Contraception and Family Planning Practice Questions

Q: The contraindications for Progestasert include the following except

Previous history of abortion. ***Previous history of abortion*** - A prior history of abortion is generally **not a contraindication** for the insertion of a progestogen-releasing intrauterine device (Progestaert or similar IUDs). - The risk of complications like infection or perforation is not significantly increased in women with a history of abortion, especially if it was a safe procedure. *Previous history of ectopic pregnancy* - A history of **ectopic pregnancy** is a **relative contraindication** for progestogen-only IUDs, as these devices primarily prevent intrauterine pregnancy but can marginally increase the risk of ectopic pregnancy if conception occurs. - While IUDs are highly effective at preventing pregnancy overall, if a pregnancy does occur with an IUD in place, there is a higher chance it will be ectopic. *Pelvic Inflammatory Disease* - **Active or recent Pelvic Inflammatory Disease (PID)** is a **strong contraindication** for IUD insertion due to the increased risk of ascending infection and exacerbation of the condition. - IUD insertion can potentially introduce bacteria into the uterus, worsening an existing infection or causing a new one if the patient is at high risk. *Uterine fibroids* - **Large or distorting uterine fibroids** can be a **contraindication** for IUD insertion, especially if they alter the uterine cavity significantly. - Fibroids can make IUD insertion difficult, increase the risk of perforation, and compromise the effectiveness of the device by preventing proper placement or causing expulsion.

Q: Hormonal contraceptives are contraindicated in women

who have thromboembolic disorders. **who have thromboembolic disorders** - **Estrogen** components of hormonal contraceptives increase the risk of **venous thromboembolism** (VTE), including deep vein thrombosis and pulmonary embolism, especially in women with pre-existing clotting disorders or risk factors. - This increased risk is a major contraindication due to the potential for serious, life-threatening complications. *less than 25 years of age* - Age itself is not a contraindication for hormonal contraceptive use; many young women use them safely and effectively. - The **risk of VTE** from hormonal contraceptives is generally lower in younger women compared to older women, especially those over 35 years old and who smoke. *who are normotensive* - **Normotension** is a normal blood pressure reading, which is not a contraindication for hormonal contraceptive use. - In fact, women with well-controlled hypertension may use some hormonal contraceptives, although close monitoring is often required. *who have anaemia* - **Anemia** is not a contraindication to hormonal contraceptive use and, in some cases, can even be improved by them. - Hormonal contraceptives can reduce menstrual blood loss, thereby potentially improving or preventing **iron-deficiency anemia**.

Q: What is the sequence of events in termination of pregnancy by medical method?

Mifepristone — Misoprostol — Bleeding — USG. ***Mifepristone — Misoprostol — Bleeding — USG*** - The process begins with **mifepristone**, a progesterone receptor antagonist that **blocks progesterone action**, leading to **cervical softening** and **sensitization of the uterus to prostaglandins**. - This is followed by **misoprostol** (24-48 hours later), a prostaglandin analogue, which **induces uterine contractions** and causes **expulsion of uterine contents**, leading to bleeding. A follow-up **ultrasound (USG)** after 2 weeks confirms completion. *Mifepristone — Misoprostol — USG — Bleeding* - While mifepristone and misoprostol are correctly sequenced, the **bleeding** typically occurs *before* the follow-up ultrasound, as it's the clinical sign of successful expulsion. - The ultrasound would be performed *after* the expected expulsion and bleeding to confirm complete termination and rule out complications. *Misoprostol — Mifepristone — USG — Bleeding* - This sequence is incorrect because **mifepristone must be given first** to block progesterone and prepare the uterus. - Administering **misoprostol before mifepristone** would be less effective as the uterus would not be primed for cervical softening and increased sensitivity to prostaglandins. *Mifepristone — Bleeding — Misoprostol — USG* - While mifepristone is given first, **significant bleeding** typically occurs *after* the administration of misoprostol, which actively induces contractions and expels the uterine contents. - This sequence incorrectly places **bleeding before misoprostol**, implying it happens immediately after mifepristone alone, which is not the typical response.

