Medical Termination of Pregnancy Act — MCQs
How many medical practitioners' opinions are required for termination of pregnancy where gestational age exceeds 12 weeks but is within 20 weeks?
A 27 -week pregnant woman with a fetus diagnosed with congenital anomalies is considering a Medical Termination of Pregnancy (MTP). Whose presence is not required for the authorization of MTP in this case?
For medical termination of pregnancy, consent is given by-
All of the following can be used in first-trimester medical termination of pregnancy (MTP), except
MTP cannot be done after:
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 14 years old rape victim with 22 weeks of gestation coming to hospital. All of the following can be done except:
Which one of the following causes the greatest risk of ectopic pregnancy?
What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
Air embolism occurs in which method of abortion?
Medical Termination of Pregnancy Act Indian Medical PG Practice Questions and MCQs
Question 1: How many medical practitioners' opinions are required for termination of pregnancy where gestational age exceeds 12 weeks but is within 20 weeks?
- A. Four
- B. Only one
- C. Two (Correct Answer)
- D. Three
Explanation: ***Two*** - According to the **Medical Termination of Pregnancy Act**, if the gestational age exceeds 12 weeks but is within 20 weeks, the opinion of **two registered medical practitioners** is required to perform an abortion. - This ensures a more robust review of the medical necessity and circumstances surrounding the decision to terminate a pregnancy at a later stage. *Four* - The requirement for four medical practitioners is not stipulated in the **Medical Termination of Pregnancy Act** for any gestational age. - Such a high number of opinions would create unnecessary logistical hurdles and delays for women seeking legal abortions. *Only one* - The opinion of only **one registered medical practitioner** is sufficient for terminations where the gestational age is up to **12 weeks**. - For gestational ages exceeding 12 weeks, the law mandates a more cautious approach, requiring additional medical consensus. *Three* - While multiple opinions are required for later-term abortions, the specific number mandated by the **Medical Termination of Pregnancy Act** for pregnancies between 12 and 20 weeks is two, not three. - The requirement shifts to a medical board for pregnancies exceeding **20 weeks** (and up to 24 weeks for specific categories of women), but this involves more than "three" individual opinions in a standard sense.
Question 2: A 27 -week pregnant woman with a fetus diagnosed with congenital anomalies is considering a Medical Termination of Pregnancy (MTP). Whose presence is not required for the authorization of MTP in this case?
- A. A. Obstetrician
- B. B. Lawyer (Correct Answer)
- C. C. Pediatrician
- D. D. Sonologist
Explanation: **B. Lawyer** - The **Medical Termination of Pregnancy Act (MTP Act)** in India specifies the medical professionals required for MTP authorization. A lawyer's presence is not mandated for this medical decision. - Legal authorization involves medical personnel and, in certain cases, a **Medical Board**, but not legal professionals directly in the authorization process. *A. Obstetrician* - An **obstetrician** or gynecologist is a medical expert specializing in pregnancy and childbirth, making their presence crucial for assessing the patient's and fetal condition. - The **MTP Act** requires the opinion of at least two registered medical practitioners, especially for pregnancies beyond 20 weeks, making an obstetrician essential. *C. Pediatrician* - In cases of **fetal anomalies**, a **pediatrician** (or a neonatologist) is highly likely to be part of the Medical Board formed to evaluate the anomaly and assess the prognosis for the child. - Their expertise helps in understanding the **severity and potential outcomes** of the congenital anomaly, informing the MTP decision. *D. Sonologist* - A **sonologist** (radiologist performing ultrasound) is critical for accurately diagnosing and detailing the **congenital anomalies** through imaging. - Their report provides essential **diagnostic information** that forms the basis for the MTP decision, especially in cases where anomalies are the primary concern.
Question 3: 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
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**.
