Contraception and Family Planning Practice Questions

Q: A 25-year-old lady is undergoing manual vacuum aspiration for an unplanned conception. The maximum negative pressure generated during the procedure is: (DNB Pattern 2018)

400-600 mm Hg. ***400-600 mm Hg*** - This range of negative pressure is typically generated during **manual vacuum aspiration (MVA)**, which is depicted in the image. MVA is a common method for early pregnancy termination. - The MVA syringe creates a vacuum for aspiration of uterine contents, and this pressure range is effective for safe and complete evacuation. *100-200 mm Hg* - This pressure range is generally **too low** for effective and complete uterine aspiration in an MVA procedure. - Insufficient vacuum may lead to incomplete abortion, requiring further intervention. *200-400 mm Hg* - While higher than 100-200 mm Hg, this range might still be **suboptimal** for ensuring complete removal of uterine contents during MVA. - The generally accepted effective pressure is higher to maximize success rates and minimize complications. *600-800 mm Hg* - This pressure range is typically **higher than necessary** for MVA and could potentially increase the risk of uterine injury or perforation. - Excessive vacuum pressure is not associated with improved outcomes and may be more dangerous.

Q: Aspiration with the instrument shown is termed menstrual regulation when performed within how many days of a missed period?

14 days. ***14 days*** - This procedure is known as **menstrual regulation**, defined as uterine aspiration performed within **14 days** of a missed period in a woman with previously regular cycles. - Manual vacuum aspiration (MVA) is the instrument used to perform this early uterine cavity aspiration. *28 days* - 28 days after a missed period corresponds to approximately **8 weeks of gestation**. - This is beyond the conventional window for menstrual regulation, which is limited to within 14 days of a missed period. *42 days* - 42 days after a missed period corresponds to approximately **10 weeks of gestation**. - At this stage, the pregnancy is more advanced and falls outside the definition of menstrual regulation. *72 days* - 72 days after a missed period corresponds to approximately **14 weeks of gestation**. - This represents a more advanced pregnancy, well beyond the window for menstrual regulation.

Q: The sterilization method shown here is known as: (DNB Pattern 2018)

Tubal occlusion by hysteroscopic sterilization. ***Tubal occlusion by hysteroscopic sterilization*** - The image depicts a device inserted into the **fallopian tube** via a hysteroscopic approach to cause permanent **occlusion**. - This method involves placing small coils that induce an inflammatory reaction, leading to **fibrosis** and blockage of the tubes, preventing spermatozoa from reaching the ovum. Note that device-related adverse effects — including chronic pelvic pain, hypersensitivity reactions, and device migration — have been reported and contributed to safety concerns. - **Historical note:** Hysteroscopic coil sterilization devices (e.g., Essure) have been withdrawn or discontinued in many markets due to safety concerns and should not be inferred as a routine current sterilization option. *Tubal ligation* - This method involves **surgically cutting, tying, blocking, or sealing** the fallopian tubes, typically performed via laparoscopy or minilaparotomy. - The image does not show a surgical incision or a ligated/cut segment of the fallopian tube. *Vasectomy* - **Vasectomy** is a male sterilization procedure involving the cutting or sealing of the **vas deferens** to prevent sperm from entering the seminal fluid. - The image clearly shows a portion of the female reproductive system, specifically the uterus and fallopian tube. *Intrauterine device (IUD) insertion* - An **IUD** is a small, T-shaped device inserted into the **uterus** to prevent pregnancy, either by releasing copper or hormones. - The device in the image is placed inside the fallopian tube, not within the main uterine cavity, and its morphology does not resemble a typical IUD.

Q: The most popular technique of tubal ligation is :

Pomeroy Technique. ***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.

Q: 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:

1, 3 and 4. ***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.

Q: 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 ?

Nexplanon. ***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.

Q: Indication for removal of IUDs include which of the following ? 1. Perforation of uterus 2. Pregnancy with device in situ 3. One year after menopause 4. Persistent migraine Select the correct answer using the code given below :

