Contraception and Family Planning Practice Questions

Q: The contraception method shown below is made of:

Molybdenum-cobalt steel alloy. ***Molybdenum-cobalt steel alloy*** - The image displays the Essure device, which used a **molybdenum-cobalt steel alloy** for its inner core, providing structural integrity. - The outer fibers of the device were made of **polyethylene terephthalate**, inducing a localized inflammatory response to cause tubal occlusion, but the question specifically asks about the core material. *Quinacrine pellet* - Quinacrine is a drug used in **nonsurgical sterilization** but is delivered as a pellet, not as a coiled device as depicted. - This method involves placing quinacrine pellets directly into the uterus to induce scarring and block the fallopian tubes, which is a different mechanism and appearance. *Quinacrine pellet with LNG* - While quinacrine is mentioned above for non-surgical sterilization, a combination with **levonorgestrel (LNG)** in a single pellet form for this specific purpose is not a standard or widely recognized contraceptive method that matches the device shown. - LNG is a progestin commonly found in hormonal IUDs and implants, but not typically associated with the quinacrine pellet method for tubal occlusion. *Nickel-titanium steel alloy* - While **nickel-titanium alloys** (like nitinol) are used in various medical devices due to their shape memory and superelastic properties, the **Essure device** specifically used a molybdenum-cobalt steel alloy for its core. - Other medical implants might use nickel-titanium, but it is not the primary material for the device shown in the image.

Q: Identify the laparoscopic tubal sterilization shown below.

Filshie clip. ***Filshie clip*** - The image clearly displays a **clip** being applied to the fallopian tube, which is characteristic of the **Filshie clip** method of tubal sterilization. - Filshie clips are widely used due to their **high efficacy** and ability to be applied with minimal tissue damage. *Falope ring* - A Falope ring, also known as a Yoon ring, involves placing a **silastic band** to create a loop of the fallopian tube. The image does not show a looped tube with a ring. - This method typically causes a segment of the tube to become **necrotic** and atrophy, severing continuity. *Hulka clip* - The Hulka clip is a spring-loaded clip that is typically **smaller and more rounded** at the ends compared to the clip shown in the image. - It also involves occlusion of the fallopian tube but has a distinct appearance from the Filshie clip. *Pomeroy's technique* - Pomeroy's technique is a method of tubal ligation where a loop of the fallopian tube is **ligated and then excised**, which is a surgical procedure rather than the application of a device. - This method results in a **severed and separated** fallopian tube, unlike the clip shown in the image.

Q: What is the method of contraception shown below?

Bipolar electrocoagulation. ***Bipolar electrocoagulation*** - The image shows a **bipolar forceps** grasping and coagulating a fallopian tube. The characteristic **blackened, constricted appearance** of the tube segment is indicative of tissue coagulation. - This method uses **high-frequency electrical current** passed between two electrodes (the jaws of the forceps) to cause **thermal damage** and occlude the fallopian tube. *Pomeroy's technique* - This technique involves **ligating a loop** of the fallopian tube with absorbable suture and then **excising the looped segment**. - The image does not show a ligated and excised segment, nor the presence of sutures. *Parkland technique* - The Parkland technique involves **ligating two segments** of the fallopian tube at a distance from each other and then **resecting the intervening segment**. - This method results in a gap between the ligated ends, which is not depicted in the image. *Falope ring* - The Falope ring method involves applying a **small silicone band** or ring to a **knuckled loop** of the fallopian tube, causing necrosis and occlusion. - The image clearly displays grasping forceps and electrocoagulation, **not the application of a ring**.

Q: A 25 -year-old lady is undergoing the following procedure for an unplanned conception. The maximum pressure generated during the procedure is: (DNB Pattern 2018)

400-600 mm Hg. ***400-600 mm Hg*** - This range of negative pressure is typically generated during **manual vacuum aspiration (MVA)**, which is depicted in the image. MVA is a common method for early pregnancy termination. - The MVA syringe creates a vacuum for aspiration of uterine contents, and this pressure range is effective for safe and complete evacuation. *100-200 mm Hg* - This pressure range is generally **too low** for effective and complete uterine aspiration in an MVA procedure. - Insufficient vacuum may lead to incomplete abortion, requiring further intervention. *200-400 mm Hg* - While higher than 100-200 mm Hg, this range might still be **suboptimal** for ensuring complete removal of uterine contents during MVA. - The generally accepted effective pressure is higher to maximize success rates and minimize complications. *600-800 mm Hg* - This pressure range is typically **higher than necessary** for MVA and could potentially increase the risk of uterine injury or perforation. - Excessive vacuum pressure is not associated with improved outcomes and may be more dangerous.

