Contraception and Family Planning Practice Questions

Q: A 25-year-old woman at 7 weeks of gestation requests a termination of pregnancy. Which combination of medications is used for a medical abortion?

Mifepristone and misoprostol. ***Mifepristone and misoprostol*** - This is the **WHO-recommended standard regimen** for medical abortion up to 10 weeks of gestation. - **Mifepristone (200 mg)** is an **anti-progestin** that blocks progesterone receptors, causing decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins. - **Misoprostol (800 mcg)** is a **prostaglandin E1 analog** administered 24-48 hours later, causing strong uterine contractions and cervical ripening to expel the pregnancy. - This combination has **95-98% efficacy** in early pregnancy termination. *Methotrexate and misoprostol* - Methotrexate is an **antimetabolite** that can be used for medical abortion, but it has **slower onset** (5-7 days) and **more side effects** compared to mifepristone. - This regimen is now rarely used for elective abortion due to lower efficacy and longer time to completion. - More commonly reserved for ectopic pregnancy management. *Methotrexate and mifepristone* - These two agents are **not combined** for medical abortion. - Both are abortifacient agents but work through different mechanisms and are not used together. - Standard protocols use an anti-progestin (mifepristone) followed by a prostaglandin (misoprostol). *Mifepristone and oxytocin* - **Oxytocin** is not part of the medical abortion regimen in the first trimester. - Oxytocin is used for **labor induction in second/third trimester** and **postpartum hemorrhage prevention**. - Prostaglandins (misoprostol) are preferred over oxytocin for first-trimester medical abortion due to additional cervical ripening effects.

Q: In women with PCOS and high cardiovascular risk, which contraceptive method is generally considered safer?

Progestin-only pills. ***Progestin-only pills*** - **Progestin-only pills (POPs)** are generally safer for women with PCOS and high cardiovascular risk because they avoid the estrogenic component, which can increase the risk of **thromboembolic events** and worsen **dyslipidemia** or **hypertension**. - They also bypass the potential for estrogen-related exacerbation of **insulin resistance**, a common comorbidity in PCOS. *Combined OCPs* - **Combined oral contraceptive pills (COCs)** contain both estrogen and progestin, and the estrogen component can increase the risk of **venous thromboembolism (VTE)**, stroke, and myocardial infarction, especially in women with pre-existing cardiovascular risk factors. - Estrogen can also negatively impact **lipid profiles** and **blood pressure**, making them less suitable for high-risk individuals. *Both are equally safe* - This statement is incorrect as the **estrogen component** in combined oral contraceptive pills (COCs) introduces additional cardiovascular risks not present with progestin-only methods. - The differing hormonal compositions directly lead to varying safety profiles, particularly concerning **thromboembolic events** and **lipid metabolism**. *Neither is safe* - This statement is incorrect as **progestin-only contraceptives** are considered a safe and effective option for managing PCOS symptoms and providing contraception, even in the presence of elevated cardiovascular risk. - Their safety profile is better than combined hormonal methods for this specific patient population due to the absence of **estrogen-related risks**.

Q: Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Uterine malformation. ***Uterine malformation*** - While a uterine malformation can make IUD insertion more difficult or reduce its effectiveness, it is often considered a **relative contraindication**, depending on the specific anomaly and the patient's desire for contraception. - In certain cases, an IUD might still be a viable option, but it requires careful consideration and specialized insertion techniques. *Pregnancy* - The presence of an existing pregnancy is an **absolute contraindication** for IUD insertion, as it can lead to complications such as miscarriage or ectopic pregnancy. - An IUD is a contraceptive device, and inserting it when a woman is already pregnant directly contradicts its purpose and poses significant risks. *Undiagnosed vaginal bleeding* - This is an **absolute contraindication** because it could be a symptom of a serious underlying condition, such as cervical cancer, endometrial cancer, or ectopic pregnancy. - Inserting an IUD before diagnosing the cause of the bleeding could delay treatment of a potentially life-threatening condition and exacerbate the bleeding. *Pelvic inflammatory disease* - Current or recent (within the last 3 months) **pelvic inflammatory disease (PID)** is an **absolute contraindication** due to the increased risk of worsening infection. - IUD insertion can introduce bacteria from the vagina into the uterus, potentially exacerbating an existing infection or causing a new one.

Q: Identify the contraceptive device shown in the image.

Female condom. ***Female condom*** - This contraceptive device is designed for use by women and consists of a **sheath inserted into the vagina**, typically made of nitrile or polyurethane, which lines the vagina and part of the vulva. - It features two rings: an **inner ring** that sits high in the vagina near the cervix, and an **outer ring** that remains outside, covering the labia, as depicted in the image. - Provides protection against both pregnancy and sexually transmitted infections. *Male condom* - A male condom is a **sheath placed over an erect penis**, designed to prevent sperm from entering the vagina. - Its appearance and method of use are distinctly different, lacking the two-ring structure seen in the image. *Diaphragm* - A diaphragm is a **dome-shaped silicone cup** that is inserted into the vagina to cover the cervix. - It requires fitting by a healthcare provider and is used with spermicide. - Unlike the female condom, it does not have an external ring and does not provide STI protection. *Cervical cap* - A cervical cap is a **small, thimble-shaped silicone device** that fits tightly over the cervix. - It is smaller than a diaphragm and also requires professional fitting and spermicide use. - It does not have the characteristic dual-ring sheath structure visible in the image.

