Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 121: Which of the following is NOT a method for inducing mid-trimester abortions?

A. Intra-amniotic saline
B. Intra-amniotic prostaglandins
C. Menstrual regulation (Correct Answer)
D. Hysterotomy

Explanation: **Explanation:** The key to answering this question lies in understanding the definition of "mid-trimester." The mid-trimester (second trimester) refers to the period between **13 and 28 weeks** of gestation. **Why Menstrual Regulation (MR) is the correct answer:** Menstrual Regulation is a method used for **very early first-trimester** abortions. It involves the aspiration of the uterine contents using a Karman cannula or a syringe, typically performed within **6 weeks of the Last Menstrual Period (LMP)** (up to 14 days of a missed period). Since it is restricted to the early first trimester, it cannot be used for mid-trimester abortions. **Analysis of incorrect options:** * **Intra-amniotic Saline:** This is a classical method for mid-trimester induction (16–20 weeks). Hypertonic saline (20%) acts by causing fetal demise and releasing endogenous prostaglandins, leading to uterine contractions. * **Intra-amniotic Prostaglandins:** Prostaglandins (like PGF2α) are potent uterine stimulants. Intra-amniotic or extra-amniotic administration is a standard pharmacological approach for second-trimester termination. * **Hysterotomy:** This is a surgical method (similar to a mini-cesarean section) used for mid-trimester abortion when medical induction fails or is contraindicated. **High-Yield Clinical Pearls for NEET-PG:** * **MVA (Manual Vacuum Aspiration):** Used up to 12 weeks (first trimester). * **Medical Method of Abortion (MMA):** Mifepristone + Misoprostol is the gold standard for early medical abortion (up to 9 weeks/63 days as per Indian RMP guidelines). * **Most common method for 2nd-trimester abortion:** Dilatation and Evacuation (D&E) or Medical Induction with Misoprostol. * **Complication of Saline:** Hypernatremia and Coagulopathy (DIC).

Question 122: For emergency contraception, a single tablet of 0.75 mg of LNG was taken. It should be followed by which of the following?

A. A single dose of 0.75 mg after 12 hours (Correct Answer)
B. Two doses of 0.75 mg, 12 hours apart
C. Three doses of 0.75 mg, 12 hours apart
D. None of the above

Explanation: **Explanation:** The standard regimen for Levonorgestrel (LNG)-only emergency contraception consists of a total dose of **1.5 mg**. This can be administered in two ways: 1. **Split Dose (Yuzpe-style modification):** Two doses of **0.75 mg taken 12 hours apart**. 2. **Single Dose:** A one-time dose of 1.5 mg (now more commonly preferred for better compliance). Since the question specifies that a single tablet of 0.75 mg has already been taken, the protocol dictates that the second 0.75 mg tablet must be taken **12 hours later** to complete the required 1.5 mg dosage. **Analysis of Options:** * **Option A (Correct):** Completes the 1.5 mg total dose requirement by following the 12-hour interval protocol. * **Option B & C (Incorrect):** These would result in a total dose of 2.25 mg or 3.0 mg, respectively. Exceeding the 1.5 mg threshold does not increase efficacy but significantly increases side effects like nausea and vomiting. * **Option D (Incorrect):** A single 0.75 mg dose is sub-therapeutic for emergency contraception and has a higher failure rate. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily acts by **delaying or inhibiting ovulation**. It is *not* an abortifacient and does not work if implantation has already occurred. * **Time Window:** Most effective when taken within **72 hours** of unprotected intercourse, though it can be used up to 120 hours (with declining efficacy). * **Efficacy:** If vomiting occurs within **2 hours** of intake, the dose must be repeated. * **Gold Standard:** The most effective emergency contraceptive is the **Copper-T (IUCD)**, which can be inserted up to 5 days after intercourse.

Question 123: What is the best contraceptive method for a 22-year-old married nulliparous woman?