Question 4: All of the following can be used in first-trimester medical termination of pregnancy (MTP), except
- A. Manual vacuum aspiration
- B. Dilatation and curettage
- C. Extra-amniotic instillation of ethacridine lactate (Correct Answer)
- D. Mifepristone + misoprostol
Explanation: ***Extra-amniotic instillation of ethacridine lactate*** - **Extra-amniotic instillation of ethacridine lactate** is a method primarily used for **second-trimester** pregnancy terminations. - Its mechanism involves causing inflammation and contraction of the uterus, which is less effective and carries higher risks in the first trimester. *Manual vacuum aspiration* - **Manual vacuum aspiration (MVA)** is a common and effective surgical method for **first-trimester MTP**. - It involves using a syringe and cannula to remove the uterine contents directly. *Dilatation and curettage* - **Dilatation and curettage (D&C)** is another standard surgical procedure used for **first-trimester MTP**. - It involves dilating the cervix and using a curette to scrape the uterine lining and remove the pregnancy tissue. *Mifepristone + misoprostol* - The combination of **mifepristone and misoprostol** is the most common and effective medical method for **first-trimester MTP**. - **Mifepristone** blocks progesterone, while **misoprostol** causes uterine contractions and cervical ripening, expelling the pregnancy.
Question 5: MTP cannot be done after:
- A. 20 weeks
- B. 28 weeks (Correct Answer)
- C. 12 weeks
- D. 24 weeks
Explanation: ***28 weeks*** - The Medical Termination of Pregnancy (MTP) Act was amended in 2021, and the upper gestation limit for MTP was increased to **24 weeks** in special cases. However, MTP at 28 weeks' gestation is **not permitted**, as fetal viability is significantly higher, and legal restrictions are stricter. - Beyond 24 weeks, an MTP is only permitted in cases of **substantial fetal anomalies** diagnosed by a Medical Board, making 28 weeks generally non-permissible for routine MTP. *20 weeks* - The initial MTP Act of 1971 allowed MTP up to **20 weeks of gestation** with specific conditions, including a risk to the mother's life or health, or fetal abnormalities. - This limit was extended in certain circumstances by the 2021 amendment, but 20 weeks is generally within the permissible limit for MTP. *12 weeks* - MTP can be performed up to **12 weeks of gestation** based on the opinion of one registered medical practitioner under the MTP Act. - This period is considered safer and less complex for termination procedures. *24 weeks* - The MTP (Amendment) Act of 2021 expanded the gestation limit for MTP to **24 weeks** for specific categories of women, including survivors of sexual assault, minors, women with disabilities, and those with a change in marital status during pregnancy. - This limit requires the opinion of **two registered medical practitioners**.
Question 6: 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
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.
Question 7: A 14 years old rape victim with 22 weeks of gestation coming to hospital. All of the following can be done except:
- A. Male doctor can examine her with female attendant
- B. UPT not required
- C. Gynecologist can abort the fetus upon the patient request
- D. No need to collect vaginal swab (Correct Answer)
Explanation: ***No need to collect vaginal swab (INCORRECT STATEMENT - This CANNOT be said)*** - Collecting a **vaginal swab is MANDATORY** in all cases of sexual assault for **forensic evidence collection** to identify the perpetrator through DNA analysis. - This is a **medico-legal requirement** and must be done even if pregnancy has occurred, as it provides crucial evidence for prosecution. - The statement "no need to collect vaginal swab" is completely wrong, making it the correct answer to this "except" question. *Male doctor can examine her with female attendant (Can be done)* - It is **legally permissible and ethical** for a male doctor to examine a female patient in the presence of a **female attendant**. - This ensures patient comfort, privacy protection, and safeguards the doctor against false allegations. - This is standard medical practice in sensitive situations like sexual assault. *UPT not required (Can be done/said)* - A 14-year-old presenting with **22 weeks of gestation** has clinically evident pregnancy through abdominal examination and ultrasound. - Urine pregnancy test (UPT) is **not necessary** at this advanced gestational age as pregnancy is already confirmed. - Resources should focus on comprehensive care rather than redundant testing. *Gynecologist can abort the fetus upon the patient request (Can be done)* - Under the **Medical Termination of Pregnancy (MTP) Amendment Act 2021**, termination is permissible up to **24 weeks for rape survivors**. - For a minor, **consent of guardian** and opinion of **two registered medical practitioners** is required. - At 22 weeks, this patient is within the legal timeframe for termination given the circumstances of sexual assault.
Question 8: Which one of the following causes the greatest risk of ectopic pregnancy?
