Contraception and Family Planning Practice Questions

Q: Oral contraceptive pills (OCPs) are contraindicated in which of the following conditions?

All of the above. Combined Oral Contraceptive Pills (OCPs) contain estrogen and progesterone. The estrogen component (Ethinyl Estradiol) is primarily responsible for the major contraindications due to its metabolic effects on coagulation and the cardiovascular system. **Explanation of the Correct Answer:** The correct answer is **D (All of the above)** because each condition represents a Category 4 contraindication (Unacceptable health risk) according to the WHO Medical Eligibility Criteria (MEC): * **Thromboembolism:** Estrogen increases the hepatic synthesis of clotting factors (II, VII, IX, X) and decreases Antithrombin III. This creates a hypercoagulable state, significantly increasing the risk of Deep Vein Thrombosis (DVT) and Pulmonary Embolism. * **Heart Disease:** OCPs can worsen hypertension and increase the risk of myocardial infarction and stroke, especially in women with underlying ischemic heart disease or valvular disease complicated by atrial fibrillation or pulmonary hypertension. * **Breast Cancer:** Estrogen can stimulate the proliferation of breast tissue. OCPs are strictly contraindicated in patients with current or past history of breast cancer as they may promote the growth of hormone-sensitive tumors. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindications):** * Smokers >35 years old (>15 cigarettes/day). * Migraine with aura (increased stroke risk). * History of CVA or CAD. * Active liver disease (Hepatitis, Cirrhosis, Tumors). * Undiagnosed abnormal uterine bleeding. * **Beneficial Effects:** OCPs are protective against **Ovarian** and **Endometrial** cancers (the "Rule of O&E"). * **Drug Interactions:** Enzyme inducers like **Rifampicin** and **Antiepileptics** (Phenytoin, Carbamazepine) decrease OCP efficacy, leading to breakthrough bleeding or pregnancy.

Q: What is the method used to diagnose a misplaced intra-uterine device?

All of the above. **Explanation:** A misplaced Intra-Uterine Device (IUD) occurs when the device is either expelled, embedded in the myometrium, or has perforated the uterus to enter the peritoneal cavity. The diagnosis follows a systematic clinical and radiological approach. 1. **Ultrasound (USG):** This is the **initial investigation of choice**. It is highly effective at determining if the IUD is "in-situ" (within the endometrial cavity) or "eccentric" (displaced or embedded). If the IUD is not visualized on USG, it is considered "lost." 2. **X-ray Abdomen (Erect/AP view):** If USG is empty, an X-ray of the abdomen and pelvis is performed to locate an extra-uterine IUD. Since all modern IUDs (like Cu-T) are radio-opaque, X-ray helps confirm if the device is still within the body (perforated) or has been expelled unnoticed. 3. **Uterine Sound and Hysteroscopy:** A uterine sound can be used clinically to check for the device, but **Hysteroscopy** is the **gold standard** for diagnosing and managing intrauterine displacement or embedding. It allows direct visualization and retrieval of the device if it is still within the uterine cavity. **Why "All of the Above" is correct:** Diagnosis is a multi-step process. While USG is the first step, X-ray is mandatory to rule out translocation into the peritoneal cavity, and hysteroscopy provides definitive diagnosis for complex intrauterine misplacements. **High-Yield Clinical Pearls for NEET-PG:** * **First step/Initial investigation:** Ultrasound. * **To confirm translocation (perforation):** X-ray (if USG is negative). * **Gold Standard for intrauterine IUD:** Hysteroscopy. * **Management of Perforated IUD:** Laparoscopy is the preferred method for removal of a translocated IUD from the peritoneal cavity.

Q: Tubectomy in a patient who has recently delivered is best done after:

1 week. **Explanation:** The timing of postpartum sterilization (Tubectomy) is critical due to the physiological changes in the uterus and the risk of infection. **Why 1 week is the correct answer:** Postpartum tubectomy is ideally performed **between 24 hours and 7 days (1 week)** after delivery. During the first week, the fundus of the uterus is still high (near the umbilicus), making the fallopian tubes easily accessible via a small sub-umbilical mini-laparotomy incision. Waiting until the end of the first week allows the patient to stabilize hemodynamically and ensures the newborn is healthy before performing a permanent procedure. **Analysis of Incorrect Options:** * **Immediately (Option D):** Performing surgery immediately after delivery is avoided due to the high risk of postpartum hemorrhage, hemodynamic instability, and the potential for increased infection. * **48 hours (Option A):** While often practiced for convenience, the "best" window extends up to a week. If done too early (within hours), the risk of reactionary hemorrhage is higher. * **2 weeks (Option C):** By 2 weeks, the uterus has undergone significant involution and descended into the true pelvis. This makes the tubes difficult to reach via a simple sub-umbilical incision, increasing the technical difficulty of the surgery. **High-Yield Clinical Pearls for NEET-PG:** * **Pomeroy’s Method:** The most common surgical technique used for postpartum tubectomy. * **Interval Sterilization:** If not done within the first week, it should be deferred for **6 weeks** (post-puerperium) to allow complete uterine involution. * **Laparoscopic Sterilization:** This is **contraindicated** in the immediate postpartum period due to the large, vascular uterus and is instead the preferred method for *interval* sterilization. * **Failure Rate:** The failure rate of tubectomy is approximately 0.5 per 100 women.