Q: The following instrument is used for performing aspiration of uterine cavity within days of a missed period in a woman with previously normal cycle: (DNB Pattern 2018)

14 days. ***14 days*** - Manual vacuum aspiration (MVA) is an effective and safe method for **early uterine cavity aspiration** following a missed period. - It is typically performed when the gestational age is very early, often within **1-2 weeks** (around 14 days) of a missed period, ensuring the uterine contents are minimal. *28 days* - While MVA can be performed at 28 days (4 weeks) after a missed period, it represents a slightly later stage where the pregnancy is more established. - The procedure is safest and most effective in the earliest stages of pregnancy; 14 days post-missed period represents an **earlier and often preferred window**. *42 days* - At 42 days (6 weeks) after a missed period, the gestational sac and fetal pole are more developed. - While still possible, MVA at this stage may involve a **larger volume of aspirated tissue** and potentially a slightly higher risk compared to very early aspiration. *72 days* - 72 days (around 10 weeks) after a missed period indicates a **more advanced pregnancy**. - At this stage, other methods like **dilation and curettage (D&C)** might be preferred over MVA due to the increased size of the gestational contents.

Q: The most popular technique of tubal ligation is :

Pomeroy Technique. ***Pomeroy Technique*** - The **Pomeroy technique** is the most widely performed method of tubal ligation due to its simplicity, ease of execution, and high efficacy. - It involves lifting a loop of the fallopian tube, ligating its base, and then excising the looped segment, leading to clear separation of the tubal ends. *Madlener Operation* - The Madlener operation involves crushing and ligating a loop of the **fallopian tube** without excising any segment. - This method has a higher failure rate compared to the Pomeroy technique due to the possibility of recanalization. *Uchida method* - The **Uchida method** is a more complex technique that involves injecting a solution into the subserosal layer of the fallopian tube to separate the mucosa and muscularis, followed by excision of a segment and burying the proximal end. - It is known for its high effectiveness but is less commonly performed due to its technical complexity. *Cornual resection* - **Cornual resection** involves removing a portion of the fallopian tube where it enters the uterine wall (the cornua). - This procedure is technically more challenging and is associated with a higher risk of complications, including hemorrhage, making it less popular as a primary method for sterilization.

Q: Which of the following statements regarding female sterilization is correct? 1. It can be done 24 - 48 hours following delivery. 2. Ideal time for interval ligation is luteal phase preceding menstruation. 3. It can be combined with medical termination of pregnancy. 4. It is a preventive measure against serous ovarian cancer. Select the correct answer using the code given below:

1, 3 and 4. ***1, 3 and 4*** - Female sterilization can indeed be performed **24-48 hours postpartum** because the fundus is still high, making the fallopian tubes easily accessible. - Female sterilization can be safely **combined with medical termination of pregnancy**, offering a convenient option for women who desire permanent contraception after an abortion. - **Tubal ligation has been shown to reduce the risk of ovarian cancer** by approximately 30%, likely by preventing carcinogens from ascending through the tubes or by altering ovarian blood supply and hormone levels. - **Opportunistic salpingectomy** (removal of fallopian tubes during sterilization) provides even greater protection against high-grade serous ovarian cancer, as many such cancers originate in the fimbrial end of the fallopian tube. *1, 2 and 3* - While statements 1 and 3 are correct, **statement 2 is incorrect**. The ideal time for interval tubal ligation is the **follicular phase (early proliferative phase)**, typically within the **first 7 days of the menstrual cycle**, NOT the luteal phase preceding menstruation. - Performing sterilization in the early follicular phase minimizes the risk of an **undiagnosed early pregnancy**, as this is shortly after menstruation when pregnancy is least likely. *1, 2 and 4* - While statements 1 and 4 are correct, **statement 2 is incorrect**. The luteal phase is NOT the ideal time for interval sterilization because this is when pregnancy risk is highest. - The **follicular phase** is preferred to ensure the woman is not pregnant at the time of the procedure. *2, 3 and 4* - While statements 3 and 4 are correct, **statement 2 is incorrect**. Standard practice recommends interval tubal ligation during the **follicular phase (days 1-7 of cycle)**, not the luteal phase. - The luteal phase carries a risk of operating on an early, undiagnosed pregnancy.

Q: A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?

