Contraception and Family Planning Practice Questions

Q: What are the effects of Progesterone-only pills?

All of the options may occur. ***All of the options may occur*** - Progesterone-only pills (POPs) work through **multiple complementary mechanisms** that collectively provide effective contraception. - All three effects occur simultaneously and contribute to the overall contraceptive efficacy of POPs. - Understanding these mechanisms helps explain why POPs are effective despite lower hormone doses compared to combined oral contraceptives. **Mechanism 1: May suppress ovulation** - POPs can **partially suppress ovulation**, preventing the release of an egg. - Traditional POPs suppress ovulation in approximately 40-60% of cycles, while newer desogestrel-containing POPs achieve higher rates (97-99%). - This effect depends on the dose and type of progestin used in the formulation. **Mechanism 2: Thins the lining of the uterus** - Progesterone causes **endometrial atrophy**, making the uterine lining thin and unsuitable for embryo implantation. - This hostile uterine environment acts as a backup contraceptive mechanism if ovulation and fertilization occur. - Endometrial changes occur consistently with POP use. **Mechanism 3: Thickens cervical mucus** - This is the **primary and most consistent mechanism** of POPs. - Progesterone significantly **increases cervical mucus viscosity** and reduces its quantity within hours of administration. - The thickened mucus creates a physical barrier that prevents sperm penetration, motility, and viability.

Q: Which of the following is a side effect of Progestin Only Pills (POPs)?

Ovarian cysts. ***Ovarian cysts*** - **Functional ovarian cysts** are a known side effect of Progestin Only Pills (**POPs**), as POPs can alter the normal ovulatory cycle but usually do not completely suppress follicular development. - While generally benign and self-resolving, they can cause pain and discomfort. *Venous thromboembolism* - **POPs** are not significantly associated with an increased risk of **venous thromboembolism** due to the absence of estrogen, unlike combined hormonal contraceptives. - This is a key advantage of POPs, making them suitable for individuals at risk for thromboembolic events. *Increased risk of diabetes mellitus* - There is generally **no significant increased risk** of **diabetes mellitus** associated with POPs. - While some hormonal contraceptives *may* have minor effects on glucose metabolism, this is not a prominent or clinically significant side effect of POPs. *Ectopic pregnancy* - POPs **do not increase the risk of ectopic pregnancy**. In fact, they **reduce the overall pregnancy rate**, including ectopic pregnancies, by preventing ovulation. - However, if a pregnancy does occur while on POPs, there is a *slightly higher proportion* of those pregnancies that may be ectopic compared to unaided conceptions, but the *absolute risk* remains low.

Q: What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?

24-48 hours. ***24-48 hours*** - The FDA-approved protocol for medical abortion with mifepristone and misoprostol specifies a **24- to 48-hour interval** between the administration of the two drugs. - This timing ensures optimal efficacy as it allows mifepristone to adequately sensitize the uterus to the effects of misoprostol. *48 hours* - While 48 hours falls within the recommended range, specifically stating "48 hours" as the only option is less precise than the **24-48 hour window**. - No specific clinical advantage or disadvantage is generally reported for waiting exactly 48 hours over, for instance, 24 hours. *96 hours* - A 96-hour interval is significantly longer than the **FDA-recommended window** and is not part of the standard, evidence-based protocol. - Delaying misoprostol administration beyond 48 hours may **reduce the effectiveness** of the medical abortion and increase the risk of complications. *72 hours* - A 72-hour interval exceeds the upper limit of the **FDA-recommended window** for optimal efficacy. - While some studies have explored extended intervals, the *standard clinical practice* and FDA guidelines do not endorse 72 hours as the primary recommended interval.

Q: Which of the following is NOT an absolute contraindication for the use of an Intrauterine Device (IUD)?

Anemia. ***Anemia*** - Anemia, even if severe, is generally *not an absolute contraindication* for IUD use, especially for a **hormonal IUD** which can actually *reduce menstrual blood loss*. - While **copper IUDs** can sometimes *increase menstrual bleeding*, the benefits of contraception often outweigh the risks in anemic patients, or iron supplementation can be initiated. *Pregnancy* - **Confirmed or suspected pregnancy** is an absolute contraindication for IUD insertion due to the risk of **miscarriage**, **infection**, and harm to the fetus. - An IUD should *never* be inserted into a pregnant uterus. *Acute pelvic inflammatory disease* - **Acute PID** is a severe infection of the upper genital tract and is an *absolute contraindication* to IUD insertion. - Insertion during active infection could **exacerbate the infection** and lead to serious complications such as infertility or sepsis. *Undiagnosed vaginal bleeding* - **Undiagnosed abnormal vaginal bleeding** requires investigation to rule out serious underlying conditions such as **endometrial cancer** or **trophoblastic disease** before IUD insertion. - Inserting an IUD could **mask symptoms** or delay diagnosis of a serious pathology.

