Medical Termination of Pregnancy — MCQs
The MTP Act (as currently amended) provides rules for termination of pregnancy till what number of weeks of pregnancy?
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 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 10-week pregnant woman presents for termination of pregnancy. What is the best method of abortion?
Death caused by act done with intent to cause miscarriage is punishable by
MTP cannot be done after:
A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy. What are the drugs used for medical termination of pregnancy in this patient?
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?
Air embolism occurs in which method of abortion?
What ethical statement regarding therapeutic abortion was made in the Declaration of Oslo by the World Medical Association in 1970?
Medical Termination of Pregnancy Indian Medical PG Practice Questions and MCQs
Question 1: The MTP Act (as currently amended) provides rules for termination of pregnancy till what number of weeks of pregnancy?
- A. 12 weeks
- B. 16 weeks
- C. 20 weeks
- D. 24 weeks (Correct Answer)
Explanation: ***24 weeks*** - The **MTP (Medical Termination of Pregnancy) Act** was amended in 2021 to extend the gestational limit for termination of pregnancy from 20 to **24 weeks** for certain categories of women. - This extension applies to vulnerable groups such as survivors of **sexual assault**, minors, and women with disabilities. *12 weeks* - This was the initial gestational limit under the original MTP Act where the opinion of **one registered medical practitioner (RMP)** was sufficient. - The current amendment has significantly expanded this limit for various circumstances. *16 weeks* - This gestational period is **not explicitly a termination limit** under the MTP Act, either in its original form or its amendments. - The Act generally focuses on limits of 12, 20, and 24 weeks. *20 weeks* - This was the previous upper gestational limit for termination requiring the opinion of **two registered medical practitioners (RMPs)** under the MTP Act before the 2021 amendment. - Beyond this, termination was only permitted under very specific circumstances related to fetal abnormalities or risk to the mother's life.
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: 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.
Question 4: A 10-week pregnant woman presents for termination of pregnancy. What is the best method of abortion?
- A. Misoprostol + mifepristone
- B. Methotrexate and misoprostol
- C. Dilatation and curettage
- D. Vacuum aspiration (Correct Answer)
Explanation: ***Vacuum aspiration*** - **Vacuum aspiration (Manual or Electric)** is considered the **gold standard surgical method** for first-trimester abortion (up to 12-14 weeks of gestation). - It involves removing the uterine contents using a **suction catheter**, typically performed as an outpatient procedure under local anesthesia. - **Advantages**: Higher success rate (>99%), immediate completion, shorter procedure time, and lower ongoing bleeding compared to medical methods. - At **10 weeks**, vacuum aspiration is highly effective and is the preferred surgical option. *Misoprostol + mifepristone* - This combination is the **standard medical abortion regimen** and is highly effective up to 10-12 weeks (WHO guidelines support up to 12 weeks). - **Success rate at 10 weeks: ~95-98%**, which is excellent but slightly lower than surgical methods. - While this is a valid and commonly used option at 10 weeks, it involves a **longer process** (several hours to days), more bleeding, cramping, and requires follow-up to confirm completion. - **For exam purposes**, when comparing "best" method at 10 weeks, vacuum aspiration is preferred due to higher efficacy and immediate completion. *Methotrexate and misoprostol* - **Methotrexate** combined with misoprostol is less commonly used for abortion compared to mifepristone-based regimens. - This combination has a **longer duration of action** (5-7 days or more) and **lower efficacy** compared to mifepristone + misoprostol. - Generally reserved for **very early pregnancies** (<7 weeks) or specific clinical situations; not the preferred regimen at 10 weeks. *Dilatation and curettage* - **D&C** is an older surgical method involving cervical dilation and scraping the uterine lining with a sharp curette. - **Vacuum aspiration has largely replaced D&C** for routine first-trimester abortion due to lower risk of complications (perforation, cervical injury, incomplete evacuation). - D&C may still be used for incomplete abortion or retained products of conception but is not the first-line method.
