Contraception and Family Planning Practice Questions

Q: Which contraceptive method provides protection against ovarian cancer?

Oral contraceptive pills. ***Oral contraceptive pills*** - **Combined oral contraceptives** significantly decrease the risk of **ovarian cancer** due to the suppression of ovulation, which reduces the number of ovulatory cycles and subsequent epithelial microtrauma. - The protective effect increases with the **duration of use** and persists for many years after discontinuation. *Depo-Provera* - Depo-Provera (medroxyprogesterone acetate) is a **progestin-only injectable contraceptive** that primarily prevents ovulation. - While it offers highly effective contraception, its protective effect against ovarian cancer is **less established and not as robust** as that of combined oral contraceptives. *Intrauterine device* - **Intrauterine devices (IUDs)**, whether hormonal (levonorgestrel-releasing) or copper, primarily prevent pregnancy by altering the uterine environment or affecting sperm motility. - They do **not provide significant protection** against ovarian cancer, although hormonal IUDs have shown some possible association with reduced endometrial cancer risk. *Barrier methods* - **Barrier methods** like condoms or diaphragms physically block sperm from reaching the egg, preventing pregnancy. - They offer **no direct biological mechanism** to reduce the risk of ovarian cancer.

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: 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: 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: 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: Copper IUCD as a contraceptive measure can be used maximum till what time after unprotected intercourse?

5 days. ***5 days*** - A **copper IUCD** (intrauterine contraceptive device) can be effectively inserted for **emergency contraception** up to **5 days** after unprotected sexual intercourse. - This method is highly effective because it prevents **implantation** by creating a spermicidal and hostile uterine environment. *2 days* - While some emergency contraceptive pills might be effective within a shorter window, **2 days** is too early to be the maximum time for **copper IUCD** insertion according to guidelines for emergency contraception. - The efficacy window for the copper IUCD extends beyond this period, offering a longer post-coital option. *3 days* - **3 days** is a common window for some emergency contraceptive pills like those containing levonorgestrel, but the **copper IUCD** offers a longer timeframe for effective use. - The mechanism of action of the copper IUCD is different, allowing it to be effective for a longer duration after intercourse. *4 days* - Although closer to the correct answer, **4 days** is still not the maximum recommended time for **copper IUCD** insertion for emergency contraception. - Clinical guidelines and evidence support its use for an additional day beyond this point for optimal effectiveness.

Question 1

Which contraceptive method provides protection against ovarian cancer?

Accepted Answer

Oral contraceptive pills

Answer

Depo-Provera

Answer

Intrauterine device

Answer

Barrier methods

Question 2

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 3

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 4

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 5

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 6

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 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

Which of the following statements about intra-uterine devices (IUDs) is incorrect?

Accepted Answer

Multiload Cu-375 is a third generation intra-uterine device (IUD)

Answer

Copper devices are effective as post-coital contraceptives

Answer

Pregnancy rates of Lippes Loop and T Cu-200 are similar

Answer

LNG-20 (Mirena) has an effective life of 5 years

Question 10

Copper IUCD as a contraceptive measure can be used maximum till what time after unprotected intercourse?

Accepted Answer

5 days

Answer

2 days

Answer

3 days

Answer

4 days

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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