A. Condom
B. Oral Contraceptive Pills (OCPs) (Correct Answer)
C. Tubectomy
D. Rhythm method

Explanation: **Explanation:** The primary goal for a young, married, nulliparous woman is a highly effective, reversible method of contraception that does not interfere with future fertility. **Why OCPs are the Correct Choice:** Combined Oral Contraceptive Pills (OCPs) are considered the first-line choice for this demographic. They offer **high efficacy** (99% with perfect use) and are **rapidly reversible**, allowing for an immediate return to fertility once discontinued. Beyond contraception, OCPs provide non-contraceptive benefits such as cycle regulation, reduction in dysmenorrhea, and decreased risk of iron-deficiency anemia—common concerns in young women. **Analysis of Incorrect Options:** * **Condoms:** While they provide protection against STIs, they have a higher "typical use" failure rate (approx. 18%) compared to hormonal methods, making them less ideal as a primary contraceptive for a married couple seeking reliable spacing. * **Tubectomy:** This is a permanent sterilization method. It is contraindicated in a young, nulliparous woman who will likely desire children in the future. * **Rhythm Method:** This is a natural family planning method with a very high failure rate (up to 24%). It is unreliable for young women who may have fluctuating cycles. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Contraceptive for Newly Married:** OCPs are the "spacing method" of choice. * **Centchroman (Saheli):** A non-steroidal, once-a-week pill developed in India (CDRI, Lucknow); it is a SERM and a popular alternative in the National Family Planning Program. * **IUCD in Nulliparous:** While not the *first* choice due to the risk of expulsion and PID (though low), the **LNG-IUS (Mirena)** is increasingly considered an option, but OCPs remain the standard answer for exams unless specific contraindications exist. * **Absolute Contraindications for OCPs:** Smoker >35 years, history of Thromboembolism (DVT/PE), Migraine with aura, and Breast Cancer.

Question 124: A pregnant woman at 8 weeks gestation with an intrauterine contraceptive device (Cu T) in place and three living children requires management. What is the most suitable treatment?

A. Continue the pregnancy and remove the Cu T during delivery.
B. Remove the Cu T and perform permanent sterilization. (Correct Answer)
C. Remove the Cu T.
D. None of the above.

Explanation: ### Explanation The management of a pregnancy with an intrauterine contraceptive device (IUCD) in situ depends on the patient’s desire to continue the pregnancy and the visibility of the IUCD strings. **Why Option B is Correct:** In this scenario, the patient already has **three living children**, which is a significant factor in clinical decision-making regarding family planning. Since the pregnancy is at an early stage (8 weeks), the standard protocol is to **remove the Cu T** immediately to reduce the risk of septic abortion, chorioamnionitis, and preterm labor. Given her parity (three children), she has likely completed her family size. Therefore, **permanent sterilization** (Tubectomy) is the most suitable long-term contraceptive advice to prevent further unintended pregnancies. **Analysis of Incorrect Options:** * **Option A:** Continuing the pregnancy with the Cu T in situ increases the risk of spontaneous abortion (up to 50%) and severe maternal sepsis. If strings are visible, the device should always be removed in the first trimester. * **Option C:** While removing the Cu T is a necessary immediate step, it is an incomplete management plan for a patient with three children who has already experienced a contraceptive failure. It fails to address her future reproductive needs. **NEET-PG High-Yield Pearls:** * **Risk of Ectopic Pregnancy:** While IUCDs do not *cause* ectopic pregnancy, if a woman becomes pregnant with an IUCD in situ, the **relative risk** of that pregnancy being ectopic is higher (approx. 3–4%). * **Strings Visible vs. Not Visible:** If strings are visible in the first trimester, remove the IUCD. If strings are not visible, perform an ultrasound; if the IUCD is intrauterine, it is generally left alone to avoid disrupting the pregnancy. * **Teratogenicity:** There is no evidence that Cu T causes congenital malformations in the fetus.

Question 125: Which of the following does a natural membrane condom protect against?

A. Conception (Correct Answer)
B. Sexually Transmitted Infections (STIs)
C. Both conception and Sexually Transmitted Infections (STIs)
D. None of the above

Explanation: **Explanation:** The correct answer is **Conception**. Natural membrane condoms (also known as "lambskin" condoms) are made from the intestinal cecum of lambs. While they are effective as a mechanical barrier against sperm, they possess microscopic pores (approximately 1.5 µm in diameter). These pores are small enough to block sperm (which are about 3 µm wide), thereby preventing **conception**, but they are large enough to allow the passage of much smaller viral pathogens. **Analysis of Options:** * **Option A (Correct):** They provide effective contraception by acting as a physical barrier to sperm. * **Option B (Incorrect):** They do **not** protect against STIs, particularly viral infections like HIV, Hepatitis B, and HSV. These viruses are significantly smaller (0.1 µm) than the pores in the natural membrane. * **Option C (Incorrect):** Since they fail to provide a barrier against viral STIs, this option is false. Only latex or synthetic (polyurethane/polyisoprene) condoms protect against both. * **Option D (Incorrect):** They are an FDA-approved method for pregnancy prevention. **High-Yield Clinical Pearls for NEET-PG:** * **Latex Condoms:** The "Gold Standard" for dual protection (conception + STIs). They are degraded by oil-based lubricants (use water-based only). * **Polyurethane Condoms:** Thinner and stronger than latex; compatible with oil-based lubricants; safe for patients with latex allergies. * **Failure Rate:** The typical use failure rate for male condoms is approximately **13-18%**, while the perfect use failure rate is **2%**. * **Nonoxynol-9:** A spermicide often added to condoms; however, it may increase the risk of HIV transmission by causing vaginal/rectal mucosal irritation.

Question 126: What contraceptive advice is appropriate for a lactating mother?