Nexplanon. ***Nexplanon*** - This **etonogestrel implant** offers highly effective, **long-acting reversible contraception (LARC)** for up to three years, making it an excellent choice for a young woman seeking a long-term option. - It has a failure rate of less than 0.1% and is **progestin-only**, avoiding estrogen-related risks. *Combined oral contraceptives* - While effective, these require **daily adherence**, which might not be ideal for someone specifically requesting *long-term* and *reversible* contraception without daily commitment. - They also carry a slightly higher risk of **venous thromboembolism (VTE)** compared to progestin-only methods. *Diaphragm* - This is a **barrier method** requiring proper insertion, removal, and use with spermicide for each act of intercourse, making it less convenient for *long-term reversible* contraception. - Its typical use failure rate is significantly higher (around 12%) compared to LARC methods. *Chhaya* - Chhaya, or Saheli, is a **non-steroidal oral contraceptive** taken twice a week for the first three months, then once a week. - While it is a contraceptive option, it still requires regular weekly adherence and is not considered a **long-acting reversible contraceptive (LARC)** like an implant or IUD.

Q: Indication for removal of IUDs include which of the following ? 1. Perforation of uterus 2. Pregnancy with device in situ 3. One year after menopause 4. Persistent migraine Select the correct answer using the code given below :

1, 2 and 4. ***Correct Answer: 1, 2 and 4*** **Statement 1 - Perforation of uterus:** ✅ **Valid indication** - Uterine perforation is a serious complication where the IUD punctures the uterine wall - This is an **absolute indication** for immediate removal to prevent further damage, infection, or injury to adjacent organs - Requires prompt surgical intervention **Statement 2 - Pregnancy with device in situ:** ✅ **Valid indication** - IUD should be removed if the strings are visible and removal is feasible - Removal reduces risks of **spontaneous abortion** (50% vs 25%), **septic abortion**, **preterm labor**, and **chorioamnionitis** - If strings are not visible, removal attempts may cause more harm than leaving it in place **Statement 4 - Persistent migraine:** ✅ **Valid indication (especially for hormonal IUDs)** - Relevant primarily for **levonorgestrel-releasing IUDs** (LNG-IUS) - Some women experience exacerbated or new-onset migraines due to hormonal fluctuations - Persistent or worsening migraines, especially **migraines with aura**, may warrant IUD removal - Less relevant for copper IUDs which have no hormonal effects *Statement 3 - One year after menopause:* ❌ **NOT an absolute indication** - While general guidelines suggest removal 1 year after menopause (if inserted after age 40), this is **NOT mandatory** - **Copper IUDs** can remain in place until age 55 if inserted after age 40, providing continued contraception - **LNG-IUS** may be retained for **endometrial protection** in women receiving estrogen replacement therapy - Removal is only necessary if the device is past its effective lifespan or causing symptoms - The decision should be individualized based on patient circumstances

Question 1

The contraception method shown below is made of:

Accepted Answer

Molybdenum-cobalt steel alloy

Answer

Quinacrine pellet

Answer

Quinacrine pellet with LNG

Answer

Nickel-titanium steel alloy

Question 2

Identify the laparoscopic tubal sterilization shown below.

Accepted Answer

Filshie clip

Answer

Falope ring

Answer

Hulka clip

Answer

Pomeroy's technique

Question 3

What is the method of contraception shown below?

Accepted Answer

Bipolar electrocoagulation

Answer

Pomeroy's technique

Answer

Parkland technique

Answer

Falope ring

Question 4

A 25 -year-old lady is undergoing the following procedure for an unplanned conception. The maximum pressure generated during the procedure is: (DNB Pattern 2018)

Accepted Answer

400-600 mm Hg

Answer

100-200 mm Hg

Answer

200-400 mm Hg

Answer

600-800 mm Hg

Question 5

The following instrument is used for performing aspiration of uterine cavity within days of a missed period in a woman with previously normal cycle: (DNB Pattern 2018)

Accepted Answer

14 days

Answer

28 days

Answer

42 days

Answer

72 days

Question 6

The most popular technique of tubal ligation is :

Accepted Answer

Pomeroy Technique

Answer

Madlener Operation

Answer

Uchida method

Answer

Cornual resection

Question 7

Which of the following statements regarding female sterilization is correct?

1. It can be done 24 - 48 hours following delivery.
2. Ideal time for interval ligation is luteal phase preceding menstruation.
3. It can be combined with medical termination of pregnancy.
4. It is a preventive measure against serous ovarian cancer.

Select the correct answer using the code given below:

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 8

A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?

Accepted Answer

Nexplanon

Answer

Combined oral contraceptives

Answer

Diaphragm

Answer

Chhaya

Question 9

Which of the following are the absolute contraindications for the use of combined oral contraceptive pills ?

1. Severe hypertension
2. Pregnancy
3. Diabetes with retinopathy
4. Gall bladder disease

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 10

Indication for removal of IUDs include which of the following ?

1. Perforation of uterus
2. Pregnancy with device in situ
3. One year after menopause
4. Persistent migraine

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1 and 3 only

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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