Contraception and Family Planning Practice Questions

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 one of the following statements about male sterilization is NOT true?

It is performed under general anaesthesia. ***It is performed under general anaesthesia*** - **Vasectomies** are most commonly performed in an outpatient setting under a **local anaesthetic**, not general anaesthesia. - The procedure involves minimal discomfort, and the patient remains awake, reducing risks associated with general anaesthesia. *It is safer and less expensive* - **Male sterilization (vasectomy)** is generally considered safer than female sterilization (tubal ligation) due to its less invasive nature. - It is also typically less expensive due to the simpler outpatient procedure and local anaesthesia. *Most men develop antisperm antibodies* - After a vasectomy, a significant number of men (approximately 50-70%) develop **antisperm antibodies**. - These antibodies are usually not clinically significant but can interfere with fertility if a reversal is attempted. *It has a low failure rate* - **Vasectomy** is highly effective, with a very **low failure rate** once confirmed by a negative post-vasectomy semen analysis. - The failure rate is typically less than 1%, making it one of the most reliable forms of contraception.

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: After male sterilization, additional contraceptive protection is

needed for 2 to 3 months. ***needed for 2 to 3 months*** - After **vasectomy**, residual **sperm** distal to the ligation site can remain in the ejaculatory ducts and vas deferens. - It takes approximately **20 ejaculations** or **2 to 3 months** for these sperm to be cleared from the reproductive tract, requiring additional contraception until **azoospermia** is confirmed. *not needed* - This option is incorrect because the male reproductive tract is not immediately sterile after a vasectomy due to the presence of **pre-existing sperm**. - Without additional contraception, there is a risk of **unintended pregnancy** until sterility is confirmed by follow-up testing. *needed for 1 to 2 months* - While closer, a duration of **1 to 2 months** may not be sufficient for all residual sperm to be cleared from the system. - The standard recommendation often extends to **3 months** or a specific number of ejaculations to ensure complete sterility. *needed for 1 month* - This duration is generally too short to ensure the complete clearance of **viable sperm** from the ejaculatory ducts after a vasectomy. - Relying on this period alone would carry a higher risk of **contraceptive failure**.

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: Which of the following are correct regarding failure rate of contraceptive methods? 1. Depot medroxyprogesterone acetate 0 to 1 per HWY 2. Norplant 0.1 per HWY 3. LNG-IUS 0.02 per HWY 4. Levonorgestrel-only pills 3 per HWY

1, 2 and 3. ***1, 2 and 3*** - **Depot medroxyprogesterone acetate (DMPA)**, **Norplant** (levonorgestrel implants), and **Levonorgestrel-releasing intrauterine system (LNG-IUS)** are highly effective contraceptive methods with very low failure rates, typically below 1 pregnancy per 100 women-years (HWY) for typical use. - The quoted failure rates of 0 to 1 per HWY for DMPA, 0.1 per HWY for Norplant, and 0.02 per HWY for LNG-IUS are consistent with their known efficacy as **long-acting reversible contraceptives (LARCs)** and hormonal methods. *1, 3 and 4* - This option incorrectly includes the failure rate for **levonorgestrel-only pills (minipills)**. While minipills are effective, their typical use failure rate is generally higher than 3 per HWY, often closer to 7-10 pregnancies per 100 women-years due to the strict adherence required for daily dosing. - The failure rates for DMPA and LNG-IUS are accurate, but the inclusion of incorrectly low typical failure rate for levonorgestrel-only pills makes this option incorrect. *1, 2 and 4* - This option is incorrect because the typical failure rate of **levonorgestrel-only pills** is much higher than 3 per HWY in real-world use, often due to missed doses or delayed administration. - While DMPA and Norplant have low failure rates, the inaccuracy for levonorgestrel-only pills makes this choice invalid. *2, 3 and 4* - This option inaccurately suggests that the failure rate for **levonorgestrel-only pills** is 3 per HWY, which is generally lower than their actual typical use failure rates (closer to 7-10 pregnancies per 100 women-years). - The failure rates for Norplant and LNG-IUS are correct, but the error regarding levonorgestrel-only pills renders this option incorrect.

Q: The Pearl index of contraceptive failure is expressed as a rate per

100 women-years. ***100 women-years*** - The **Pearl Index** is a common measure of contraceptive failure rate, expressed as the number of pregnancies per **100 women-years** of exposure. - This metric allows for standardized comparison of contraceptive effectiveness across different methods and populations. *1000 women-years* - While other epidemiological rates might be expressed per 1000 person-years, the standard for the **Pearl Index** is specifically per 100 women-years. - Using 1000 would significantly underestimate the commonly reported failure rates of contraceptives. *1 woman-year* - Expressing the rate per **1 woman-year** would result in very small, often fractional, numbers that are difficult to interpret and compare. - The larger base of 100 women-years provides a more practical and understandable scale for reporting contraceptive failure. *10 women-years* - This increment is not the recognized standard for the **Pearl Index**. - Using 10 women-years would also make the reported failure rates less comparable with established data and harder to interpret clinically.

Question 1

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 2

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 3

Which one of the following statements about male sterilization is NOT true?

Accepted Answer

It is performed under general anaesthesia

Answer

It is safer and less expensive

Answer

Most men develop antisperm antibodies

Answer

It has a low failure rate

Question 4

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 5

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 6

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 7

After male sterilization, additional contraceptive protection is

Accepted Answer

needed for 2 to 3 months

Answer

not needed

Answer

needed for 1 to 2 months

Answer

needed for 1 month

Question 8

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 9

Which of the following are correct regarding failure rate of contraceptive methods?

1. Depot medroxyprogesterone acetate 0 to 1 per HWY
2. Norplant 0.1 per HWY
3. LNG-IUS 0.02 per HWY
4. Levonorgestrel-only pills 3 per HWY

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 10

The Pearl index of contraceptive failure is expressed as a rate per

Accepted Answer

100 women-years

Answer

1000 women-years

Answer

1 woman-year

Answer

10 women-years

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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