Which of the following are the absolute contraindications for the use of combined oral contraceptive pills ? 1. Severe hypertension 2. Pregnancy 3. Diabetes with retinopathy 4. Gall bladder disease Select the correct answer using the code given below :
A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?
Which one of the following is an indication for knife conisation? 1. Treatment of Nabothian follicle 2. Diagnosis and directed biopsy of cervix when punch biopsy is inadequate 3. Unsatisfactory colposcopy (transformation zone not fully visible) 4. Negative endocervical curettage Select the correct answer using the code given below:
Which of the following statements regarding female sterilization is correct? 1. It can be done 24 - 48 hours following delivery. 2. Ideal time for interval ligation is luteal phase preceding menstruation. 3. It can be combined with medical termination of pregnancy. 4. It is a preventive measure against serous ovarian cancer. Select the correct answer using the code given below:
The most popular technique of tubal ligation is :
If, on amniocentesis, the alpha fetoprotein is found to be elevated in the amniotic fluid (which correlates with elevated maternal serum levels), which of the following conditions is likely to be present?
UPSC-CMS 2023 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 61: Which of the following are the absolute contraindications for the use of combined oral contraceptive pills ? 1. Severe hypertension 2. Pregnancy 3. Diabetes with retinopathy 4. Gall bladder disease Select the correct answer using the code given below :
- A. 1, 2 and 3 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2 and 4
- D. 1, 3 and 4
Explanation: ***Correct: 1, 2 and 3*** - According to **WHO Medical Eligibility Criteria (MEC) Category 4**, the absolute contraindications for combined oral contraceptive pills include **severe hypertension** (systolic ≥160 mmHg or diastolic ≥100 mmHg, or with vascular disease), **pregnancy** (COCs are unnecessary and contraindicated), and **diabetes with vascular complications** including retinopathy, nephropathy, or neuropathy. - These conditions carry unacceptable health risks with COC use: severe hypertension increases risk of **stroke and myocardial infarction**, pregnancy makes contraception unnecessary, and diabetes with retinopathy risks **worsening microvascular complications** and thrombotic events. - **Reference**: WHO MEC Category 4 conditions represent absolute contraindications where the risks outweigh any benefits. *Incorrect: 2, 3 and 4* - This incorrectly includes **gallbladder disease** as an absolute contraindication while excluding severe hypertension. - Gallbladder disease (current or history) is classified as **WHO MEC Category 2-3** (relative contraindication requiring clinical judgment), not Category 4. - COCs may slightly increase cholesterol saturation in bile, but this does not constitute an absolute contraindication. *Incorrect: 1, 2 and 4* - This omits **diabetes with retinopathy**, which is a well-established absolute contraindication. - Diabetes with microvascular complications (retinopathy, nephropathy, neuropathy) or disease duration >20 years is **WHO MEC Category 3/4** due to increased cardiovascular and thrombotic risk with estrogen-containing contraceptives. - It also incorrectly includes gallbladder disease as an absolute contraindication. *Incorrect: 1, 3 and 4* - This excludes **pregnancy**, which is the most fundamental contraindication for any contraceptive method. - While COCs are not significantly teratogenic, their use in pregnancy is medically unnecessary and classified as WHO MEC Category 4. - This option also incorrectly includes gallbladder disease, which is only a relative contraindication requiring monitoring, not an absolute prohibition.
Question 62: A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?
- A. Combined oral contraceptives
- B. Diaphragm
- C. Nexplanon (Correct Answer)
- D. Chhaya
Explanation: ***Nexplanon*** - This **etonogestrel implant** offers highly effective, **long-acting reversible contraception (LARC)** for up to three years, making it an excellent choice for a young woman seeking a long-term option. - It has a failure rate of less than 0.1% and is **progestin-only**, avoiding estrogen-related risks. *Combined oral contraceptives* - While effective, these require **daily adherence**, which might not be ideal for someone specifically requesting *long-term* and *reversible* contraception without daily commitment. - They also carry a slightly higher risk of **venous thromboembolism (VTE)** compared to progestin-only methods. *Diaphragm* - This is a **barrier method** requiring proper insertion, removal, and use with spermicide for each act of intercourse, making it less convenient for *long-term reversible* contraception. - Its typical use failure rate is significantly higher (around 12%) compared to LARC methods. *Chhaya* - Chhaya, or Saheli, is a **non-steroidal oral contraceptive** taken twice a week for the first three months, then once a week. - While it is a contraceptive option, it still requires regular weekly adherence and is not considered a **long-acting reversible contraceptive (LARC)** like an implant or IUD.