Q: What should be done if 2 OCPs are missed on days 17-18 of the cycle?

Both a and b. ***Both a and b*** - When **two OCPs are missed** on days 17-18 (Week 3) of the cycle, the recommended approach combines two actions to restore contraceptive protection. - The woman should **take two pills on the next two days** to compensate for the missed doses and restore hormonal levels quickly. - Additionally, **backup contraception should be used for at least 7 days** to ensure contraceptive effectiveness, as the missed pills during Week 3 could compromise protection and increase the risk of ovulation. - Both actions together address the hormonal gap and provide adequate contraceptive coverage. *Take 2 pills on the next 2 days* - While this action helps **reestablish hormone levels** after missing two pills, it is **insufficient on its own**. - Without concurrent backup contraception, there remains a risk of **ovulation** and **unintended pregnancy** during the recovery period. - This must be combined with backup contraceptive methods for 7 days. *Use back up contraceptive* - Using **backup contraception** is essential because missing two pills in Week 3 increases the risk of **ovulation**. - However, backup contraception alone without resuming the pill regimen (with catch-up dosing) would not adequately restore the hormonal cycle. - Both resuming pills appropriately and using backup methods are necessary. *Continue taking single pill per day* - Simply continuing with one pill per day without any catch-up dosing would leave a **hormonal gap** from the two missed pills. - This approach does not compensate for the **missed active hormones**, leaving inadequate hormone levels for contraceptive protection. - Without catch-up dosing and backup contraception, the risk of **ovulation** and **pregnancy** remains significantly elevated.

Q: The best method for inducing mid trimester abortion is :

Prostaglandins. ***Prostaglandins*** - **Prostaglandins** (e.g., dinoprostone, misoprostol) are highly effective in inducing uterine contractions and cervical ripening, making them the preferred method for **mid-trimester abortion**. - They can be administered through various routes (vaginal, oral, buccal) and offer a good balance of efficacy and safety for this gestational age. - Prostaglandins are considered the **current gold standard** for second-trimester medical termination of pregnancy. *Injection of Hypertonic Saline* - Historically used, but **intra-amniotic hypertonic saline** carries significant risks, including hypernatremia, disseminated intravascular coagulation (DIC), and uterine rupture. - It has largely been replaced by safer and more effective methods like prostaglandins due to its adverse event profile. - This method is now considered obsolete in most clinical settings. *Ethacrydine Lactate* - **Ethacrydine lactate** (ethacridine lactate/Rivanol) is an antiseptic agent that was historically used for mid-trimester abortion via intra-amniotic injection. - While it was effective in inducing abortion, it has been largely abandoned due to complications, prolonged induction time, and the availability of safer alternatives. - It is **not the preferred method** compared to prostaglandins, which have better safety profiles and efficacy. *Dilation and Curettage (D&C)* - **Dilation and curettage (D&C)** is primarily used for first-trimester abortions or for managing incomplete abortions and miscarriages. - In the mid-trimester, the uterus is larger and the fetal tissue is more substantial, making D&C less safe and often requiring extensive dilation or potentially leading to complications like uterine perforation or hemorrhage. - **Dilation and evacuation (D&E)** may be used in mid-trimester but requires specialized training and equipment.

Q: Up to what duration can Medical Termination of Pregnancy (MTP) be performed by a single doctor?

Up to 12 weeks. ***Up to 12 weeks*** - Under the **Medical Termination of Pregnancy (MTP) Act, 1971**, as amended in 2021, a single registered medical practitioner can perform an abortion for pregnancies up to **12 weeks gestation**. - This provision allows for timely and accessible care in the early stages of pregnancy when the risks associated with the procedure are generally lower. *Up to 8 weeks* - While abortions are commonly performed at this stage, the legal limit for a single doctor is not restricted to 8 weeks but extends further. - This option is too restrictive and does not reflect the full scope of the MTP Act. *Up to 20 weeks* - Termination of pregnancy between **12 and 20 weeks** requires the opinion of **two registered medical practitioners**. - This falls outside the scope of what a single doctor can legally perform. *Up to 24 weeks* - Terminations between **20 and 24 weeks** require the opinion of **two registered medical practitioners** and are permissible only for specific categories of women (e.g., survivors of sexual assault, minors, women with disabilities) as per the MTP Amendment Act, 2021. - This expanded limit is not applicable for a single doctor's approval.

Q: What is the recommended timing for the insertion of a Copper T intrauterine device?

