Thrombophilias have been implicated in complications related to ischemic 
placental disease including recurrent pregnancy loss, intrauterine fetal demise, 
preeclampsia, fetal growth restriction, placental abruption, and preterm 
delivery. Maternal screening and treatment may lower the recurrence of these 
outcomes. Our objective was to estimate if antenatal screening for 
thrombophilias with the intention to offer treatment among women with a prior 
adverse pregnancy outcome (APO) is preferable to no screening. A 
decision-analytical model was constructed for pregnant women with prior APO, 
comparing screening for thrombophilia with intention to treat with no screening. 
Values obtained from previously published studies include probability of 
positive test: 0.3 (0.1 to 0.6); good outcome with treatment: 0.9 (0.3 to 0.99); 
no thrombophilia, good outcome: 0.75 (0.5 to 0.9); test negative, thrombophilia 
positive: 0.05 (0.01 to 0.1); test negative, thrombophilia positive, good 
outcome: 0.75 (0.5 to 0.9); thrombophilia/test negative, good outcome: 0.98 (0.5 
to 0.99). Sensitivity analyses were run over a wide range of assumptions. 
Thrombophilia screening with intention to treat in women with prior APO 
associated with ischemic placental disease is the strategy of choice compared 
with no testing over a wide range of assumptions. Sensitivity analyses support 
this to be robust. Women with poor pregnancy history related to placental 
ischemic disease may benefit from thrombophilia screening and treatment in a 
subsequent pregnancy.