Reproductive Ethics

Reproductive Ethics Indian Medical PG Question 1: Consider the following statements with regard to selection of Accredited Social Health Activist (ASHA) under NRHM : 1. ASHA must be a woman preferably of age 18 to 25 years. 2. ASHA should be married. 3. ASHA must be a resident of the village. 4. ASHA may be a married, widowed or divorced woman. Which of the statements given above are correct with regard to process of selection of ASHA?

• A. 1 and 2 only
• B. 2 and 3 only
• C. 3 and 4 only (Correct Answer)
• D. 1, 2, 3 and 4

Reproductive Ethics Explanation: ***3 and 4 only*** - An ASHA worker must be a **resident of the village** she serves to ensure local knowledge and trust, making statement 3 correct. - The criteria specify that an ASHA may be **married, widowed, or divorced**, making statement 4 correct and reflecting inclusivity in selection. *1 and 2 only* - While ASHA candidates are typically women, the age criteria are usually **25 to 45 years**, not 18-25, making statement 1 incorrect. - Being married is not a mandatory criterion; **single, widowed, or divorced women** are also eligible, making statement 2 incorrect. *2 and 3 only* - As explained earlier, being married (statement 2) is **not a mandatory requirement**, as eligibility extends to widowed or divorced women. - While being a resident of the village (statement 3) is correct, statement 2 is incorrect, so this option is not entirely correct. *1, 2, 3 and 4* - This option includes statements 1 and 2, which are **incorrect**. Statement 1 refers to an incorrect age range, and statement 2 incorrectly states that ASHA must be married.

Reproductive Ethics Indian Medical PG Question 2: For medical termination of pregnancy, consent is given by-

• A. Guardian
• B. Husband of the lady
• C. Concerned lady (Correct Answer)
• D. Both husband and wife

Reproductive Ethics Explanation: ***Concerned lady*** - For a medical termination of pregnancy, **informed consent** must be given directly by the woman seeking the procedure. - This upholds her **autonomy** and right to make decisions regarding her own body and healthcare. *Guardian* - A guardian's consent is typically required only if the woman is a **minor** or is otherwise **legally incapacitated** and unable to provide consent herself. - In most cases, an adult woman is presumed to be competent to consent for her own medical procedures. *Husband of the lady* - The husband's consent is **not legally required** for a medical termination of pregnancy, as it is the woman's fundamental right to decide. - Requiring a husband's consent would infringe upon the woman's **bodily autonomy** and reproductive rights. *Both husband and wife* - While open communication with a spouse is often encouraged, **joint consent** from both the husband and wife is not a legal prerequisite for a medical termination of pregnancy. - The ultimate decision-making authority rests solely with the **pregnant woman**.

Reproductive Ethics Indian Medical PG Question 3: The MTP Act was introduced in:

• A. 1961
• B. 1971 (Correct Answer)
• C. 1975
• D. 1974

Reproductive Ethics Explanation: ***1971*** - The **Medical Termination of Pregnancy (MTP) Act** was enacted in **1971** in India. - This legislation was a significant step towards legalizing and regulating abortion services in the country under specific conditions. - The Act came into force on **April 1, 1972**. *1961* - This year is not associated with the introduction of the MTP Act. - Other significant legislative changes may have occurred, but not related to medical termination of pregnancy. *1975* - The year **1975** is incorrect as the MTP Act was already in effect from 1971. - This year marked a different period in India's legal and social history. *1974* - The year **1974** is also incorrect; the MTP Act was passed and came into force before this date. - No major amendments to the MTP Act were introduced in 1974.

Reproductive Ethics Indian Medical PG Question 4: A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?