Q: Mini pill should be started on the

first day of the cycle. ***first day of the cycle*** - Starting the **mini-pill** (progestin-only pill) on the **first day of the menstrual cycle** ensures **immediate contraceptive protection** without need for backup contraception. - Current guidelines allow starting within the **first 5 days of the cycle** for immediate protection, but day 1 is the most conservative and traditional recommendation. - The mini-pill works primarily through **cervical mucus thickening** (which occurs within 48 hours) and may inconsistently suppress ovulation in some women. *fifth day of the cycle* - Starting on the fifth day of the cycle **can still provide immediate protection** according to current guidelines, as it falls within the acceptable first 5-day window. - However, for maximum certainty and following traditional teaching, day 1 remains the preferred recommendation. - If started after day 5, **backup contraception for 48 hours** would be needed. *second day of the cycle* - Starting on the second day falls within the **first 5 days of the cycle** and provides immediate contraceptive protection according to current evidence-based guidelines. - The **first day** is traditionally emphasized in older guidelines and remains the most conservative approach. - No backup contraception needed when started within this timeframe. *third day of the cycle* - Starting on the third day is within the **first 5-day window** where immediate protection is achieved. - However, traditional teaching (especially relevant for this 2010 exam question) emphasized starting on **day 1** for optimal compliance and immediate efficacy. - Modern guidelines confirm no backup needed if started within first 5 days of true menstrual bleeding.

Q: The following are the contra-indications to the use of combined oral contraceptive pills, except

bronchial asthma. ***bronchial asthma*** - **Bronchial asthma** is not a contraindication for the use of combined oral contraceptive pills (COCs). COCs do not worsen asthma symptoms or increase the risk of asthma exacerbations. - While some medications can interact with asthma treatment, COCs generally have no significant adverse effects on respiratory function or asthma management. *active viral hepatitis* - **Active viral hepatitis** is a contraindication because COCs are metabolized in the liver, and their use could further impair liver function in a patient with active inflammation. - The liver is crucial for metabolizing estrogens and progestins, and compromised liver function can lead to altered drug levels and increased risk of adverse effects. *history of deep venous thrombosis* - A **history of deep venous thrombosis (DVT)** is a significant contraindication due to the increased risk of **thromboembolism** associated with combined oral contraceptive pills. - Estrogen components in COCs can increase the synthesis of clotting factors and decrease natural anticoagulants, raising the risk of future thrombotic events. *breastfeeding* - **Breastfeeding**, especially during the first six weeks postpartum, is a relative contraindication for combined oral contraceptive pills. - Estrogen in COCs can reduce milk supply and potentially pass into breast milk, affecting the infant. Progestin-only contraceptives are generally preferred for breastfeeding mothers.

Q: Worldwide, which is the most commonly used copper-bearing intrauterine contraceptive device?

Copper T-380. ***Copper T-380*** - The **Copper T-380A (ParaGard)** is the most widely used and effective non-hormonal IUD globally. - Its **380 mm² copper surface area** provides high contraceptive efficacy for up to 10 years. *Copper-7* - This was an earlier generation copper IUD with a **smaller copper surface area** and a distinct 7-shaped design. - It had a higher expulsion rate and was **largely replaced** by more effective T-shaped devices. *GyneFix* - **GyneFix** is a frameless copper IUD consisting of copper sleeves on a surgical thread, which is knotted into the uterine fundus. - While effective, its market penetration and global usage are **significantly less** compared to the Copper T-380. *Copper T-200* - The **Copper T-200** was an earlier T-shaped copper IUD with **200 mm² of copper surface area**. - It had a **shorter lifespan** and lower efficacy compared to the T-380, leading to its obsolescence in many regions.

Q: In a lady with a regular 28-day menstrual cycle, what is the 'safe period'?

First and last seven days. ***First and last seven days*** - In a typical 28-day cycle, **ovulation** usually occurs around day 14. Sperm can survive for up to 5 days, and the egg is viable for about 24 hours. Therefore, avoiding unprotected intercourse from approximately day 7 to day 19 would be considered within the fertile window. The "safe period" refers to days with a lower probability of conception. - The **first seven days** (including menstruation) and the **last seven days** (preceding the next menstrual period) are generally considered the least fertile times, as they are furthest from ovulation. *Initial 14 days* - This period includes the follicular phase, leading up to and including **ovulation**. - The **fertile window** typically encompasses several days before ovulation, the day of ovulation, and the day after, making the initial 14 days a high-risk period, not a safe one. *Later 14 days* - This period includes the **luteal phase** after ovulation has occurred. - While the latter part of this period (days 21-28) is generally less fertile, the days immediately following ovulation (around days 15-18) still carry a risk of conception if the egg is viable or if ovulation was delayed. *First seven days only* - While the first seven days are generally considered a **low-risk period**, relying solely on this neglects the increased risk shortly before and during ovulation. - This option only covers a portion of the "safe period" and does not account for the reduced fertility towards the end of the menstrual cycle.

