Complications of Abortion — MCQs
Which of the following statements about tuberculosis (TB) of the uterus is NOT true?
Air embolism occurs in which method of abortion?
Acute PID, the most common route of spread?
A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?
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?
Which of the following statements is false regarding postpartum hemorrhage and pelvic hematomas?
Under which section of the BNS is the punishment for voluntarily causing criminal abortion primarily covered?
A doctor conducts criminal abortion for a woman with consent. He will be prosecuted under which of the following IPC sections?
Antiprogesterone compound RU-486 is effective for inducing abortion if the duration of pregnancy is what?
A pregnant woman presents with an IUD in place, and the thread is clearly visible. She wishes to continue the pregnancy. What is the most appropriate next step?
Complications of Abortion Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements about tuberculosis (TB) of the uterus is NOT true?
- A. Increase incidence of ectopic pregnancy
- B. Involvement of endosalpinx
- C. Most common is ascending infection (Correct Answer)
- D. Mostly secondary
Explanation: ***Most common is ascending infection*** - Uterine tuberculosis is overwhelmingly due to **hematogenous spread** from a primary site, often the lungs, rather than an ascending infection from the lower genital tract. - Tuberculosis typically reaches the female genital tract by the **bloodstream**, with the fallopian tubes being the most common initial site of involvement. *Mostly secondary* - Genital tuberculosis, including uterine involvement, is almost always a **secondary infection**, meaning it results from the spread of Mycobacterium tuberculosis from another primary site in the body, most commonly the lungs. - The initial infection establishes elsewhere, and then the bacteria **disseminate hematogenously** to the reproductive organs. *Increase incidence of ectopic pregnancy* - Tubal damage and scarring caused by tuberculosis, particularly in the fallopian tubes (**salpingitis**), disrupt the normal passage of the ovum. - This anatomical alteration significantly **increases the risk** of the fertilized egg implanting outside the uterus, leading to ectopic pregnancy. *Involvement of endosalpinx* - The **fallopian tubes (endosalpinx)** are the most common site of genital tuberculosis, with eventual spread to the uterus through the lymphatic system or direct extension. - Tubal involvement can lead to **salpingitis isthmica nodosa** and hydrosalpinx, contributing to infertility and ectopic pregnancy.
Question 2: 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
Question 3: Acute PID, the most common route of spread?
- A. Descending
- B. Ascending infection (Correct Answer)
- C. Lymphatics
- D. Hematogenous
Explanation: ***Ascending infection*** - **Pelvic Inflammatory Disease (PID)** most commonly occurs when microorganisms from the **lower genital tract (vagina, cervix)** ascend into the upper genital tract (uterus, fallopian tubes, ovaries). - This upward spread leads to infection and inflammation of the endometrium (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis). *Descending* - A descending route of infection implies spread from an organ superior to the pelvis, which is not the typical mechanism for acute PID. - While infections can sometimes spread from adjacent structures, direct downward spread from non-genital organs is rare for primary PID. *Lymphatics* - While lymphatic spread can occur in some infections, it is not the primary or most common route for the initial onset of acute PID. - Lymphatic spread is more commonly associated with chronic or severe infections, or specific types of pelvic infections like tuberculosis. *Hematogenous* - Hematogenous spread involves pathogens traveling through the bloodstream to reach the pelvic organs. - This route is less common for typical acute PID but can be seen in cases of systemic infections or specific sexually transmitted infections like tuberculosis.
Question 4: A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?
- A. Incomplete abortion
- B. Complete abortion
- C. Inevitable abortion
- D. Threatened abortion (Correct Answer)
Explanation: ***Threatened abortion*** - This diagnosis is characterized by **vaginal bleeding** in the first half of pregnancy with a **closed internal os** and evidence of fetal viability on ultrasound. - The fundal height being consistent with gestational age also indicates ongoing pregnancy, despite the bleeding. *Inevitable abortion* - This condition is indicated by vaginal bleeding accompanied by a **dilated cervix (open internal os)**, suggesting that the pregnancy cannot be salvaged. - While bleeding is present, the **closed internal os** in the given scenario rules out inevitable abortion. *Incomplete abortion* - This involves vaginal bleeding, an **open internal os**, and the **partial expulsion of pregnancy tissue**, with some products of conception remaining in the uterus. - The presentation does not include an open os or retained products of conception, as the fetus is viable and the os is closed. *Complete abortion* - This occurs when **all products of conception have been expelled** from the uterus, characterized by an initially open os that subsequently closes, and often a decrease in bleeding. - The presence of a **viable fetus** and a closed os clearly rules out a complete abortion.
Question 5: 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 6: Which of the following statements is false regarding postpartum hemorrhage and pelvic hematomas?
- A. The vulva is the most common site for pelvic hematoma. (Correct Answer)
- B. Hematomas less than 5 cm can often be managed conservatively.
- C. Uterine atony is the most common cause of postpartum hemorrhage.
- D. The most common artery to form a vulvar hematoma is the pudendal artery.
