Table 14.2. Diagnosis and treatment of recurrent abortion

Table 14-2. Diagnosis and treatment of recurrent abortion.
Cause	Diagnosis	Treatment
Genetic error	Obtain a 3-generation pedigree and karyotype of both parents and any previously aborted material.	Artificial insemination by donor, embryo transfer, preimplantation diagnosis, or prenatal testing on subsequent conceptions.
Anatomic abnormalities of reproductive tract	Perform hysterosalpingogram or hysteroscopy.	Uterine operation: Jones, Tompkins, Strassman procedure, myomectomy. Cervical cerclage (abdominal or vaginal), reconstruction of cervical isthmus.
Hormonal abnormalities	Perform laboratory studies for T₄ and TSH, serum progesterone or endometrial biopsy during luteal phase, and consider glucose tolerance test.	Thyroid replacement, progesterone or clomiphene citrate, diabetic diet and/or insulin, as indicated.
Infection	Obtain cervical cultures for Chlamydia and gonorrhea, and consider cultures for Mycoplasma and Ureaplasma.	Approriate antibiotics.
Systemic disease	Evaluate blood pressure and kidney function, check for lupus anticoagulant and anticardiolipin antibody.	Low-dose aspirin, heparin, and/or prednisone, as indicated.
Exogenous agents	Patient history and/or drug screen.	Discourage smoking, alcohol, and recreational drug use.
Immunologic factors	Testing not readily available.	Treatment under investigation.