Within 10 days of start of menstrual cycle. ***Within 10 days of start of menstrual cycle*** - Inserting the **Copper T IUD** during this phase ensures the woman is not pregnant, as ovulation typically occurs later in the cycle. - The **cervix is slightly dilated** during menstruation, making insertion easier and less uncomfortable. - This is the **recommended timing** as per standard guidelines for IUD insertion. *3 days after periods are over* - While this timing might seem appropriate, it doesn't align with the optimal window for ensuring **non-pregnancy** and ease of insertion. - The **cervix may have already closed** significantly, making insertion potentially more difficult than during menstruation. *During active pelvic infection* - Insertion of an IUD during an **active pelvic infection** is **absolutely contraindicated** due to the risk of exacerbating the infection and leading to more serious complications like **pelvic inflammatory disease (PID)**. - The presence of infection increases the likelihood of bacteria being carried into the **uterine cavity**, potentially causing severe consequences. *Just after menstruation* - While close to the ideal window, this timing is less specific than "within 10 days" and may miss the optimal cervical conditions. - The benefits of a slightly dilated cervix during the early menstrual phase would be maximized with the more precise timing of within 10 days of cycle start.

Q: What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Within 3 weeks. **Correct Answer: Within 3 weeks** - The highest risk of **Pelvic Inflammatory Disease (PID)** after IUD insertion is typically observed in the **first 20 days (approximately 3 weeks)** post-insertion. - This elevated risk is mainly due to the potential introduction of **bacteria** from the vagina or cervix into the uterus during the insertion process. - Studies show that the risk of PID is **6-fold higher** in the first 20 days compared to later periods. *Incorrect: Within 5 weeks* - While PID can occur after 3 weeks, the **highest incidence** is concentrated in the earlier period (first 3 weeks). - The risk significantly **decreases after the initial weeks**, suggesting that the critical window for bacterial ascent is shorter. *Incorrect: Within 7 weeks* - By 7 weeks, the risk of developing PID attributable to IUD insertion becomes **negligible** compared to the general population. - Most infections that manifest beyond the initial month are usually due to **newly acquired sexually transmitted infections (STIs)**, not the insertion itself. *Incorrect: Within 14 weeks* - At 14 weeks, any PID development is generally **not linked to the IUD insertion event** but rather to other risk factors like new sexual partners or untreated STIs. - The immediate trauma and potential bacterial contamination from the insertion procedure have **long ceased to be the primary cause** of infection.

Q: What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?

200mg. ***200mg*** - The standard dose of **mifepristone** for medical termination of pregnancy (MTP) is **200mg orally**. - This dose is typically followed 24-48 hours later by a **prostaglandin analog** (e.g., misoprostol) to complete the termination process. *10mg* - This dose is significantly lower than the recommended therapeutic dose for medical abortion. - Such a low dose would likely be **ineffective** in achieving termination. *20 mg* - This dose is also much lower than the standard therapeutic recommendation. - It would not adequately block progesterone receptors to initiate the termination process effectively. *100mg* - While closer to the standard dose, 100mg is still considered **sub-therapeutic** for many individuals undergoing medical abortion. - A lower efficacy rate would be expected compared to the 200mg dose.

Question 1

What are the effects of Progesterone-only pills?

Accepted Answer

All of the options may occur

Answer

May suppress ovulation

Answer

Thins the lining of the uterus

Answer

Thickens cervical mucus

Question 2

Which of the following is a side effect of Progestin Only Pills (POPs)?

Accepted Answer

Ovarian cysts

Answer

Venous thromboembolism

Answer

Increased risk of diabetes mellitus

Answer

Ectopic pregnancy

Question 3

What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?

Accepted Answer

24-48 hours

Answer

96 hours

Answer

48 hours

Answer

72 hours

Question 4

Which of the following is NOT an absolute contraindication for the use of an Intrauterine Device (IUD)?

Accepted Answer

Anemia

Answer

Pregnancy

Answer

Acute pelvic inflammatory disease

Answer

Undiagnosed vaginal bleeding

Question 5

What should be done if 2 OCPs are missed on days 17-18 of the cycle?

Accepted Answer

Both a and b

Answer

Take 2 pills on the next 2 days

Answer

Continue taking single pill per day

Answer

Use back up contraceptive

Question 6

The best method for inducing mid trimester abortion is :

Accepted Answer

Prostaglandins

Answer

Dilation and Curettage (D&C)

Answer

Injection of Hypertonic Saline

Answer

Ethacrydine Lactate

Question 7

Up to what duration can Medical Termination of Pregnancy (MTP) be performed by a single doctor?

Accepted Answer

Up to 12 weeks

Answer

Up to 8 weeks

Answer

Up to 20 weeks

Answer

Up to 24 weeks

Question 8

What is the recommended timing for the insertion of a Copper T intrauterine device?

Accepted Answer

Within 10 days of start of menstrual cycle

Answer

3 days after periods are over

Answer

Just after menstruation

Answer

During active pelvic infection

Question 9

What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Accepted Answer

Within 3 weeks

Answer

Within 5 weeks

Answer

Within 7 weeks

Answer

Within 14 weeks

Question 10

What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?

Accepted Answer

200mg

Answer

10mg

Answer

20mg

Answer

100mg

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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