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

Recurrent pregnancy loss has a focused list of causes worth testing for: uterine cavity problems, antiphospholipid antibody syndrome, thyroid disease, and chromosomal issues. Let's run through each test against that list.

1. Hysteroscopy: this looks directly inside the uterus for a septum, scar tissue, or fibroids pressing into the cavity, all known and fixable causes of repeated loss. It stays on the recommended list.
2. Testing for antiphospholipid antibodies: antiphospholipid syndrome is one of the best documented, treatable causes of recurrent loss, so checking for lupus anticoagulant and anticardiolipin antibodies is a core part of the workup.
3. Testing for TORCH infections: these infections are known to cause a single sporadic loss or birth defects in an ongoing pregnancy, but they have not been shown to cause a repeating pattern of loss. Because of this low yield, current guidelines advise against routine TORCH testing in recurrent pregnancy loss.
4. Thyroid function tests: untreated hypothyroidism is linked to pregnancy loss and is simple to fix once found, so checking thyroid function is a standard, useful part of the workup.

Three of these four tests, hysteroscopy, antiphospholipid antibody testing, and thyroid function testing, all target causes with real evidence behind them. TORCH testing stands apart because it targets a cause of single losses, not recurrent ones, and current guidelines do not recommend it here.

Let's summarize:

• The recurrent pregnancy loss workup targets uterine, antiphospholipid, endocrine, and genetic causes.
• TORCH infections explain isolated losses or fetal anomalies, not a repeating pattern.
• Modern guidelines list TORCH screening as unhelpful here, not thyroid testing.

So the unwanted investigation is TORCH testing, option 3. Note that the original answer key for this 2002 question named thyroid function tests as the unwanted test, but current obstetric guidelines have moved thyroid testing into the recommended workup and instead flag routine TORCH screening as the low-yield test, which is why this answer has been updated.