BOH, including hypertension, antiphospholipid antibody (APLA) syndrome, cervical incompetence, and preterm deliveries 2.
- Other risk factors may include malpresentation, gestational diabetes, and previous Caesarean section 2, 4.
- The presence of these risk factors can increase the likelihood of adverse outcomes in subsequent pregnancies, making it essential to identify and manage them appropriately 2, 4.
Importance of BOH in Clinical Practice
- BOH is an essential consideration in clinical practice, as it can help identify women at high risk of adverse outcomes in subsequent pregnancies 2, 3.
- By assessing a woman's BOH, healthcare providers can provide targeted care and interventions to reduce the risk of complications and improve outcomes 2, 5.
- BOH can also inform decisions about pregnancy management, including the need for closer monitoring, preventive therapies, and other interventions 2, 5.