A. Combined pill
B. Mini pill
C. Barrier method
D. All of the above (Correct Answer)

Explanation: **Explanation:** The choice of contraception in a lactating mother depends primarily on the **timing postpartum** and the **effect of hormones on breast milk** (quantity and quality). 1. **Barrier Methods (Option C):** These are the safest and most preferred initial methods as they are non-hormonal and do not interfere with lactation. They can be started at any time postpartum. 2. **Mini Pill / Progesterone Only Pill (Option B):** POPs are the hormonal method of choice during lactation. Unlike estrogen, progesterone does not suppress milk production. According to WHO MEC criteria, they can be started after 6 weeks postpartum in breastfeeding women (though many guidelines allow earlier use). 3. **Combined Oral Contraceptive Pill (Option A):** While COCPs are generally avoided in the early postpartum period because estrogen can decrease milk volume and increase the risk of VTE, they are **not absolutely contraindicated** forever. Once lactation is well-established (usually after 6 months), COCPs can be prescribed if the mother desires, making them a valid "appropriate" option depending on the clinical timeline. Since all three methods can be used at different stages of the postpartum period, **"All of the above"** is the most appropriate answer. **High-Yield NEET-PG Pearls:** * **Lactational Amenorrhea Method (LAM):** Effective only if the mother is exclusively breastfeeding, is amenorrheic, and the baby is <6 months old. * **IUCD (Cu-T):** Can be inserted within 48 hours (Postpartum IUCD) or after 6 weeks (Interval IUCD). * **DMPA (Injectable):** Best started at 6 weeks postpartum to avoid theoretical concerns regarding neonatal liver metabolism of steroids. * **Ideal Time for Sterilization:** Minilap is ideally done 24 hours to 7 days postpartum.

Question 127: Which of the following situations is an exception where an Intrauterine Device (IUD) is NOT recommended for a woman?

A. Has one child
B. Has a normal menstrual cycle
C. Has access to follow-up care
D. Has multiple sexual partners (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Has multiple sexual partners** **Medical Concept:** The primary concern with Intrauterine Devices (IUDs) in women with multiple sexual partners is the increased risk of **Pelvic Inflammatory Disease (PID)**. While the IUD itself does not cause infection, it can facilitate the ascent of sexually transmitted infections (STIs)—specifically *Chlamydia trachomatis* and *Neisseria gonorrhoeae*—from the cervix into the upper genital tract. According to the WHO Medical Eligibility Criteria (MEC), a high individual risk of STIs is a **Category 3** contraindication (risks usually outweigh advantages) for IUD insertion. **Analysis of Incorrect Options:** * **A. Has one child:** Being parous is actually an indication for IUD use. While IUDs can be used in nulliparous women (MEC Category 2), they are technically easier to insert and better tolerated in women who have already had a child. * **B. Has a normal menstrual cycle:** A normal cycle is an ideal baseline for IUD insertion. However, if a woman has heavy menstrual bleeding (menorrhagia), a Copper-T might be avoided, but a Levonorgestrel-releasing IUD (LNG-IUS/Mirena) would be the treatment of choice. * **C. Has access to follow-up care:** This is a prerequisite for safe IUD use. Patients must be able to return for a post-insertion check (usually after the first menses) to ensure the device is in place and to screen for early signs of infection or expulsion. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate for IUD:** A parous woman in a stable monogamous relationship (low STI risk). * **Insertion Timing:** Most commonly done during menstruation (to ensure the patient is not pregnant and because the cervix is slightly dilated). * **PID Risk:** The risk of PID is highest in the first **20 days** post-insertion, usually due to pre-existing asymptomatic infection. * **Absolute Contraindications (MEC 4):** Current PID, unexplained vaginal bleeding, distorted uterine cavity (fibroids), and current cervical/endometrial cancer.

Question 128: What is the failure rate after tubal sterilization using the Pomeroy technique?