Q: What is the use of the instrument shown in the image?

Laparoscopic sterilization. ***Laparoscopic sterilization*** - The image likely depicts a **laparoscope** or a device used for **tubal ligation**, which is a common method of **sterilization**. - **Laparoscopic sterilization** involves blocking or sealing the fallopian tubes to prevent the passage of eggs. *Induction of abortion* - Induction of abortion typically uses **medical methods (medications)** or **surgical procedures** like D&C, which do not involve the device shown. - The instrument shown is designed for **access and intervention** within the abdominal cavity, not for uterine evacuation. *Creating pneumoperitoneum in laparoscopic surgery* - **Pneumoperitoneum** is created using a **Veress needle** and a **CO2 insufflator** to distend the abdominal cavity, providing space for surgery. - The instrument shown is not a Veress needle or an insufflator; it appears to be an instrument used *after* pneumoperitoneum is established. *Surgical removal of an ectopic pregnancy* - While an ectopic pregnancy can be removed laparoscopically, the instrument shown is a general laparoscopic tool. - The primary purpose of this specific instrument (likely a **grasping forceps** or **dissector**) is not solely for ectopic pregnancy removal, but for various laparoscopic manipulations including sterilization.

Q: Which of the following female sterilization techniques involves excision of a tubal segment from the cornual end?

Kroener method. ***Kroener method*** - The Kroener method involves **excision of the fimbrial (distal) end of the fallopian tube** (fimbriectomy), making it a reliable sterilization technique. - This technique results in immediate and effective sterilization by removing the portion of the tube that captures the ovum from the ovary. - **Note**: The question asks about the cornual end, but Kroener method specifically removes the fimbrial end, not the cornual end. *Irving method* - The Irving method involves **ligation and transection of the fallopian tube at the isthmic portion**, with the proximal cut end being buried within the posterior uterine wall or broad ligament. - This technique is designed to prevent **recanalization** by separating the ends of the tube and burying the cornual/proximal segment. - This method works closer to the cornual end than Kroener method. *Uchida method* - The Uchida method involves **injecting a sclerosing solution** into the tubal lumen after serosal incision and removing a portion of the tube, leaving the muscularis and mucosa intact within the broad ligament. - This method aims to prevent subsequent **fistula formation** by burying the proximal tubal stump. *Madlener technique* - The Madlener technique involves **crushing a loop of the fallopian tube** (usually at the mid-portion) and ligating it with a non-absorbable suture, without excising any part of the tube. - This method has a higher failure rate due to the potential for **recanalization** and involves less tissue destruction compared to excisional methods.

Q: Which contraceptive method has the least failure rate?

MIRENA. ***MIRENA*** - MIRENA, a **levonorgestrel-releasing intrauterine system (LNG-IUS)**, has the **lowest failure rate among all contraceptive methods**, with a Pearl Index of **0.1-0.2%**. - Its superior efficacy is due to both its **hormonal action** (thickening cervical mucus, thinning endometrial lining, suppressing ovulation in some cycles) and its **long-acting reversible contraceptive (LARC)** nature, which **eliminates user error**. - Unlike DMPA, MIRENA maintains consistently low failure rates in both perfect and typical use scenarios. *CuT* - The **copper-T intrauterine device (IUD)** is highly effective with a failure rate of about **0.6-0.8%**, but slightly higher than MIRENA. - Its mechanism is primarily non-hormonal, causing a **sterile inflammatory reaction** in the uterus that is spermicidal and prevents implantation. *DMPA* - **Depot Medroxyprogesterone Acetate (DMPA)**, an injectable contraceptive, has a perfect use failure rate of about **0.2-0.3%**, comparable to MIRENA in ideal conditions. - However, its **typical use failure rate is significantly higher (around 6%)** due to adherence challenges with scheduled 3-monthly injections, making it less effective in real-world practice. - It works by **inhibiting ovulation**, thickening cervical mucus, and thinning the endometrial lining. *O.C. PILLS* - **Oral contraceptive pills** have a perfect use failure rate of about **0.3%**, but their typical use failure rate is much higher (around 7-9%) due to **missed doses** or inconsistent use. - They primarily act by **suppressing ovulation** through a combination of estrogen and progestin.

Q: What is the minimum number of Medical Termination of Pregnancies (MTPs) that a Registered Medical Practitioner (RMP) must assist in to perform MTP in the first trimester?

