Contraception and Family Planning Practice Questions

Q: Tubectomy is typically performed on which part of the fallopian tube and why?

Isthmus - narrowest. ***Isthmus - narrowest*** - The **isthmus** is preferred for tubectomy because its **narrowest diameter** and thick muscular wall make it easier to ligate and minimize recanalization. - Its narrow lumen also reduces the chances of spontaneous rejoining and pregnancy, ensuring a more effective and permanent sterilization. *Ampulla - uniform thickness of muscle* - The **ampulla** is a wider, more distensible part of the fallopian tube, making it **less suitable for ligation** due to a higher risk of recanalization. - While tubular muscle thickness is a factor, the **ampulla's larger lumen** makes it less ideal for effective and permanent occlusion compared to the isthmus. *Ampulla - widest* - The **ampulla's wider diameter** increases the technical difficulty of creating a secure and permanent occlusion, as ligating a broad segment is less effective. - A wider lumen makes **spontaneous recanalization** more likely, compromising the contraceptive efficacy of the procedure. *Isthmus - uniform thickness of muscle* - While the isthmus does have a relatively **uniform and thick muscular wall**, it is the **narrowness of the lumen** that is the primary reason for its selection in tubectomy. - The consistency of its muscle is a contributing factor to its robustness, but the **small caliber** is key to preventing recanalization.

Q: All of the following can be used in first-trimester medical termination of pregnancy (MTP), except

Extra-amniotic instillation of ethacridine lactate. ***Extra-amniotic instillation of ethacridine lactate*** - **Extra-amniotic instillation of ethacridine lactate** is a method primarily used for **second-trimester** pregnancy terminations. - Its mechanism involves causing inflammation and contraction of the uterus, which is less effective and carries higher risks in the first trimester. *Manual vacuum aspiration* - **Manual vacuum aspiration (MVA)** is a common and effective surgical method for **first-trimester MTP**. - It involves using a syringe and cannula to remove the uterine contents directly. *Dilatation and curettage* - **Dilatation and curettage (D&C)** is another standard surgical procedure used for **first-trimester MTP**. - It involves dilating the cervix and using a curette to scrape the uterine lining and remove the pregnancy tissue. *Mifepristone + misoprostol* - The combination of **mifepristone and misoprostol** is the most common and effective medical method for **first-trimester MTP**. - **Mifepristone** blocks progesterone, while **misoprostol** causes uterine contractions and cervical ripening, expelling the pregnancy.

Q: Which of the following is not a long-acting reversible contraceptive method?

Combined oral contraceptives. ***Combined oral contraceptives*** - While effective, **combined oral contraceptives** require daily adherence and are not typically classified as long-acting due to their need for frequent, consistent administration. - Their mechanism involves **exogenous hormones** that suppress ovulation and thicken cervical mucus, but their contraceptive effect relies on continuous daily intake. *Implanon* - **Implanon** (etonogestrel implant) is a **subdermal contraceptive implant** that provides effective contraception for up to three years. - It works by slowly releasing progestin, making it a **long-acting reversible contraceptive (LARC)**. *Copper T* - The **Copper T intrauterine device (IUD)** is a non-hormonal LARC that can prevent pregnancy for **up to 10 years**. - It acts by creating an inflammatory reaction in the uterus that is toxic to sperm and eggs, preventing fertilization. *Depo-Provera injection* - The **Depo-Provera injection** (medroxyprogesterone acetate) is a progestin-only contraceptive given every **3 months**. - While it offers extended protection, it is **not universally classified as a LARC** by major guidelines (WHO, ACOG, CDC), which typically reserve this designation for IUDs and implants that do not require regular clinic visits.