Question 5: Death caused by act done with intent to cause miscarriage is punishable by
- A. 312 IPC
- B. 316 IPC
- C. 314 IPC (Correct Answer)
- D. 309 IPC
Explanation: ***314 IPC*** - **Section 314 of the Indian Penal Code (IPC)** specifically deals with the punishment for an act done with intent to cause miscarriage which results in the death of the woman. - If the act is done without the woman's consent, the punishment can be for life imprisonment or up to ten years, along with a fine. If done with consent, the punishment is up to ten years imprisonment and a fine. *312 IPC* - **Section 312 IPC** deals with causing miscarriage generally, without necessarily resulting in the death of the woman. - The punishment under this section is less severe, up to three years imprisonment and a fine if the woman is not quick with child, and up to seven years and a fine if she is quick with child. *316 IPC* - **Section 316 IPC** addresses causing the death of an unborn child when the intention was to prevent the child from being born alive. - This section applies when the child dies before or during birth but the mother survives, which is not the scenario described in the question where the mother's death is the outcome. *309 IPC* - **Section 309 IPC** pertains to the attempt to commit suicide. - This section is completely unrelated to the act of causing miscarriage or death arising from such an act.
Question 6: 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 7: A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy. What are the drugs used for medical termination of pregnancy in this patient?
- A. Misoprostol and Mifepristone (Correct Answer)
- B. Misoprostol and Medroxyprogesterone
- C. Mifepristone and Medroxyprogesterone
- D. Mifepristone and Methotrexate
Explanation: ***Misoprostol and Mifepristone*** - This combination is the **standard and most effective medical regimen** for termination of pregnancy in the first trimester (up to 9-10 weeks). - **Mifepristone** (200mg) is an **antiprogestin** that blocks progesterone receptors, essential for maintaining pregnancy, followed 24-48 hours later by **Misoprostol** (800mcg), a **prostaglandin analog** that causes cervical ripening and strong uterine contractions. - This regimen has a **95-98% success rate** and is the WHO-recommended protocol. *Misoprostol and Medroxyprogesterone* - **Medroxyprogesterone** is a **progestin**, which would **support and maintain pregnancy** rather than terminate it, making this combination ineffective for medical abortion. - Medroxyprogesterone is used for contraception and menstrual regulation, not pregnancy termination. *Mifepristone and Medroxyprogesterone* - **Medroxyprogesterone** is a progestin and would **directly antagonize the antiprogestin action of Mifepristone**, preventing pregnancy termination. - This combination is pharmacologically contradictory and would not achieve abortion. *Mifepristone and Methotrexate* - **Mifepristone and Methotrexate are not used together** in medical abortion protocols. - **Methotrexate** (antimetabolite) is occasionally used with **Misoprostol** (not Mifepristone) as an alternative regimen, but it is much slower (7-14 days vs 24-48 hours), less effective, and primarily reserved for ectopic pregnancy management. - The standard combination for intrauterine pregnancy termination is Mifepristone + Misoprostol, not Mifepristone + Methotrexate.
Question 8: 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 9: 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 10: What ethical statement regarding therapeutic abortion was made in the Declaration of Oslo by the World Medical Association in 1970?
- A. Hunger and health rights
- B. Prohibition of torture and inhumane treatment
- C. Ethical guidelines for medical research
- D. Ethical considerations for therapeutic abortion (Correct Answer)
Explanation: ***Ethical considerations for therapeutic abortion*** - The **Declaration of Oslo (1970)** specifically addressed the ethical principles surrounding **therapeutic abortion**, outlining the physician's role and responsibilities. - This declaration provided guidance on situations where a medical practitioner might consider ending a pregnancy to protect the **life or health of the mother**. *Hunger and health rights* - While important ethical considerations, these topics are primarily addressed in other declarations and international human rights instruments, not specifically the **Declaration of Oslo on therapeutic abortion**. - The focus of the Oslo Declaration was narrowly on the **ethical dilemmas surrounding pregnancy termination**. *Prohibition of torture and inhumane treatment* - This ethical statement is primarily associated with documents like the **Declaration of Tokyo (1975)**, which explicitly addresses the physician's role in preventing and condemning torture, not therapeutic abortion. - The content of the Oslo Declaration is distinct from discussions of torture and inhumane treatment. *Ethical guidelines for medical research* - Ethical guidelines for medical research, especially involving human subjects, are primarily covered by documents like the **Declaration of Helsinki (1964)**, not the Declaration of Oslo. - These two declarations serve different purposes and address distinct ethical domains.
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