Q: Which contraceptive method is not an interceptive?

Norplant. ### Explanation The core concept here is the definition of **Interception**. Interception (or post-coital contraception) refers to methods that act **after** fertilization but **before** implantation. They prevent the blastocyst from attaching to the uterine wall. **Why Norplant is the correct answer:** **Norplant** is a progestogen-only subdermal implant. Its primary mechanism of action is the **prevention of ovulation** (by suppressing LH surge) and thickening of cervical mucus to prevent sperm penetration. Since it is a long-acting reversible contraceptive (LARC) used *before* intercourse occurs, it is a primary contraceptive, not an interceptive. **Analysis of incorrect options:** * **Cu-T (Copper-T):** When used as emergency contraception within 5 days of unprotected intercourse, it acts as an interceptive by causing a sterile inflammatory response in the endometrium, making it hostile for a fertilized ovum to implant. * **RU-486 (Mifepristone):** This is an anti-progestational agent. It prevents implantation by blocking progesterone receptors in the endometrium or, if implantation has occurred, causes decidual breakdown. It is a potent interceptive. * **OC Pills:** High-dose Oral Contraceptive pills (specifically the Yuzpe regimen) can be used as emergency contraception. They act by delaying ovulation or altering the endometrium to prevent implantation, thus qualifying as interceptive. **High-Yield Clinical Pearls for NEET-PG:** * **Most effective emergency contraceptive:** Copper-T (failure rate <0.1%). * **Drug of choice for emergency contraception:** Levonorgestrel (LNG) 1.5 mg single dose (within 72 hours). * **Mifepristone dose for emergency contraception:** 10 mg to 25 mg (low dose). * **Interception vs. Abortion:** Interception acts *before* implantation (6th day); Abortion acts *after* implantation.

Q: Oral contraceptive pills provide protection against which of the following cancers?

Ovary. Combined Oral Contraceptive Pills (COCPs) exert a significant protective effect against certain gynecological cancers, primarily through the suppression of ovulation and the induction of a progestational state. ### **Explanation of the Correct Answer** **B. Ovary:** COCPs reduce the risk of **Epithelial Ovarian Cancer** by approximately 40–50%. The underlying mechanism is the **"Incessant Ovulation Theory."** By suppressing FSH and LH, COCPs prevent ovulation, thereby reducing repetitive trauma to the ovarian epithelium and lowering local inflammatory mediators. This protection begins after 3–6 months of use, increases with duration, and persists for up to 15–30 years after discontinuation. ### **Explanation of Incorrect Options** * **A. Hepatic:** COCPs are actually associated with an increased risk of benign liver tumors, specifically **Hepatic Adenomas**. They do not provide protection against hepatocellular carcinoma. * **C. Cervix:** Long-term use of COCPs (>5 years) is associated with a **slight increase** in the risk of Cervical Cancer, likely due to increased susceptibility to HPV or changes in the transformation zone. * **D. Breast:** The relationship is controversial, but most studies suggest a **minimal transient increase** in breast cancer risk during use, which returns to baseline 10 years after stopping. ### **High-Yield Clinical Pearls for NEET-PG** * **Dual Protection:** COCPs protect against both **Ovarian** and **Endometrial** cancer (the latter due to the progestogen-induced thinning of the lining). * **Colorectal Cancer:** COCPs also significantly reduce the risk of colorectal cancer (by ~15–20%). * **Benign Conditions:** They provide protection against Benign Breast Disease (fibroadenomas/cysts) and Pelvic Inflammatory Disease (PID) by thickening cervical mucus. * **Contraindication:** History of breast cancer is a Category 4 (absolute) contraindication for COCP use.

Q: What is the drug used for first-trimester abortion?

