The association of antiphospholipid antibodies (aPLs) with a poor obstetric history and/or thrombotic event is typical of the antiphospholipid syndrome (APS). We report four cases of poor pregnancy outcome where a diagnostic label of APS resulted in delayed recognition of other causes of pregnancy loss. Pregnancy outcomes in these women were not improved with antithrombotic therapy alone. Successful outcomes were achieved only when other causes of recurrent miscarriage were considered and treated.