Question 31: Which of the following are absolute contraindications of Combined Oral Contraceptive (COCs)?
1. Arterial or venous thrombosis history
2. Severe hypertension
3. Gestational trophoblastic neoplasia
4. Diabetes with vascular complications
- A. 1, 2 and 4 (Correct Answer)
- B. 1, 3 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3
Explanation: ***1, 2 and 4***
- A history of **arterial or venous thrombosis** (e.g., deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction) is an absolute contraindication due to the increased risk of clotting associated with estrogen in COCs.
- **Severe hypertension** (systolic ≥160 mmHg or diastolic ≥100 mmHg) is a contraindication because COCs can exacerbate blood pressure control and increase the risk of cardiovascular events.
- **Diabetes with vascular complications** (e.g., nephropathy, retinopathy, neuropathy, macrovascular disease) indicates advanced microvascular or macrovascular disease, making COCs unsafe due to increased cardiovascular risk.
*1, 3 and 4*
- While a history of **arterial or venous thrombosis** and **diabetes with vascular complications** are absolute contraindications, **gestational trophoblastic neoplasia** itself is generally not an absolute contraindication to COCs once the disease is in remission or resolved.
- The primary concern with gestational trophoblastic neoplasia is avoiding pregnancy during the monitoring period, for which COCs can be used, although other methods may be preferred.
*2, 3 and 4*
- **Severe hypertension** and **diabetes with vascular complications** are absolute contraindications, but **gestational trophoblastic neoplasia** is not.
- The use of COCs in gestational trophoblastic neoplasia is generally considered acceptable after successful treatment and during the follow-up period to prevent pregnancy.
*1, 2 and 3*
- **Arterial or venous thrombosis history** and **severe hypertension** are absolute contraindications.
- However, **gestational trophoblastic neoplasia** is not an absolute contraindication for COCs once the patient has been successfully treated and is being monitored.
Question 32: After male sterilization, additional contraceptive protection is
- A. needed for 2 to 3 months (Correct Answer)
- B. not needed
- C. needed for 1 to 2 months
- D. needed for 1 month
Explanation: ***needed for 2 to 3 months***
- After **vasectomy**, residual **sperm** distal to the ligation site can remain in the ejaculatory ducts and vas deferens.
- It takes approximately **20 ejaculations** or **2 to 3 months** for these sperm to be cleared from the reproductive tract, requiring additional contraception until **azoospermia** is confirmed.
*not needed*
- This option is incorrect because the male reproductive tract is not immediately sterile after a vasectomy due to the presence of **pre-existing sperm**.
- Without additional contraception, there is a risk of **unintended pregnancy** until sterility is confirmed by follow-up testing.
*needed for 1 to 2 months*
- While closer, a duration of **1 to 2 months** may not be sufficient for all residual sperm to be cleared from the system.
- The standard recommendation often extends to **3 months** or a specific number of ejaculations to ensure complete sterility.
*needed for 1 month*
- This duration is generally too short to ensure the complete clearance of **viable sperm** from the ejaculatory ducts after a vasectomy.
- Relying on this period alone would carry a higher risk of **contraceptive failure**.