Contraception and Family Planning Practice Questions

Q: A woman using combined oral contraceptive has the following non contraceptive benefits except:

Protection against cervical cancer. ***Protection against cervical cancer*** - Combined oral contraceptives (COCs) have been shown to **increase the risk of cervical cancer**, not protect against it. - This increased risk is thought to be related to persistent **HPV infection** in women using COCs for extended periods. *Protection against PID* - COCs **thicken cervical mucus**, which acts as a barrier, reducing the ascent of bacteria and thus offering some protection against **Pelvic Inflammatory Disease (PID)**. - This effect is a non-contraceptive benefit of COC use. *Protection against ovarian cancer* - The suppression of ovulation by COCs significantly **reduces the risk of ovarian cancer**, with the protective effect increasing with longer duration of use. - This protective effect is one of the well-established non-contraceptive benefits. *Prevention of colorectal malignancy* - Some studies suggest that COCs may offer a **protective effect against colorectal cancer**, although this benefit is less consistently demonstrated compared to ovarian cancer protection. - This is considered a potential non-contraceptive benefit.

Q: Contraceptive options for a 28 year old woman who is breastfeeding a six week old baby, wanting to avoid pregnancy for a longer interval are the following except:

Combined oral contraceptives. ***Combined oral contraceptives*** - **Combined oral contraceptives (COCs)** contain both estrogen and progestin, and the **estrogen component** can reduce milk supply in breastfeeding mothers. - According to WHO Medical Eligibility Criteria, COCs are **Category 4 (unacceptable health risk)** for breastfeeding women <6 weeks postpartum and **Category 3 (risks usually outweigh benefits)** from 6 weeks to <6 months postpartum. - At **6 weeks postpartum**, while technically transitioning from absolute contraindication, COCs remain **not recommended** for breastfeeding women due to potential negative effects on lactation. - Among the options listed, this is the **least suitable** choice for this patient. *IUD- 380A* - The **copper-containing IUD (Cu-380A)** is a highly effective, non-hormonal contraceptive option that can be safely used postpartum, even while breastfeeding. - It does not affect milk supply or composition, making it an excellent choice for long-term contraception. - **WHO MEC Category 1** (no restriction) for breastfeeding women. *LNG-IUD* - The **levonorgestrel-releasing intrauterine device (LNG-IUD)** is a safe and effective hormonal contraceptive for breastfeeding women. - The **progestin** released locally has minimal systemic absorption and generally does not affect milk production or infant health. - **WHO MEC Category 2** (advantages generally outweigh risks) for breastfeeding women at 6 weeks postpartum. *Implanon* - **Implanon (etonogestrel implant)** is a **progestin-only** contraceptive implant that is highly effective and safe for use during breastfeeding. - It does not interfere with milk supply and provides long-acting contraception (up to 3 years). - **WHO MEC Category 2** for breastfeeding women, making it another excellent choice for this patient.

Q: Consider the following statements regarding MTP (Medical Termination of Pregnancy): 1. Suction and evacuation can be done up till 12 weeks. 2. Medical methods can be used up till 10 weeks 3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks Which of the statements given above is/are correct?

2 only. **2 only** - **Medical methods** for abortion, primarily using medications like **mifepristone** and **misoprostol**, are generally recommended and most effective for pregnancies up to **10 weeks of gestation**. - Beyond 10 weeks, the success rate decreases, and the risk of complications increases, making surgical methods more appropriate. *1 only* - **Suction and evacuation**, also known as **vacuum aspiration**, is a surgical method typically performed for pregnancies up to **14-16 weeks** of gestation, not limited to 12 weeks. - After 12 weeks, the procedure may be referred to as D&C (dilation and curettage) or D&E (dilation and evacuation), depending on the gestational age and technique used. *2 and 3* - While statement 2 is correct, statement 3 is incorrect because **Manual Vacuum Aspiration (MVA)** using a syringe can be safely and effectively used for pregnancies up to **10-12 weeks** of gestation, not just up to 6 weeks. - MVA is a versatile and often preferred method for early pregnancy termination due to its simplicity and effectiveness. *1 and 3* - Both statements 1 and 3 are incorrect in their specified gestational limits. Suction and evacuation can be performed beyond 12 weeks, and MVA can be used beyond 6 weeks, up to 10-12 weeks.

Q: Which of the following is NOT a method of second Trimester abortion?

Intra-amniotic KCl instillation. ***Intra-amniotic KCl instillation*** - Intra-amniotic KCl instillation is **NOT an abortion method** but rather a **feticide procedure** used to induce fetal demise before the actual termination. - It involves injecting potassium chloride directly into the fetal heart or amniotic sac to cause fetal asystole, and **must be followed by another method** (medical induction or D&E) to complete the abortion. - It is used primarily in **late second trimester and beyond** when legally or ethically required to ensure fetal demise prior to expulsion, but is **not a standalone abortion method**. *Hysterotomy* - Hysterotomy is a **surgical method** of abortion that involves making an incision in the uterus (similar to cesarean section) to remove the fetus. - While rarely used today due to **higher maternal morbidity** compared to D&E or medical methods, it **remains a recognized second-trimester abortion method**. - It may be considered in specific situations such as failed medical abortion, cervical pathology preventing D&E, or when other methods are contraindicated. *Mifepristone and PGE1* - This combination is a **standard medical abortion method** for the second trimester. - Mifepristone (antiprogestogen) sensitizes the uterus to prostaglandins, and PGE1 (misoprostol) induces uterine contractions and cervical ripening. - It is **safe, effective, and commonly used** for second-trimester medical termination. *PGE2 analog* - **Prostaglandin E2 analogs** (such as dinoprostone) are established methods for second-trimester abortion. - They induce uterine contractions and cervical ripening, and can be administered vaginally, extra-amniotically, or intravenously. - They are a **standard medical induction method** for second-trimester termination.