A. Zero
B. 0.10%
C. 0.40% (Correct Answer)
D. 1.00%

Explanation: The **Pomeroy technique** is the most commonly used method for female tubal sterilization due to its simplicity and efficacy. It involves lifting a loop of the mid-portion of the fallopian tube, ligating the base with absorbable suture (plain catgut), and resecting the loop. ### Why 0.40% is Correct The failure rate of the Pomeroy technique is approximately **0.4% (or 1 in 250 cases)**. The underlying medical concept relies on the use of **absorbable sutures**. As the suture is absorbed, the two cut ends of the tube pull apart and undergo fibrosis (peritonealization), creating a gap that prevents recanalization. If non-absorbable sutures were used, they would cause chronic inflammation and potentially lead to fistula formation, increasing the risk of failure. ### Explanation of Incorrect Options * **A. Zero:** No contraceptive method, including sterilization, is 100% effective. Failures can occur due to recanalization, luteal phase pregnancy, or surgical error. * **B. 0.10%:** This rate is too low for the Pomeroy method. However, it is closer to the failure rate of **Vasectomy** (approx. 0.1–0.15%). * **D. 1.00%:** This is higher than the standard reported failure rate for the Pomeroy technique. A 1% failure rate is more characteristic of methods like the Madlener technique (which uses non-absorbable sutures without resection). ### High-Yield Clinical Pearls for NEET-PG * **Most common cause of failure:** Spontaneous recanalization or formation of a tuboperitoneal fistula. * **Ectopic Pregnancy Risk:** If a woman becomes pregnant after tubal sterilization, there is a high probability (approx. 30%) that it is an **ectopic pregnancy**. * **CREST Study:** This landmark study provides long-term failure rates for various methods; it notes that the **Unipolar Cautery** has the lowest failure rate, while the **Spring Clip (Hulka-Clemens)** has the highest. * **Irving Technique:** Has the lowest failure rate among surgical methods (near 0%) but is surgically more complex.

Question 129: Non-medicated Intrauterine Devices (IUDs) are called as?

A. 1st generation IUDs (Correct Answer)
B. 2nd generation IUDs
C. 3rd generation IUDs
D. Multi-load devices

Explanation: ### Explanation **Correct Option: A (1st generation IUDs)** Intrauterine devices are classified into generations based on their composition and mechanism of action. **1st generation IUDs** are **non-medicated, inert devices** typically made of polyethylene or other polymers. They act primarily by inducing a sterile inflammatory response (foreign body reaction) in the endometrium, which is spermicidal and prevents implantation. The most classic example is the **Lippes Loop**, which is S-shaped and contains barium sulfate for radiopacity. **Analysis of Incorrect Options:** * **B. 2nd generation IUDs:** These are **medicated devices containing copper** (e.g., Cu-T 200, Cu-T 380A, Multiload 250/375). The addition of copper increases contraceptive efficacy by enhancing the spermicidal effect. * **C. 3rd generation IUDs:** These are **hormone-releasing devices** (e.g., Progestasert, LNG-20/Mirena). They release levonorgestrel, which thickens cervical mucus and thins the endometrial lining. * **D. Multi-load devices:** These are specific types of 2nd generation copper IUDs characterized by flexible side arms that reduce the risk of expulsion. **High-Yield Clinical Pearls for NEET-PG:** * **Lippes Loop:** The most common 1st generation IUD; it is no longer the first line due to higher rates of bleeding and expulsion compared to newer generations. * **Cu-T 380A (ParaGard):** The current "Gold Standard" copper IUD; it is effective for **10 years**. * **Mirena (LNG-20):** The 3rd generation IUD of choice for **Menorrhagia** (DUB) and provides protection for **5 years**. * **Mechanism of Action:** All IUDs primarily act by preventing fertilization (pre-conceptive), not as abortifacients.

Question 130: What is the main mechanism of combined oral contraceptive pills (OCPs)?

A. Feedback inhibition of the pituitary, preventing the LH surge (Correct Answer)
B. Changes in cervical mucus
C. Decreased motility and secretion of the fallopian tube
D. Prevention of ovulation

Explanation: **Explanation:** The primary mechanism of action for Combined Oral Contraceptive Pills (COCPs) is the **prevention of ovulation** via the hypothalamic-pituitary-ovarian axis. COCPs contain both estrogen (usually ethinyl estradiol) and progestogen. 1. **Why Option A is correct:** The exogenous estrogen and progesterone provide negative feedback to the hypothalamus and anterior pituitary. This suppresses the release of GnRH, FSH, and LH. Specifically, the suppression of the **LH surge** is the definitive step that prevents ovulation. Without the LH surge, the dominant follicle cannot rupture. 2. **Why Options B and C are incorrect:** While COCPs do cause thickening of cervical mucus (making it hostile to sperm) and alter fallopian tube motility, these are considered **secondary/peripheral mechanisms**. They provide "back-up" protection but are not the *main* mechanism. 3. **Why Option D is incorrect:** While "Prevention of Ovulation" is technically what happens, in medical competitive exams like NEET-PG, you must choose the **most specific physiological process**. Option A describes the *mechanism* (feedback inhibition of LH surge), whereas Option D describes the *result*. **High-Yield Clinical Pearls for NEET-PG:** * **Progesterone component:** Primarily responsible for preventing ovulation (inhibits LH) and thickening cervical mucus. * **Estrogen component:** Primarily inhibits FSH (preventing follicular development) and provides cycle control (stabilizes the endometrium to prevent breakthrough bleeding). * **Pearl:** The most common cause of COCP failure is a "user failure" (missed pills), particularly at the beginning or end of the pill-free interval. * **Ideal Candidate:** Best for spacing births in young, non-smoker women without hypertension or history of thromboembolism.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

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