• A. One doctor is involved
• B. MTP done in 2nd trimester only when mother's life is in danger
• C. MTP can be carried out up to 24 weeks (Correct Answer)
• D. MTP cannot be more than 20 weeks

Reproductive Ethics Explanation: ***MTP can be carried out up to 24 weeks*** - The **Medical Termination of Pregnancy (Amendment) Act, 2021**, allows termination of pregnancy up to **24 weeks** for certain vulnerable groups, including survivors of sexual assault and minors. - As a 14-year-old victim of sexual assault, she falls under the category which permits MTP up to 24 weeks. *One doctor is involved* - For pregnancies between 12 and 20 weeks, the opinion of **two registered medical practitioners** is required for MTP. - Beyond 20 weeks up to 24 weeks, as in this case, the opinion of **two registered medical practitioners** is also mandatory. *MTP done in 2nd trimester only when mother's life is in danger* - While danger to the mother's life is a valid reason for MTP, the **MTP Act 2021** has expanded the grounds for MTP in the second trimester (beyond 12 weeks) to include other categories like **sexual assault survivors** and **minors**, even if the mother's life is not immediately in danger. - The primary consideration here is the **vulnerability** of the pregnant person, not solely imminent danger to life. *MTP cannot be more than 20 weeks* - This statement is incorrect as per the **Medical Termination of Pregnancy (Amendment) Act, 2021**. - The Act raised the upper gestation limit from 20 to **24 weeks** for specific categories of women, including victims of sexual assault and minors, aligning with the current case.

Reproductive Ethics Indian Medical PG Question 5: What is the most appropriate intervention for a client expressing concerns about erectile dysfunction and its potential impact on his marriage?

• A. Suggest referral to a sex counselor or other appropriate professional. (Correct Answer)
• B. Encourage the client to discuss his feelings about erectile dysfunction.
• C. Provide information on sexual health resources.
• D. Encourage the client to bring his partner to counseling sessions.

Reproductive Ethics Explanation: ***Suggest referral to a sex counselor or other appropriate professional.*** - Referral to an **appropriate professional** (which may include physicians for medical evaluation and sex counselors for psychological aspects) is the most comprehensive approach for **erectile dysfunction (ED)**. - ED often has multiple etiologies—**organic** (cardiovascular disease, diabetes, medications, hormonal imbalances) and **psychological** (performance anxiety, relationship issues, depression)—requiring interdisciplinary assessment. - A **sex counselor** or therapist can address the psychological and relational dimensions, while medical professionals can evaluate and treat underlying physical causes. - This intervention provides **specialized, expert guidance** that addresses both the physiological and emotional aspects affecting the marriage. *Encourage the client to discuss his feelings about impotence.* - While exploring feelings is an important therapeutic intervention, it is **insufficient as a sole intervention** when the underlying cause of ED may be medical. - This approach does not address potential **organic causes** or provide the specialized strategies needed for comprehensive ED management. - Without professional evaluation, the client may continue to experience distress without appropriate medical or psychological treatment. *Provide information on sexual health resources.* - Offering resources is helpful as an **adjunct intervention**, but it's a **passive approach** that lacks personalized assessment and treatment. - The client may feel **overwhelmed** without professional guidance on which resources are relevant to his specific situation. - This does not ensure proper evaluation to differentiate between organic and psychogenic causes of ED. *Encourage the client to bring his partner to counseling sessions.* - While **couples therapy** can be beneficial, particularly for relationship factors contributing to ED, it may not be the **initial priority**. - The client may need **individual assessment** first to explore personal concerns, rule out medical causes, and reduce feelings of vulnerability before involving the partner. - Premature couple involvement might increase **performance anxiety** or resistance if the client is not ready to discuss this sensitive issue with his partner present.

Reproductive Ethics Indian Medical PG Question 6: Which of the following services are provided to pregnant women under the Integrated Child Development Scheme (ICDS)?

