Final answer:
The woman should seek further evaluation from a maternal-fetal medicine specialist or a reproductive endocrinologist to identify causes of recurrent pregnancy loss.
Step-by-step explanation:
A 29-year-old gravida 3, para 0 woman has experienced two spontaneous losses at 19 and 18 weeks, characterized by the painless passing of the amniotic sac in the evening. The next step for her care would be to consult with a specialist in maternal-fetal medicine or reproductive endocrinology to assess for potential causes of recurrent pregnancy loss.
This evaluation may include a range of diagnostic tests such as karyotyping for both parents, assessment of uterine anatomy via ultrasound or MRI, and evaluations for clotting disorders or immunological issues. The findings will direct further treatment, which may involve surgical correction of uterine abnormalities.
Anticoagulation therapy, or, in some cases, the use of a cervical cerclage, which is a procedure that can help prevent premature dilation and effacement of the cervix in certain cases of recurrent mid-trimester losses.