A 26-year-old G3P0030 has had three consecutive spontaneous abortions in the first trimester.
As part of an evaluation for this problem, which of the following tests is most appropriate in the evaluation of this patient?a. Hysterosalpingogram
A major cause of spontaneous abortions in the first trimester is chromosomal abnormalities. Parental chromosome anomalies account for 2% to 4% of recurrent losses; therefore, karyotype evaluation of the parents is an important part of the evaluation. The causes of losses in the second trimester are more likely to be uterine or environmental in origin. Patients should also be screened for thyroid function, diabetes mellitus, and collagen vascular disorders. There is also a correlation between patients with a positive lupus anticoagulant and recurrent miscarriages. For recurrent second-trimester losses, a hysterosalpingogram should be ordered to rule out uterine structural abnormalities, such as bicornuate uterus, septate uterus, or unicornuate uterus. Endometrial biopsy is performed to rule out an insufficiency of the luteal phase or evidence of chronic endometritis. A postcoital test may be useful during an infertility evaluation for couples who cannot conceive, but does not address postconception losses. Measuring the cervical length by ultrasonography is helpful in the management of patients with recurrent second-trimester losses caused by cervical incompetence.