Question

In a case of recurrent spontaneous abortion, which of the following investigations is unwanted?

• A. Hysteroscopy
• B. Testing for antiphospholipid antibodies
• C. Testing for TORCH infections
• D. Thyroid function tests

Hint:

Hysteroscopy, antiphospholipid antibody testing, and thyroid function tests are all part of the standard recurrent pregnancy loss workup; TORCH screening is not.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
Recurrent spontaneous abortion, usually defined as two or more consecutive pregnancy losses, has a standard workup aimed at finding a treatable cause. We need to spot the test on this list that current guidelines do not recommend.

Step 2: Key Concept:
The accepted workup for recurrent pregnancy loss looks for four broad causes: an abnormal uterine cavity, antiphospholipid antibody syndrome, endocrine problems such as thyroid disease, and parental chromosomal abnormalities. TORCH infections (toxoplasma, other agents, rubella, cytomegalovirus, herpes) are a cause of a single sporadic loss or congenital infection in an ongoing pregnancy, but they are not established as a cause of recurrent pregnancy loss, so routine TORCH testing is not recommended in this setting by current obstetric guidelines.

Step 3: Detailed Explanation:
Hysteroscopy directly looks inside the uterine cavity for a septum, adhesions, or submucous fibroids, all of which are established, correctable causes of recurrent loss, so this is a genuinely useful test and option (1) is correctly part of the workup.
Testing for antiphospholipid antibodies, including lupus anticoagulant and anticardiolipin antibodies, is a core part of the recurrent pregnancy loss workup, since antiphospholipid antibody syndrome is one of the most important treatable causes, so option (2) is correctly part of the workup.
Thyroid function tests are recommended because uncorrected hypothyroidism is linked to pregnancy loss, and this is an easily treatable condition, so option (4) is correctly part of the workup.
Testing for TORCH infections, by contrast, has repeatedly been shown to have low yield in recurrent pregnancy loss, because these infections typically cause a single loss or fetal anomaly rather than a repeating pattern, and current guidelines from bodies such as ACOG and ASRM specifically advise against routine TORCH screening in this setting. This makes TORCH testing the one unwanted investigation here.

Step 4: Final Answer:
Of the four listed tests, TORCH screening is the one that current guidelines do not recommend for recurrent pregnancy loss.
Hence, the correct answer is option (3). Note: the original 2002 answer key for this question marked thyroid function tests (option 4) as the unwanted test. Current obstetric practice recommends thyroid function testing as a standard, useful part of the recurrent pregnancy loss workup, while TORCH screening is the test that is now considered low yield and not routinely recommended, so this answer has been updated to option (3) to match current guidelines.