Q: Combined contraceptive pills give protection from the following EXCEPT:

Cancer of cervix. ***Cancer of cervix*** - Combined oral contraceptives (COCs) do not protect against **cervical cancer**; in fact, long-term use is associated with a slightly **increased risk**, potentially due to increased exposure to **HPV** or hormonal effects on the cervix. - The primary protection against cervical cancer is **HPV vaccination** and regular **cervical screening** (Pap smears). *Cancer of endometrium* - COCs provide significant protection against **endometrial cancer** by causing endometrial atrophy and suppressing cell proliferation, which mitigates the risk posed by unopposed estrogen. - This protective effect is observed even after discontinuing COCs. *Cancer of ovary* - COCs significantly reduce the risk of **ovarian cancer**, particularly epithelial ovarian cancer, through the suppression of ovulation. - The protective effect increases with the duration of COC use and can persist for many years after discontinuation. *Ectopic pregnancy* - COCs are highly effective in preventing **pregnancy** altogether, thereby drastically reducing the risk of both uterine and **ectopic pregnancies**. - While not 100% effective, their contraceptive action makes ectopic pregnancy very rare in users compared to non-users.

Q: Which one of the following is the best contraceptive for a newly married couple who wants to postpone pregnancy for one year?

Combined oral contraceptives. ***Combined oral contraceptives*** - **Combined oral contraceptives (COCs)** offer highly effective, reversible contraception suitable for postponing pregnancy for a specific period like one year. - They provide consistent hormonal regulation, leading to **predictable menstrual cycles** and potential non-contraceptive benefits like reduced dysmenorrhea and acne. - **Easy to initiate and discontinue** without any procedure, which may be preferred by newly married couples. - Typical use effectiveness is around **91%**, with perfect use approaching 99%. *Safe period method* - The **safe period method (rhythm method or natural family planning)** relies on tracking the menstrual cycle to identify fertile days, which is generally considered less reliable for couples prioritizing pregnancy postponement. - Its effectiveness is highly dependent on a **regular menstrual cycle** and strict adherence, making its typical use failure rate higher (12-24%). *Condom with spermicidal cream* - While **condoms with spermicidal cream** offer protection against both pregnancy and sexually transmitted infections, their effectiveness is lower than hormonal methods for preventing pregnancy. - Their typical use **failure rate is around 18%**, which might not be ideal for a couple committed to postponing pregnancy for a full year. *Intrauterine contraceptive device* - An **intrauterine contraceptive device (IUD)** is a highly effective, long-acting reversible contraceptive with >99% effectiveness. - While medically appropriate for any duration including one year, it requires an **insertion procedure** which some newly married couples may prefer to avoid. - For couples seeking **non-invasive contraception** with easier initiation and the flexibility to discontinue without a procedure, COCs may be more acceptable despite slightly lower typical use effectiveness.

Question 1

What is the recommendation for use of Levonorgestrel for the purpose of emergency contraception ?

Accepted Answer

Two tablets of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 96 hours

Answer

One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 72 hours

Answer

None of the options

Answer

One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 120 hours

Question 2

The contraindications for Progestasert include the following except

Accepted Answer

Previous history of abortion

Answer

Previous history of ectopic pregnancy

Answer

Pelvic Inflammatory Disease

Answer

Uterine fibroids

Question 3

Hormonal contraceptives are contraindicated in women

Accepted Answer

who have thromboembolic disorders

Answer

less than 25 years of age

Answer

who are normotensive

Answer

who have anaemia

Question 4

What is the sequence of events in termination of pregnancy by medical method?

Accepted Answer

Mifepristone — Misoprostol — Bleeding — USG

Answer

Mifepristone — Misoprostol — USG — Bleeding

Answer

Misoprostol — Mifepristone — USG — Bleeding

Answer

Mifepristone — Bleeding — Misoprostol — USG

Question 5

Mini pill should be started on the

Accepted Answer

first day of the cycle

Answer

fifth day of the cycle

Answer

second day of the cycle

Answer

third day of the cycle

Question 6

The following are the contra-indications to the use of combined oral contraceptive pills, except

Accepted Answer

bronchial asthma

Answer

active viral hepatitis

Answer

history of deep venous thrombosis

Answer

breastfeeding

Question 7

Worldwide, which is the most commonly used copper-bearing intrauterine contraceptive device?

Accepted Answer

Copper T-380

Answer

Copper-7

Answer

GyneFix

Answer

Copper T-200

Question 8

In a lady with a regular 28-day menstrual cycle, what is the 'safe period'?

Accepted Answer

First and last seven days

Answer

Initial 14 days

Answer

Later 14 days

Answer

First seven days only

Question 9

Combined contraceptive pills give protection from the following EXCEPT:

Accepted Answer

Cancer of cervix

Answer

Cancer of endometrium

Answer

Cancer of ovary

Answer

Ectopic pregnancy

Question 10

Which one of the following is the best contraceptive for a newly married couple who wants to postpone pregnancy for one year?

Accepted Answer

Combined oral contraceptives

Answer

Safe period method

Answer

Condom with spermicidal cream

Answer

Intrauterine contraceptive device

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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