Q: Which one of the following is NOT an emergency contraception method?

Norplant. ***Norplant*** - **Norplant** is a brand name for a **subdermal implant** that provides long-term contraception (up to 5 years) and is not used as an emergency method. - Its mechanism involves the continuous release of a progestin, thereby inhibiting ovulation and thickening cervical mucus over an extended period. *Levonorgestrel* - **Levonorgestrel** is a common and effective form of **emergency contraception**, taken as a single dose or two doses within 72-120 hours of unprotected intercourse. - It works primarily by inhibiting or delaying **ovulation** and preventing fertilization, not by inducing abortion. *Intra uterine contraceptive device* - The **copper intrauterine device (IUD)** is the most effective method of emergency contraception, effective up to 5 days after unprotected intercourse. - It primarily prevents implantation by causing a **spermicidal inflammatory reaction** within the uterus. *High dose oral contraceptive pill* - High-dose **combined oral contraceptive pills** ("Yuzpe method") can be used as emergency contraception, taken in two doses 12 hours apart within 72 hours of unprotected sex. - This method utilizes the **estrogen and progestin** in the pills to prevent ovulation and fertilization.

Q: Which one of the following clinical situations is NOT ideal to perform female sterilization procedure?

During active pelvic inflammatory disease. ***During active pelvic inflammatory disease*** - **Active infection** increases surgical risks, complications, and may worsen the existing **pelvic inflammatory disease**. - Standard medical practice requires **treating the infection first** before performing elective procedures like sterilization. *Postmenstrual period* - This is an **ideal time** for sterilization as the uterus is **atrophic** and there is high certainty that the woman is not pregnant. - The **risk of pregnancy** is minimal, and the procedure can be performed with greater safety and efficacy. *Concurrent with MTP* - Performing sterilization concurrently with **medical termination of pregnancy (MTP)** is **standard practice** and often advisable. - This approach ensures the woman is not pregnant and provides convenient **permanent contraception** without requiring an additional surgical procedure. *7 days postpartum* - The **immediate postpartum period** is an excellent time for female sterilization due to the enlarged uterus being easily palpated and **fallopian tubes** being readily accessible. - The woman is usually secure in her decision, and this timing allows for **one hospital stay** for both delivery and sterilization.

Q: Which of the following is an absolute contraindication for use of oral contraceptive pills?

Focal Migraine. ***Focal Migraine*** - A **focal migraine**, especially with aura, significantly increases the risk of **ischemic stroke** in women using combined oral contraceptives. - Due to the heightened risk of **thrombosis** associated with oral contraceptives, a history of focal migraine is considered an **absolute contraindication** (WHO MEC Category 4). *Epilepsy* - Epilepsy is generally not an absolute contraindication for oral contraceptive pills, though some **antiepileptic drugs** can reduce contraceptive efficacy due to **enzyme induction**. - Adjustments in contraceptive methods may be needed, but the condition itself does not make OCPs absolutely unsafe. *Bronchial Asthma* - Bronchial asthma is **not a contraindication** to the use of oral contraceptive pills. - There is no known interaction or increased risk of adverse events between OCPs and asthma. *Smoking* - **Smoking** in women **aged ≥35 years who smoke ≥15 cigarettes/day** is an **absolute contraindication** (WHO MEC Category 4) due to significantly increased risk of **cardiovascular events** including myocardial infarction and stroke. - In younger women or lighter smokers, it represents a **relative contraindication** (WHO MEC Category 2-3). - In the context of this question, **focal migraine** is the correct answer as it is an absolute contraindication regardless of age or severity, whereas smoking becomes absolute only in specific circumstances.

Q: Which of the following are absolute contraindications of Combined Oral Contraceptive (COCs)? 1. Arterial or venous thrombosis history 2. Severe hypertension 3. Gestational trophoblastic neoplasia 4. Diabetes with vascular complications