Oral mifepristone. **Explanation:** Medical management of first-trimester abortion (up to 10 weeks or 70 days of gestation) primarily involves a combination of **Mifepristone** and **Misoprostol**. **Why Mifepristone is correct:** Mifepristone (RU-486) is an anti-progestational agent. It works by blocking progesterone receptors in the decidua, leading to decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins. In the first trimester, the standard WHO and GOI protocol is **200 mg Oral Mifepristone** followed 24–48 hours later by **800 mcg Misoprostol** (vaginal, buccal, or sublingual). **Why other options are incorrect:** * **Intra-amniotic saline:** This is a hypertonic solution used historically for **second-trimester** induction. It is now largely obsolete due to risks of hypernatremia and maternal coagulopathy. * **Extra-amniotic ethacridine lactate:** This was a common method for **mid-trimester** (13–20 weeks) abortion. It acts as a local irritant to induce contractions but has been replaced by safer prostaglandin regimens. * **Oxytocin infusion:** Oxytocin is ineffective in the first trimester because the uterus lacks sufficient oxytocin receptors at this early stage. It is primarily used for labor induction at term or managing second-trimester losses after cervical ripening. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Act 2021 Update:** Medical abortion is legal up to **24 weeks** under specific conditions, but the Mifepristone+Misoprostol "Medical Abortion Pack" is specifically validated for use up to **9 weeks (63 days)** in many clinical settings, though evidence supports use up to 10 weeks. * **Mechanism of Misoprostol:** It is a PGE1 analogue that causes uterine contractions and cervical ripening. * **Side Effects:** The most common side effect of Mifepristone is heavy bleeding; for Misoprostol, it is diarrhea and shivering.

Q: Which of the following is NOT a method of contraception during lactation?

Oral contraceptive pills (OCPs). **Explanation:** The correct answer is **C. Oral contraceptive pills (OCPs)**. In the context of lactation, "OCPs" typically refers to **Combined Oral Contraceptive Pills (COCs)** containing both estrogen and progesterone. Estrogen is known to **suppress prolactin levels**, which leads to a significant decrease in the quantity and quality of breast milk. Therefore, COCs are generally avoided during the first 6 months of breastfeeding to prevent interference with infant nutrition. **Analysis of Options:** * **A. Lactational Amenorrhea Method (LAM):** A natural method based on the physiological suppression of ovulation by high prolactin levels. It is effective for up to 6 months if the mother is exclusively breastfeeding and remains amenorrheic. * **B. Intrauterine Device (IUD):** Both Cu-T and LNG-IUS are safe during lactation. They do not affect milk production. Postpartum IUCD (PPIUCD) can be inserted within 48 hours of delivery or after 6 weeks (involution). * **D. Progestin-only pills (POPs/Minipills):** These are the **contraceptives of choice** for breastfeeding mothers who desire oral hormonal contraception. Unlike estrogen, progestins do not affect milk volume or composition. **High-Yield Clinical Pearls for NEET-PG:** * **Timing of COCs:** According to WHO Medical Eligibility Criteria (MEC), COCs are MEC Category 4 (unacceptable risk) before 3 weeks postpartum and Category 3 (risks outweigh benefits) between 3 weeks to 6 months if breastfeeding. * **DMPA (Injectable):** Can be safely started 6 weeks postpartum in lactating women. * **Ideal Contraceptive:** Progestin-only methods (POPs, Implants) or Non-hormonal methods (Barrier, IUDs) are preferred during lactation.

Question 1

Oral contraceptive pills (OCPs) are contraindicated in which of the following conditions?

Accepted Answer

All of the above

Answer

Heart disease

Answer

Thromboembolism

Answer

Breast cancer

Question 2

What is the method used to diagnose a misplaced intra-uterine device?

Accepted Answer

All of the above

Answer

Ultrasound

Answer

X-ray abdomen (erect view)

Answer

Uterine sound and hysteroscopy

Question 3

Tubectomy in a patient who has recently delivered is best done after:

Accepted Answer

1 week

Answer

48 hours

Answer

2 weeks

Answer

Immediately

Question 4

Which contraceptive method is not an interceptive?

Accepted Answer

Norplant

Answer

Cu-T

Answer

RU-486

Answer

OC pills

Question 5

What is the best contraceptive method for a newly married, healthy couple?

Accepted Answer

Oral contraceptive pills

Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Natural methods

Question 6

Oral contraceptive pills provide protection against which of the following cancers?

Accepted Answer

Ovary

Answer

Hepatic

Answer

Cervix

Answer

Breast

Question 7

What is the drug used for first-trimester abortion?

Accepted Answer

Oral mifepristone

Answer

Intra-amniotic saline

Answer

Extra-amniotic ethacridine lactate

Answer

Oxytocin infusion

Question 8

Previous ectopic pregnancy is a contraindication for which type of contraception?

Accepted Answer

Levonorgestrel-releasing IUS

Answer

Copper-containing IUD

Answer

Depot medroxyprogesterone acetate

Answer

Progestin-containing subdermal implant

Question 9

Which of the following is NOT a method of contraception during lactation?

Accepted Answer

Oral contraceptive pills (OCPs)

Answer

Lactational amenorrhea method

Answer

Intrauterine device (IUD)

Answer

Progestin-only pills (Minipills)

Question 10

What is the typical cutoff time for Continuous Umbilical Transfusion (CuT)?

Accepted Answer

2 minutes

Answer

1 minute

Answer

3 minutes

Answer

4 minutes

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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