Question 63: Which one of the following is an indication for knife conisation? 1. Treatment of Nabothian follicle 2. Diagnosis and directed biopsy of cervix when punch biopsy is inadequate 3. Unsatisfactory colposcopy (transformation zone not fully visible) 4. Negative endocervical curettage Select the correct answer using the code given below:
- A. 1 and 4
- B. 1, 2 and 3
- C. 1 and 3 only
- D. 2 and 3 only (Correct Answer)
Explanation: ***2 and 3 only*** - **Knife conisation** (cold-knife conization) is a surgical procedure that removes a **cone-shaped piece of tissue** from the cervix for both diagnostic and therapeutic purposes. - **Statement 2 is correct**: Conisation is indicated for diagnosis and obtaining adequate tissue when punch biopsy is inadequate or when there is discrepancy between cytology, colposcopy, and histology. - **Statement 3 is correct**: Unsatisfactory colposcopy (when the transformation zone cannot be fully visualized) is a key indication for diagnostic conisation. *1, 2 and 3* - This option incorrectly includes treatment of **Nabothian follicles**. Nabothian cysts are benign retention cysts that are asymptomatic and require **no treatment**. They are not an indication for conisation. *1 and 4* - Both statements are **incorrect**. Nabothian follicles do not require treatment, and a **negative endocervical curettage (ECC)** is not an indication for conisation. In fact, a **positive ECC** (showing dysplasia) would be an indication. *1 and 3 only* - This option incorrectly includes **Nabothian follicle treatment**, which is not an indication for conisation as these are benign cysts requiring no intervention.
Question 64: Which of the following statements regarding female sterilization is correct? 1. It can be done 24 - 48 hours following delivery. 2. Ideal time for interval ligation is luteal phase preceding menstruation. 3. It can be combined with medical termination of pregnancy. 4. It is a preventive measure against serous ovarian cancer. Select the correct answer using the code given below:
- A. 1, 3 and 4 (Correct Answer)
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3
Explanation: ***1, 3 and 4*** - Female sterilization can indeed be performed **24-48 hours postpartum** because the fundus is still high, making the fallopian tubes easily accessible. - Female sterilization can be safely **combined with medical termination of pregnancy**, offering a convenient option for women who desire permanent contraception after an abortion. - **Tubal ligation has been shown to reduce the risk of ovarian cancer** by approximately 30%, likely by preventing carcinogens from ascending through the tubes or by altering ovarian blood supply and hormone levels. - **Opportunistic salpingectomy** (removal of fallopian tubes during sterilization) provides even greater protection against high-grade serous ovarian cancer, as many such cancers originate in the fimbrial end of the fallopian tube. *1, 2 and 3* - While statements 1 and 3 are correct, **statement 2 is incorrect**. The ideal time for interval tubal ligation is the **follicular phase (early proliferative phase)**, typically within the **first 7 days of the menstrual cycle**, NOT the luteal phase preceding menstruation. - Performing sterilization in the early follicular phase minimizes the risk of an **undiagnosed early pregnancy**, as this is shortly after menstruation when pregnancy is least likely. *1, 2 and 4* - While statements 1 and 4 are correct, **statement 2 is incorrect**. The luteal phase is NOT the ideal time for interval sterilization because this is when pregnancy risk is highest. - The **follicular phase** is preferred to ensure the woman is not pregnant at the time of the procedure. *2, 3 and 4* - While statements 3 and 4 are correct, **statement 2 is incorrect**. Standard practice recommends interval tubal ligation during the **follicular phase (days 1-7 of cycle)**, not the luteal phase. - The luteal phase carries a risk of operating on an early, undiagnosed pregnancy.
Question 65: The most popular technique of tubal ligation is :
- A. Madlener Operation
- B. Pomeroy Technique (Correct Answer)
- C. Uchida method
- D. Cornual resection
Explanation: ***Pomeroy Technique*** - The **Pomeroy technique** is the most widely performed method of tubal ligation due to its simplicity, ease of execution, and high efficacy. - It involves lifting a loop of the fallopian tube, ligating its base, and then excising the looped segment, leading to clear separation of the tubal ends. *Madlener Operation* - The Madlener operation involves crushing and ligating a loop of the **fallopian tube** without excising any segment. - This method has a higher failure rate compared to the Pomeroy technique due to the possibility of recanalization. *Uchida method* - The **Uchida method** is a more complex technique that involves injecting a solution into the subserosal layer of the fallopian tube to separate the mucosa and muscularis, followed by excision of a segment and burying the proximal end. - It is known for its high effectiveness but is less commonly performed due to its technical complexity. *Cornual resection* - **Cornual resection** involves removing a portion of the fallopian tube where it enters the uterine wall (the cornua). - This procedure is technically more challenging and is associated with a higher risk of complications, including hemorrhage, making it less popular as a primary method for sterilization.
Question 66: If, on amniocentesis, the alpha fetoprotein is found to be elevated in the amniotic fluid (which correlates with elevated maternal serum levels), which of the following conditions is likely to be present?
- A. Neural tube defects (Correct Answer)
- B. Duchenne muscular dystrophy
- C. Cardiac septal defects
- D. Galactosaemia
Explanation: ***Neural tube defects*** - **Elevated alpha-fetoprotein (AFP)** in amniotic fluid and maternal serum is a key indicator of neural tube defects like **spina bifida** or **anencephaly**. - These defects result in an open neural tube, allowing AFP to leak directly into the amniotic fluid. *Duchenne muscular dystrophy* - This is an **X-linked recessive genetic disorder** causing progressive muscle degeneration. - While it can be detected prenatally through genetic testing, it is **not associated with elevated AFP** levels. *Cardiac septal defects* - These are **structural abnormalities of the heart** (e.g., ventricular septal defect, atrial septal defect). - They are typically diagnosed via **fetal echocardiography** and do not cause elevated AFP levels. *Galactosaemia* - This is an **autosomal recessive metabolic disorder** where the body cannot properly metabolize galactose. - It is diagnosed by detecting elevated galactose or genetic testing, and **AFP levels are unaffected**.