1, 2 and 4. ***1, 2 and 4*** - A history of **arterial or venous thrombosis** (e.g., deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction) is an absolute contraindication due to the increased risk of clotting associated with estrogen in COCs. - **Severe hypertension** (systolic ≥160 mmHg or diastolic ≥100 mmHg) is a contraindication because COCs can exacerbate blood pressure control and increase the risk of cardiovascular events. - **Diabetes with vascular complications** (e.g., nephropathy, retinopathy, neuropathy, macrovascular disease) indicates advanced microvascular or macrovascular disease, making COCs unsafe due to increased cardiovascular risk. *1, 3 and 4* - While a history of **arterial or venous thrombosis** and **diabetes with vascular complications** are absolute contraindications, **gestational trophoblastic neoplasia** itself is generally not an absolute contraindication to COCs once the disease is in remission or resolved. - The primary concern with gestational trophoblastic neoplasia is avoiding pregnancy during the monitoring period, for which COCs can be used, although other methods may be preferred. *2, 3 and 4* - **Severe hypertension** and **diabetes with vascular complications** are absolute contraindications, but **gestational trophoblastic neoplasia** is not. - The use of COCs in gestational trophoblastic neoplasia is generally considered acceptable after successful treatment and during the follow-up period to prevent pregnancy. *1, 2 and 3* - **Arterial or venous thrombosis history** and **severe hypertension** are absolute contraindications. - However, **gestational trophoblastic neoplasia** is not an absolute contraindication for COCs once the patient has been successfully treated and is being monitored.

Q: During Pomeroy’s method of female sterilization, which portion of tube is ligated?

Isthmo-ampullary. ***Isthmo-ampullary*** - In **Pomeroy's method** of female sterilization, a loop of fallopian tube is picked up at the **isthmo-ampullary junction** (junction of middle and outer third of the tube). - This mid-portion of the tube is elevated into a knuckle, ligated at its base with absorbable suture, and the loop above the ligature is excised. - The **isthmo-ampullary junction** is the classic site described in standard texts for Pomeroy's technique, as it provides adequate length for creating a loop while maintaining sufficient distance from the uterine cornua. *Isthmus* - While the isthmus may be partially involved in the loop, **Pomeroy's method specifically targets the isthmo-ampullary junction**, not the pure isthmic segment. - Ligation of the isthmus alone (too close to the uterus) would not be the standard Pomeroy's technique and could increase risk of complications. *Cornual* - The **cornual portion** refers to the interstitial part of the fallopian tube located within the uterine wall. - This segment is not targeted in Pomeroy's method due to increased risk of uterine injury and bleeding. - Cornual resection is a different surgical approach used in other sterilization techniques. *Ampullary* - The **ampulla** is the wider, lateral portion of the fallopian tube where fertilization typically occurs. - While the ampulla may form part of the loop in Pomeroy's method, the **ligation point** is specifically at the isthmo-ampullary junction, not in the pure ampullary segment. - Ligation too far laterally in the ampulla would not be standard Pomeroy's technique.

Question 1

Regimen for medical abortion upto 7 weeks of gestation as per Government of India guidelines includes:

Accepted Answer

200 mg of mifepristone on D1 followed by 800 µg of misoprostol on D3

Answer

400 mg of mifepristone on D1 followed by 400 µg of misoprostol on D3

Answer

400 mg of mifepristone on D1 followed by 800 µg of misoprostol on D3

Answer

200 mg of mifepristone on D1 followed by 400 µg of misoprostol on D3

Question 2

A woman using combined oral contraceptive has the following non contraceptive benefits except:

Accepted Answer

Protection against cervical cancer

Answer

Protection against PID

Answer

Protection against ovarian cancer

Answer

Prevention of colorectal malignancy

Question 3

Contraceptive options for a 28 year old woman who is breastfeeding a six week old baby, wanting to avoid pregnancy for a longer interval are the following except:

Accepted Answer

Combined oral contraceptives

Answer

IUD- 380A

Answer

LNG-IUD

Answer

Implanon

Question 4

Consider the following statements regarding MTP (Medical Termination of Pregnancy):

1. Suction and evacuation can be done up till 12 weeks.
2. Medical methods can be used up till 10 weeks
3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks
Which of the statements given above is/are correct?

Accepted Answer

2 only

Answer

1 only

Answer

2 and 3

Answer

1 and 3

Question 5

Which of the following is NOT a method of second Trimester abortion?

Accepted Answer

Intra-amniotic KCl instillation

Answer

Hysterotomy

Answer

Mifepristone and PGE1

Answer

PGE2 analog

Question 6

Which one of the following is NOT an emergency contraception method?

Accepted Answer

Norplant

Answer

Levenorgestrel

Answer

Intra uterine contraceptive device

Answer

High dose oral contraceptive pill

Question 7

Which one of the following clinical situations is NOT ideal to perform female sterilization procedure?

Accepted Answer

During active pelvic inflammatory disease

Answer

Postmenstrual period

Answer

Concurrent with MTP

Answer

7 days postpartum

Question 8

Which of the following is an absolute contraindication for use of oral contraceptive pills?

Accepted Answer

Focal Migraine

Answer

Epilepsy

Answer

Bronchial Asthma

Answer

Smoking

Question 9

Which of the following are absolute contraindications of Combined Oral Contraceptive (COCs)?

1. Arterial or venous thrombosis history
2. Severe hypertension
3. Gestational trophoblastic neoplasia
4. Diabetes with vascular complications

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 10

During Pomeroy’s method of female sterilization, which portion of tube is ligated?

Accepted Answer

Isthmo-ampullary

Answer

Cornual

Answer

Ampullary

Answer

Isthmus

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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