Q: A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

OCP. ***OCP*** - **Oral Contraceptive Pills (OCPs)** are a highly effective method that also help regulate **menstrual cycles** due to their hormonal content. - They provide effective contraception while simultaneously addressing the symptom of **irregular menstruation** in a newly married woman. *Barrier method* - **Barrier methods** like condoms are effective for contraception but do not address or regulate irregular menstrual cycles. - Their effectiveness depends heavily on consistent and correct use with each act of intercourse. *Calendar method* - The **calendar method** relies on tracking the menstrual cycle to predict fertile windows and is unreliable with **irregular menstruation**. - It would be ineffective as a contraceptive for a woman with unpredictable cycle lengths, leading to a high risk of unintended pregnancy. *Progesterone only pills* - **Progesterone-only pills** (POPs) can be used for contraception, but they may cause or exacerbate **menstrual irregularities**. - While effective in preventing pregnancy, they do not offer the cycle-regulating benefits that combination OCPs do for women with irregular periods.

Q: The contraceptive which is contraindicated in DVT is?

OCP. ***OCP*** - **Oral contraceptive pills (OCPs)**, especially those containing estrogen, increase the risk of **venous thromboembolism (VTE)**, including deep vein thrombosis (DVT). - Estrogen promotes a **hypercoagulable state** by increasing clotting factors and decreasing natural anticoagulants. *Barrier method* - **Barrier methods** like condoms or diaphragms are non-hormonal and act physically to prevent sperm from reaching the egg. - They have **no systemic effects** on coagulation and are safe for individuals with DVT. *Non hormonal IUCD* - **Non-hormonal intrauterine contraceptive devices (IUCDs)**, such as copper IUCDs, prevent conception primarily by causing a local inflammatory reaction in the uterus. - They do not release hormones and therefore **do not affect coagulation** or increase DVT risk. *Billing's method* - The **Billing's ovulation method** (cervical mucus method) is a natural family planning technique based on observing changes in cervical mucus. - It involves no medications or devices and thus has **no impact on DVT risk**.

Q: What is the dose of mifepristone in emergency contraception?

10 mg. ***10 mg*** - **10 mg is the WHO-recommended dose** of mifepristone for emergency contraception. - This single dose is **equally effective** as higher doses (25-50 mg) and works primarily by **delaying or inhibiting ovulation**. - It has been validated through **multiple international clinical trials** and is the standard regimen used globally. - When taken within **72-120 hours** of unprotected intercourse, it significantly reduces pregnancy risk. *25 mg* - While 25 mg of mifepristone has been studied for emergency contraception and shows efficacy, it is **not the standard recommended dose**. - The **10 mg dose is preferred** as it achieves similar efficacy with potentially fewer side effects and lower cost. - Some countries may use 25 mg, but **WHO guidelines recommend 10 mg** as the optimal dose. *200 mg* - A 200 mg dose of mifepristone is typically utilized for **medical abortion regimens**, often in combination with a prostaglandin analog (misoprostol). - This dosage achieves a different pharmacological effect, leading to **detachment of the embryo** and uterine contractions. - This is **far higher than needed** for emergency contraception purposes. *200 mcg* - **Mifepristone is not dosed in micrograms** (mcg) for emergency contraception or medical abortion; it is measured in milligrams (mg). - This unit and dosage are more commonly associated with other medications, such as **misoprostol** when used for obstetric indications. - 200 mcg would be 0.2 mg, which is **subtherapeutic** for any mifepristone indication.

Q: After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

6 weeks. ***6 weeks*** - For **non-breastfeeding mothers**, combined oral contraceptives (COCs) are most safely initiated at **6 weeks postpartum** according to WHO Medical Eligibility Criteria. - At 6 weeks postpartum, the risk of **venous thromboembolism (VTE)** has returned to baseline, making this the safest timing (WHO MEC Category 1 - no restriction). - This timing balances both safety and effective contraception for mothers not breastfeeding. *Immediately after delivery* - Starting COCs immediately postpartum significantly increases the risk of **venous thromboembolism (VTE)** due to the hypercoagulable state after delivery. - This timing is contraindicated for combined hormonal methods (WHO MEC Category 3-4). *2 weeks* - At 2 weeks (14 days) postpartum, the VTE risk remains elevated in the early postpartum period. - Combined hormonal contraceptives are generally not recommended before 3 weeks (21 days) postpartum for non-breastfeeding women. - This timing does not meet standard safety guidelines. *12 weeks* - While 12 weeks postpartum is medically safe for initiating COCs, it is unnecessarily delayed. - This extended waiting period increases the risk of unintended pregnancy when effective contraception could be safely provided earlier at 6 weeks.