25. ***25*** - Under the **Medical Termination of Pregnancy Rules, 2003**, a Registered Medical Practitioner (RMP) must assist in at least **25 MTPs performed by a registered medical practitioner** who has experience in performing MTPs. - This requirement is part of the criteria for an RMP to be approved to perform MTPs independently, ensuring they gain sufficient practical experience. *5* - This number is **insufficient** according to the MTP Rules, 2003, for an RMP to be considered adequately trained to perform MTPs independently in the first trimester. - The stipulated experience aims for a higher volume of supervised procedures to ensure competence. *15* - This number also falls short of the **minimum experience criteria** set by the MTP Rules, 2003, for an RMP to perform MTPs independently. - The regulations emphasize a more extensive practical exposure to ensure proficiency and safety in performing the procedure. *50* - While assisting in 50 MTPs would certainly provide adequate experience, it is **not the minimum requirement** specified by the MTP Rules, 2003. - The law specifies a lower but still substantial number as the threshold for certification.

Q: In which of the following conditions is IUCD insertion contraindicated?

Acute PID. ***Acute PID*** - **Acute Pelvic Inflammatory Disease (PID)** is a strong contraindication for IUCD insertion as it can worsen the infection and lead to severe complications. - Inserting an IUCD in the presence of acute infection can facilitate the spread of bacteria into the sterile upper genital tract. *Previous LSCS (Lower Segment Cesarean Section)* - A previous **Lower Segment Cesarean Section (LSCS)** is generally **not an absolute contraindication** for IUCD insertion. - The uterus has healed, and the risk of perforation or expulsion is not significantly higher than in women without a prior LSCS. *Lactating mother (breastfeeding)* - Being a **lactating mother** is **not a contraindication** for IUCD insertion; in fact, IUCDs are often a preferred contraceptive method for breastfeeding women. - Hormonal IUCDs release only small amounts of progestin, which has minimal impact on milk supply, and copper IUCDs are non-hormonal. *Chronic pelvic pain (without infection)* - While chronic pelvic pain may require investigation, if **no active infection** or other contraindication is identified, it is generally **not an absolute contraindication** to IUCD insertion. - However, the patient should be counselled that an IUCD might potentially exacerbate or change the pattern of her chronic pain, and alternative options should be discussed.

Q: What is the LNG content of Mirena?

52 mg. ***52 mg*** - Mirena is a **levonorgestrel-releasing intrauterine system (IUS)** that contains 52 mg of **levonorgestrel (LNG)**. - This specific dosage ensures effective contraception for up to 8 years by continuously releasing a small amount of LNG. *20 mg* - This dosage refers to **Kyleena**, another levonorgestrel IUS that contains 19.5 mg (approximately 20 mg) of LNG. - Kyleena is effective for up to 5 years and is a smaller-sized IUS option. *13.5 mg* - This dosage is associated with the IUS **Skyla**, which contains 13.5 mg of levonorgestrel for a shorter duration of use (up to 3 years). - Different IUS devices are designed with varying **LNG content** to suit different clinical needs and durations. *39 mg* - This is not a standard **LNG content** for currently available IUS devices. - The main levonorgestrel IUS options contain 52 mg (Mirena, Liletta), 19.5 mg (Kyleena), or 13.5 mg (Skyla).

Question 1

A 25-year-old woman at 7 weeks of gestation requests a termination of pregnancy. Which combination of medications is used for a medical abortion?

Accepted Answer

Mifepristone and misoprostol

Answer

Methotrexate and misoprostol

Answer

Methotrexate and mifepristone

Answer

Mifepristone and oxytocin

Question 2

In women with PCOS and high cardiovascular risk, which contraceptive method is generally considered safer?

Accepted Answer

Progestin-only pills

Answer

Combined OCPs

Answer

Both are equally safe

Answer

Neither is safe

Question 3

Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Accepted Answer

Uterine malformation

Answer

Undiagnosed vaginal bleeding

Answer

Pregnancy

Answer

Pelvic inflammatory disease

Question 4

Identify the contraceptive device shown in the image.

Accepted Answer

Female condom

Answer

Male condom

Answer

Diaphragm

Answer

Cervical cap

Question 5

What is the use of the instrument shown in the image?

Accepted Answer

Laparoscopic sterilization

Answer

Induction of abortion

Answer

Creating pneumoperitoneum in laparoscopic surgery

Answer

Surgical removal of an ectopic pregnancy

Question 6

Which of the following female sterilization techniques involves excision of a tubal segment from the cornual end?

Accepted Answer

Kroener method

Answer

Uchida method

Answer

Irving method

Answer

Madlener technique

Question 7

Which contraceptive method has the least failure rate?

Accepted Answer

MIRENA

Answer

CuT

Answer

DMPA

Answer

O.C. PILLS

Question 8

What is the minimum number of Medical Termination of Pregnancies (MTPs) that a Registered Medical Practitioner (RMP) must assist in to perform MTP in the first trimester?

Accepted Answer

25

Answer

5

Answer

15

Answer

50

Question 9

In which of the following conditions is IUCD insertion contraindicated?

Accepted Answer

Acute PID

Answer

Previous LSCS (Lower Segment Cesarean Section)

Answer

Lactating mother (breastfeeding)

Answer

Chronic pelvic pain (without infection)

Question 10

What is the LNG content of Mirena?

Accepted Answer

52 mg

Answer

20 mg

Answer

13.5 mg

Answer

39 mg

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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