• A. Health check-up
• B. Nutrition and health education
• C. Immunization against tetanus
• D. Supplementary nutrition (Correct Answer)

Reproductive Ethics Explanation: ***Supplementary nutrition*** - **Supplementary nutrition** is the most direct and primary tangible service provided under ICDS specifically targeting pregnant women as beneficiaries. - Under ICDS, pregnant women receive **300 calories and 10-12 grams of protein** for at least 90 days during pregnancy to bridge the calorie and protein gap in their diets. - This is a core service directly provided at Anganwadi centers, ensuring better health outcomes for both mother and developing fetus. - Among all ICDS services for pregnant women, supplementary nutrition is the **most distinctive and substantial direct benefit** that pregnant women receive. *Health check-up* - While health check-ups are part of ICDS package services, they are primarily conducted by ANMs and medical officers from the health system. - Anganwadi Workers facilitate identification, weight monitoring, and referrals, but the comprehensive health examinations are delivered through convergence with the health department rather than as a direct standalone ICDS service. *Nutrition and health education* - Nutrition and health education is indeed provided under ICDS to pregnant women and mothers. - However, it is an **enabling/educational service** rather than a direct tangible provision like supplementary nutrition. - The question likely seeks the most characteristic direct service, which is supplementary nutrition. *Immunization against tetanus* - Immunization services including tetanus toxoid are part of the integrated ICDS-health system approach. - However, vaccines are administered by health workers (ANMs), not by Anganwadi Workers themselves. - ICDS role is primarily facilitative through awareness generation and referral linkages to health facilities.

Reproductive Ethics Indian Medical PG Question 7: Pregnancy is contraindicated in which of the following cardiac conditions?

• A. Mitral regurgitation
• B. Aortic stenosis
• C. Mitral stenosis
• D. Primary pulmonary hypertension (Correct Answer)

Reproductive Ethics Explanation: ***Primary pulmonary hypertension*** - Pregnancy is **contraindicated** in primary pulmonary hypertension due to the significant risk of **maternal mortality**, which can be as high as 30-50%. - The physiological changes of pregnancy, such as increased **cardiac output** and blood volume, exacerbate pulmonary vascular resistance and can lead to **right heart failure** and sudden death. *Mitral stenosis* - While mitral stenosis can cause complications in pregnancy, it is not an absolute contraindication for all cases, especially if it is **mild to moderate** and well-managed. - The main concern is the increased **blood volume** and heart rate during pregnancy, which can worsen pulmonary congestion, but careful monitoring can often mitigate risks. *Aortic stenosis* - Severe aortic stenosis can be problematic during pregnancy due to the heart's inability to increase **cardiac output** adequately in response to increased demand. - However, pregnancy is typically not absolutely contraindicated, and management often involves close monitoring and in some cases, **balloon valvuloplasty** before or during pregnancy. *Mitral regurgitation* - Mitral regurgitation is generally **well-tolerated** during pregnancy because the reduced systemic vascular resistance in pregnancy makes it easier for blood to flow forward into the aorta, actually reducing the regurgitant volume. - While severe cases require careful monitoring, it is generally **not a contraindication** to pregnancy.

Reproductive Ethics Indian Medical PG Question 8: Which one of the following is the best contraceptive for a newly married couple who wants to postpone pregnancy for one year?

• A. Safe period method
• B. Condom with spermicidal cream
• C. Intrauterine contraceptive device
• D. Combined oral contraceptives (Correct Answer)

Reproductive Ethics Explanation: ***Combined oral contraceptives*** - **Combined oral contraceptives (COCs)** offer highly effective, reversible contraception suitable for postponing pregnancy for a specific period like one year. - They provide consistent hormonal regulation, leading to **predictable menstrual cycles** and potential non-contraceptive benefits like reduced dysmenorrhea and acne. - **Easy to initiate and discontinue** without any procedure, which may be preferred by newly married couples. - Typical use effectiveness is around **91%**, with perfect use approaching 99%. *Safe period method* - The **safe period method (rhythm method or natural family planning)** relies on tracking the menstrual cycle to identify fertile days, which is generally considered less reliable for couples prioritizing pregnancy postponement. - Its effectiveness is highly dependent on a **regular menstrual cycle** and strict adherence, making its typical use failure rate higher (12-24%). *Condom with spermicidal cream* - While **condoms with spermicidal cream** offer protection against both pregnancy and sexually transmitted infections, their effectiveness is lower than hormonal methods for preventing pregnancy. - Their typical use **failure rate is around 18%**, which might not be ideal for a couple committed to postponing pregnancy for a full year. *Intrauterine contraceptive device* - An **intrauterine contraceptive device (IUD)** is a highly effective, long-acting reversible contraceptive with >99% effectiveness. - While medically appropriate for any duration including one year, it requires an **insertion procedure** which some newly married couples may prefer to avoid. - For couples seeking **non-invasive contraception** with easier initiation and the flexibility to discontinue without a procedure, COCs may be more acceptable despite slightly lower typical use effectiveness.

