A recent review of the literature on thrombophilia and adverse pregnancy outcome (APO) reveals contradictory findings. We have limited our review of literature mostly to the most recent decade. On the basis of our review, screening for thrombophilias with a history of APO (preeclampsia, abruptio placenta, intrauterine growth restriction, and fetal loss) is not clear. There are retrospective and prospective studies that recommend testing for genetic and acquired markers of thrombophilia for those with the enumerated APO. The rationale for such recommendation is to use heparin prophylaxis in subsequent pregnancies. However, this recommendation is not based on randomized trials. Hence, a randomized double-blinded controlled trial is urgently needed to evaluate the benefit of heparin during pregnancy in women with a history of APO in association with thrombophilia.