Q: Absolute contraindication of IUCD is?

Acute PID. ***Acute PID*** - **Acute pelvic inflammatory disease (PID)** is an absolute contraindication for IUCD insertion because the device can potentially worsen the existing infection or spread it further into the uterus and fallopian tubes. - Inserting an IUCD in the presence of acute PID significantly increases the risk of serious complications, including **sepsis** and **infertility**. *Previous history of abortion* - A **previous history of abortion** is generally not an absolute contraindication for IUCD insertion; rather, it may be a relative contraindication depending on factors such as the recency of the abortion or presence of infection risks. - IUCDs can be safely inserted after an abortion if there are no signs of infection and the uterus has involuted sufficiently. *Breast cancer* - **Breast cancer** is primarily a contraindication for **hormonal contraceptives** (like hormonal IUCDs) due to the potential estrogen or progestin sensitivity of certain cancers. - However, **copper IUCDs** (which are non-hormonal) are generally safe to use in patients with a history of breast cancer. *PCOD* - **Polycystic ovary syndrome (PCOS)** is not a contraindication for IUCD insertion; in fact, hormonal IUCDs can sometimes be beneficial in managing symptoms like heavy menstrual bleeding associated with PCOS. - IUCDs do not interfere with the underlying pathophysiology of PCOS.

Q: A woman comes after 96 hours post coitus. Best contraceptive of choice is?

IUCD. ***IUCD*** - An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation. - It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**. - Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus. *Progesterone only pills* - **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse. - At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD. *OCP* - **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods. - Their effectiveness also significantly declines after **72 hours** post-coitus. *Mifepristone* - **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse. - While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception.

Question 1

Tubectomy is typically performed on which part of the fallopian tube and why?

Accepted Answer

Isthmus - narrowest

Answer

Ampulla - uniform thickness of muscle

Answer

Ampulla - widest

Answer

Isthmus - uniform thickness of muscle

Question 2

All of the following can be used in first-trimester medical termination of pregnancy (MTP), except

Accepted Answer

Extra-amniotic instillation of ethacridine lactate

Answer

Manual vacuum aspiration

Answer

Dilatation and curettage

Answer

Mifepristone + misoprostol

Question 3

Which of the following is not a long-acting reversible contraceptive method?

Accepted Answer

Combined oral contraceptives

Answer

Implanon

Answer

Copper T

Answer

Depo-Provera injection

Question 4

A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

Accepted Answer

OCP

Answer

Barrier method

Answer

Calendar method

Answer

Progesterone only pills

Question 5

The contraceptive which is contraindicated in DVT is?

Accepted Answer

OCP

Answer

Barrier method

Answer

Non hormonal IUCD

Answer

Billing's method

Question 6

What is the dose of mifepristone in emergency contraception?

Accepted Answer

10 mg

Answer

25 mg

Answer

200 mcg

Answer

200 mg

Question 7

After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

Accepted Answer

6 weeks

Answer

Immediately after delivery

Answer

2 weeks

Answer

12 weeks

Question 8

Absolute contraindication of IUCD is?

Accepted Answer

Acute PID

Answer

Previous history of abortion

Answer

Breast cancer

Answer

PCOD

Question 9

A woman comes after 96 hours post coitus. Best contraceptive of choice is?

Accepted Answer

IUCD

Answer

Progesterone only pills

Answer

OCP

Answer

Mifepristone

Question 10

A 10-week pregnant woman presents for termination of pregnancy. What is the best method of abortion?

Accepted Answer

Vacuum aspiration

Answer

Misoprostol + mifepristone

Answer

Methotrexate and misoprostol

Answer

Dilatation and curettage

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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