- A. Previous ectopic pregnancy (Correct Answer)
- B. Intrauterine contraceptive devices use
- C. Previous normal delivery
- D. Previous medical termination of pregnancy
Explanation: ***Previous ectopic pregnancy*** - A history of prior ectopic pregnancy significantly increases the risk of a **recurrent ectopic pregnancy** due to potential **tubal damage** from the previous event. - This is considered the **highest risk factor** among the choices provided because it indicates a pre-existing vulnerability in the reproductive system. *Intrauterine contraceptive devices use* - While IUDs do not cause ectopic pregnancies, they **prevent intrauterine pregnancies** more effectively than ectopic ones, leading to a higher proportion of pregnancies being ectopic if conception occurs. - The absolute risk of an ectopic pregnancy with an IUD in place is still **lower than in women not using contraception** but the ratio of ectopic to intrauterine pregnancies is higher. *Previous normal delivery* - A history of previous normal delivery is generally **protective against ectopic pregnancy**, as it suggests healthy tubal function and uterine environment. - This factor has **no association** with an increased risk of ectopic pregnancy. *Previous medical termination of pregnancy* - There is generally **no significant increased risk** of ectopic pregnancy associated with a single medical termination of pregnancy, especially when performed early in gestation. - Repeated or complicated terminations, especially surgical, *could* theoretically increase risk due to **tubal damage or inflammation**, but medical termination typically carries little to no added risk.
Question 9: What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
- A. 96 hours
- B. 48 hours
- C. 24-48 hours (Correct Answer)
- D. 72 hours
Explanation: ***24-48 hours*** - The FDA-approved protocol for medical abortion with mifepristone and misoprostol specifies a **24- to 48-hour interval** between the administration of the two drugs. - This timing ensures optimal efficacy as it allows mifepristone to adequately sensitize the uterus to the effects of misoprostol. *48 hours* - While 48 hours falls within the recommended range, specifically stating "48 hours" as the only option is less precise than the **24-48 hour window**. - No specific clinical advantage or disadvantage is generally reported for waiting exactly 48 hours over, for instance, 24 hours. *96 hours* - A 96-hour interval is significantly longer than the **FDA-recommended window** and is not part of the standard, evidence-based protocol. - Delaying misoprostol administration beyond 48 hours may **reduce the effectiveness** of the medical abortion and increase the risk of complications. *72 hours* - A 72-hour interval exceeds the upper limit of the **FDA-recommended window** for optimal efficacy. - While some studies have explored extended intervals, the *standard clinical practice* and FDA guidelines do not endorse 72 hours as the primary recommended interval.
Question 10: Air embolism occurs in which method of abortion?
- A. Criminal abortion (Correct Answer)
- B. Spontaneous abortion
- C. Induced abortion with saline injection
- D. Medical Termination of pregnancy
Explanation: ***Criminal abortion (Correct Answer)*** - **Air embolism** is a life-threatening complication classically associated with **criminal/unsafe abortions** performed by unskilled individuals using unsanitary techniques - **Mechanism**: Air can be deliberately or accidentally introduced into the **uterine venous sinuses** through intrauterine insufflation, use of unsterile instruments, or syringe-based procedures - The air enters the systemic circulation through open venous channels in the uterus, potentially causing cardiovascular collapse and death - This is one of the most serious complications distinguishing unsafe abortion from medically supervised procedures *Spontaneous abortion (Incorrect)* - **Spontaneous abortion** (miscarriage) is a natural termination of pregnancy resulting from genetic abnormalities, hormonal imbalances, or maternal health issues - No iatrogenic intervention occurs, so air embolism is not a risk - Complications may include hemorrhage or infection, but not air embolism *Induced abortion with saline injection (Incorrect)* - **Hypertonic saline** is injected into the amniotic sac to induce fetal demise and labor - Complications include **hypernatremia, DIC, hemorrhage**, and rarely **cardiovascular shock** - The mechanism involves chemical irritation and prostaglandin release, not air introduction - Air embolism is not a characteristic complication of this method *Medical Termination of Pregnancy (Incorrect)* - **MTP** performed under safe, legal conditions uses either **medical methods** (mifepristone + misoprostol) or **surgical methods** (suction evacuation) by trained professionals - Modern techniques and protocols specifically prevent introduction of air into the uterine cavity - Conducted under sterile conditions with appropriate equipment, making air embolism extremely rare - This represents the gold standard for safe pregnancy termination
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