Explanation: ***The vulva is the most common site for pelvic hematoma.*** - While vulvar hematomas are common, the **vagina is actually the most common site** for puerperal hematomas. - **Retroperitoneal hematomas** are the least common but most dangerous type, often associated with a higher mortality rate due to delayed diagnosis. *Hematomas less than 5 cm can often be managed conservatively.* - **Small, stable hematomas** (typically less than 2-5 cm) that are not expanding can often be managed with observation, pain control, and ice packs. - Close monitoring for continued bleeding, signs of infection, or hemodynamic instability is crucial even with conservative management. *Uterine atony is the most common cause of postpartum hemorrhage.* - **Uterine atony** (failure of the uterus to contract after birth) accounts for approximately 70-80% of all cases of postpartum hemorrhage. - This condition leads to excessive bleeding from the placental site due to the inability of uterine muscle fibers to compress blood vessels effectively. *The most common artery to form a vulvar hematoma is the pudendal artery.* - Vulvar hematomas primarily arise from injury to branches of the **pudendal artery**, particularly during lacerations or episiotomies. - Trauma to the **perineum** during childbirth can cause these arteries or their venous counterparts to bleed into the surrounding loose connective tissue.
Question 7: Under which section of the BNS is the punishment for voluntarily causing criminal abortion primarily covered?
- A. 89
- B. 90
- C. 91
- D. 88 (Correct Answer)
Explanation: ***Correct Option: 88*** - Section 88 of the Bharatiya Nyaya Sanhita (BNS) specifically deals with the **offense of voluntarily causing miscarriage**, outlining the conditions and punishments associated with it. - This section covers the core legal framework for prosecution in cases of **criminal abortion**. - It is the primary provision under which punishment for voluntarily causing abortion is covered. *Incorrect Option: 89* - Section 89 of the BNS deals with causing miscarriage **without the woman's consent**, which is a more severe form of the offense. - While related to abortion, this section addresses a specific aggravated circumstance rather than the general act of voluntarily causing miscarriage. *Incorrect Option: 90* - Section 90 of the BNS addresses the **death of an unborn child** caused by an act amounting to culpable homicide, which is a different offense altogether. - This section focuses on homicide of an unborn child, not primarily the act of voluntarily causing a miscarriage. *Incorrect Option: 91* - Section 91 of the BNS deals with acts done with intent to prevent a child from being born alive or to cause it to die after birth. - This section focuses on offenses related to the **life of a child around birth**, distinct from the act of causing a miscarriage.
Question 8: A doctor conducts criminal abortion for a woman with consent. He will be prosecuted under which of the following IPC sections?
- A. 316 IPC
- B. 313 IPC
- C. 312 IPC (Correct Answer)
- D. 317 IPC
Explanation: ***312 IPC*** - This section of the **Indian Penal Code (IPC)** specifically deals with **causing miscarriage** or criminal abortion. - Doing so with the woman's consent, but outside of legal provisions, falls under this section. *316 IPC* - This section deals with **causing the death of a quick unborn child**, an act amounting to culpable homicide. - It would apply if the act intended to cause the death of the child, not just to induce an abortion. *313 IPC* - This section addresses **causing miscarriage without the woman's consent**. - Since the question states the abortion was done "with consent," this section is not applicable. *317 IPC* - This section pertains to the **exposure and abandonment of a child** under twelve years of age by parent or person having care of it. - This is unrelated to the act of performing an abortion.
Question 9: Antiprogesterone compound RU-486 is effective for inducing abortion if the duration of pregnancy is what?
- A. 63 days (Correct Answer)
- B. 72 days
- C. 88 days
- D. 120 days
Explanation: ***63 days*** - **Mifepristone (RU-486)**, an antiprogesterone, is most effective for medical abortion when used within 63 days (9 weeks) of gestation. - Its efficacy decreases and the risk of incomplete abortion or complications increases beyond this timeframe, making surgical options more suitable for later pregnancies. *72 days* - While still relatively early in pregnancy, **mifepristone's efficacy** starts to decline after 63 days, and the recommended window for optimal success of a medical abortion is generally within the first 9 weeks. - Beyond 63 days, the need for **surgical intervention** or repeat doses of misoprostol becomes more likely, and the overall success rate for medical abortion is reduced. *88 days* - By 88 days (approximately 12.5 weeks), medical abortion with mifepristone alone becomes significantly less effective and often requires **surgical evacuation**. - The risk of **incomplete abortion**, heavier bleeding, and other complications substantially increases, highlighting the importance of earlier intervention. *120 days* - At 120 days (approximately 17 weeks), medical abortion with mifepristone would be largely ineffective and unsafe as a primary method for pregnancy termination. - Pregnancies at this stage typically require **surgical procedures** like D&E (dilation and evacuation) due to the size of the fetus and placenta.
Question 10: A pregnant woman presents with an IUD in place, and the thread is clearly visible. She wishes to continue the pregnancy. What is the most appropriate next step?
- A. Leave the IUD inside
- B. Remove gently (Correct Answer)
- C. MTP (Medical Termination of Pregnancy)
- D. Cesarean section
Explanation: ***Remove gently*** - When the **IUD thread is visible**, gentle removal is recommended if the woman wishes to **continue the pregnancy**, as this significantly reduces the risk of miscarriage and infection. - Leaving an **IUD in situ** during pregnancy increases risks of **septic miscarriage**, **preterm delivery**, and **chorioamnionitis**. *Leave the IUD inside* - Leaving an **IUD in place** during pregnancy increases the risks of **septic miscarriage**, **chorioamnionitis**, and **preterm labor**. - The presence of the IUD can also lead to **placental complications** and difficulties with fetal development. *MTP (Medical Termination of Pregnancy)* - MTP is an option for unintended pregnancies but is not the most appropriate first step when the patient explicitly **wishes to continue the pregnancy**. - MTP would be considered if the patient chose to terminate, but the question states she wants to continue. *Cesarean section* - **Cesarean section** is a mode of delivery and is not an appropriate initial intervention for an early pregnancy with an **IUD in situ**. - The removal of an IUD from an early pregnancy does not necessitate a cesarean section.
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