1, 2 and 4. ***Correct Answer: 1, 2 and 4*** **Statement 1 - Perforation of uterus:** ✅ **Valid indication** - Uterine perforation is a serious complication where the IUD punctures the uterine wall - This is an **absolute indication** for immediate removal to prevent further damage, infection, or injury to adjacent organs - Requires prompt surgical intervention **Statement 2 - Pregnancy with device in situ:** ✅ **Valid indication** - IUD should be removed if the strings are visible and removal is feasible - Removal reduces risks of **spontaneous abortion** (50% vs 25%), **septic abortion**, **preterm labor**, and **chorioamnionitis** - If strings are not visible, removal attempts may cause more harm than leaving it in place **Statement 4 - Persistent migraine:** ✅ **Valid indication (especially for hormonal IUDs)** - Relevant primarily for **levonorgestrel-releasing IUDs** (LNG-IUS) - Some women experience exacerbated or new-onset migraines due to hormonal fluctuations - Persistent or worsening migraines, especially **migraines with aura**, may warrant IUD removal - Less relevant for copper IUDs which have no hormonal effects *Statement 3 - One year after menopause:* ❌ **NOT an absolute indication** - While general guidelines suggest removal 1 year after menopause (if inserted after age 40), this is **NOT mandatory** - **Copper IUDs** can remain in place until age 55 if inserted after age 40, providing continued contraception - **LNG-IUS** may be retained for **endometrial protection** in women receiving estrogen replacement therapy - Removal is only necessary if the device is past its effective lifespan or causing symptoms - The decision should be individualized based on patient circumstances

Q: How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?

4. **4** - **Extended continuous regimens** of combined oral contraceptive pills typically involve taking active pills for 84 days, followed by a 7-day placebo or hormone-free interval. - This regimen results in **four withdrawal bleeds per year**, as opposed to thirteen for conventional cyclic regimens. *6* - This frequency of withdrawal bleeding would be more common with regimens that have shorter active pill cycles, such as 21 days active with 7 days off, but not with typical extended continuous use. - While some custom regimens might approach this frequency, it is not the standard for "extended continuous" which aims to reduce bleeding frequency. *3* - A frequency of three withdrawal bleeds per year would imply a longer continuous active pill phase than the typical 84 days, such as 112 days on active pills followed by a 7-day break. - While such regimens exist, they are less commonly described as the standard "extended continuous" which typically refers to the 84/7 day cycle. *5* - Five withdrawal bleeds per year is not a standard frequency for either conventional cyclic or typical extended continuous oral contraceptive regimens. - It would require an unusual cycle length for active pills and break days that does not correspond to common prescribing patterns.

Q: Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ? 1. Copper-T 380A 2. Implants 3. LNG-IUS Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Long-acting reversible contraceptives (LARCs)** include all methods that are effective for an extended period, do not require daily attention, and are reversible. The **Copper-T 380A intra-uterine device (IUD)**, **subdermal implants**, and the **levonorgestrel-releasing intra-uterine system (LNG-IUS)** all fit this description. - These methods are highly effective due to minimal user error and provide contraception for several years, making them ideal for long-term birth control. *1 and 3 only* - This option incorrectly excludes **implants**, which are a well-established and highly effective form of LARC, offering contraception for up to three years. - While Copper-T 380A and LNG-IUS are indeed LARCs, the exclusion of implants makes this option incomplete. *1 and 2 only* - This option incorrectly excludes the **levonorgestrel-releasing intra-uterine system (LNG-IUS)**, which is an increasingly popular and effective LARC, providing contraception for up to five years. - The LNG-IUS is a hormonal LARC often used for both contraception and managing heavy menstrual bleeding. *2 and 3 only* - This option incorrectly excludes the **Copper-T 380A IUD**, which is a non-hormonal LARC. - The Copper-T 380A is one of the most widely used LARCs globally, offering highly effective contraception for up to ten years.

Question 1

A 25-year-old lady is undergoing manual vacuum aspiration for an unplanned conception. The maximum negative pressure generated during the procedure is: (DNB Pattern 2018)

Accepted Answer

400-600 mm Hg

Answer

600-800 mm Hg

Answer

100-200 mm Hg

Answer

200-400 mm Hg

Question 2

Aspiration with the instrument shown is termed menstrual regulation when performed within how many days of a missed period?

Accepted Answer

14 days

Answer

28 days

Answer

42 days

Answer

72 days

Question 3

The sterilization method shown here is known as: (DNB Pattern 2018)

Accepted Answer

Tubal occlusion by hysteroscopic sterilization

Answer

Tubal ligation

Answer

Vasectomy

Answer

Intrauterine device (IUD) insertion

Question 4

The most popular technique of tubal ligation is :

Accepted Answer

Pomeroy Technique

Answer

Madlener Operation

Answer

Uchida method

Answer

Cornual resection

Question 5

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:

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 6

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 ?

Accepted Answer

Nexplanon

Answer

Combined oral contraceptives

Answer

Diaphragm

Answer

Chhaya

Question 7

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 :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 8

Indication for removal of IUDs include which of the following ?

1. Perforation of uterus
2. Pregnancy with device in situ
3. One year after menopause
4. Persistent migraine

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1 and 3 only

Question 9

How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?

Accepted Answer

4

Answer

6

Answer

3

Answer

5

Question 10

Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ?

1. Copper-T 380A 
2. Implants 
3. LNG-IUS

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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