Reproductive Ethics Indian Medical PG Question 9: Identify the instrument shown below:

• A. Jardine decapitation hook
• B. Uterine sound (Correct Answer)
• C. Myoma screw
• D. Vulsellum

Reproductive Ethics Explanation: ***Uterine sound*** - This instrument, characterized by a **long, slender shaft** with a blunt, slightly curved or knobbed tip and a handle, is consistent with a uterine sound. - It is used in gynecology to **measure the depth and direction of the uterine cavity**. *Jardine decapitation hook* - A Jardine decapitation hook is a specific obstetrical instrument used for **fetal decapitation** in cases of obstructed labor with a dead fetus, and it has a distinct sharp, curved hook for this purpose. - Its appearance is very different from the smooth, blunt-tipped instrument shown. *Myoma screw* - A myoma screw is used in gynecological surgery for **grasping and extracting uterine fibroids** (myomas) from the uterus. - It typically has a **threaded, corkscrew-like tip** designed to penetrate and hold fibrous tissue, which is not visible here. *Vulsellum* - A vulsellum is a type of **forceps with sharp, hooked tips** used to grasp and hold tissues, particularly the cervix, during gynecological procedures. - The pictured instrument is a long, thin rod with a blunt end, not a grasping instrument with sharp hooks.

Reproductive Ethics Indian Medical PG Question 10: What is the instrument shown below used for?

• A. Dilate urethral strictures
• B. Measure uterus size in pregnancy
• C. Measure thickness of uterine wall
• D. Dilating the ostium uteri (Correct Answer)

Reproductive Ethics Explanation: ***Dilating the ostium uteri*** - The image depicts a set of **Hegar dilators**, which are instruments used to **dilate the cervical os (ostium uteri)**. - They come in graduated sizes and are inserted sequentially to gradually widen the cervical canal for procedures like D&C, IUD insertion, or hysteroscopy. *Dilate urethral strictures* - While dilators are used for urethral strictures, the instruments shown are specifically designed with a curvature and length optimized for the **cervical canal**, not the male or female urethra. - **Urethral stricture dilators** generally have a different shape, often longer and straighter or with a specific angle for the male urethra. *Measure uterus size in pregnancy* - Measuring uterus size in pregnancy is typically done by **fundal height measurement** with a tape measure or **ultrasound**, not with these solid dilators. - Hegar dilators are for dilating, not measuring length or size of the uterus during pregnancy. *Measure thickness of uterine wall* - The thickness of the uterine wall is measured using **imaging techniques** like **ultrasound** or MRI. - These dilators are solid instruments designed for mechanical dilation and cannot measure tissue thickness.

Reproductive Ethics Flashcard 1 of 5

Question: If beta-HCG values are less than 1500 IU/L, and there is decreasing trend in levels (between day 1 and day 3), it suggests _____

Answer: abortion

Reproductive Ethics Flashcard 2 of 5

Question: TENS is contraindicated in pregnancy as it can lead to _____

Answer: premature abortions

Reproductive Ethics Flashcard 3 of 5

Question: Checklist under DAKSHATA program for Safe childbirth includes the following: _____

Answer: :)

Reproductive Ethics Flashcard 4 of 5

Question: _____ is defined as the number of contraceptive failures per 100 woman-years of exposure (HWY).

Answer: Pearl index

Reproductive Ethics Flashcard 5 of 5

Question: 98fda84365eb4fc0826a85021d206697-ao-5

Answer: 5 Cleans of intranatal care

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