Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 701: In the context of tubal ligation, what is the failure rate of Pomeroy's technique?

A. 0.1-0.5%
B. 1-2%
C. 5-10%
D. 0.5-1% (Correct Answer)

Explanation: ***0.5-1%*** - Pomeroy's technique generally has a reported **failure rate** in the range of **0.5% to 1% per 100 women-years**. - This rate indicates that despite being a highly effective method of sterilization, a small percentage of women may still experience **pregnancy** after the procedure. *0.1-0.5%* - This range is typically considered too low for the **failure rate** of Pomeroy's technique, which is known to have a slightly higher but still very effective rate. - While some highly effective contraceptive methods might approach this range, tubal ligation techniques like Pomeroy's have a small, but consistently reported, higher failure rate. *1-2%* - While still low, this range is generally considered to be a slightly **higher than average failure rate** for Pomeroy's technique. - An incidence in this range might suggest a technical issue during the procedure or a less effective method in general. *5-10%* - This range represents a significantly **higher failure rate** than what is typically associated with Pomeroy's technique, which is recognized as a very effective method of permanent sterilization. - A failure rate this high would be comparable to less effective or temporary contraceptive methods, rather than a surgical sterilization procedure.

Question 702: The combined estrogen-progestin pill acts mainly by:

A. Suppression of FSH and LH release (Correct Answer)
B. Enhancing uterine contraction to dislodge the fertilized ovum
C. Making the endometrium less suitable for implantation
D. Thickening of cervical mucus to prevent sperm penetration

Explanation: ***Suppression of FSH and LH release*** - The **estrogen** and **progestin** components of combined oral contraceptives exert a negative feedback on the **hypothalamus** and **pituitary gland**. - This leads to the suppression of **follicle-stimulating hormone (FSH)** and **luteinizing hormone (LH)**, which prevents **ovarian follicle development** and **ovulation**. *Making the endometrium less suitable for implantation* - While combined oral contraceptives do make the **endometrium** less receptive, this is a **secondary mechanism** and not the primary way they prevent pregnancy. - The endometrial changes primarily serve as a **backup plan** if ovulation accidentally occurs. *Enhancing uterine contraction to dislodge the fertilized ovum* - Combined oral contraceptives do **not enhance uterine contractions** to dislodge a fertilized ovum. - This mechanism is generally associated with methods like certain **emergency contraceptives** or early abortion methods. *Thickening of cervical mucus to prevent sperm penetration* - This is a significant effect of the **progestin component**, but it is also a **secondary mechanism** of action for combined pills. - While crucial for contraception, the **primary mechanism** remains the inhibition of ovulation.

Question 703: Antiprogesterone compound RU-486 is effective for inducing abortion if the duration of pregnancy is what?

A. 63 days (Correct Answer)
B. 72 days
C. 88 days
D. 120 days

Explanation: ***63 days*** - **Mifepristone (RU-486)**, an antiprogesterone, is most effective for medical abortion when used within 63 days (9 weeks) of gestation. - Its efficacy decreases and the risk of incomplete abortion or complications increases beyond this timeframe, making surgical options more suitable for later pregnancies. *72 days* - While still relatively early in pregnancy, **mifepristone's efficacy** starts to decline after 63 days, and the recommended window for optimal success of a medical abortion is generally within the first 9 weeks. - Beyond 63 days, the need for **surgical intervention** or repeat doses of misoprostol becomes more likely, and the overall success rate for medical abortion is reduced. *88 days* - By 88 days (approximately 12.5 weeks), medical abortion with mifepristone alone becomes significantly less effective and often requires **surgical evacuation**. - The risk of **incomplete abortion**, heavier bleeding, and other complications substantially increases, highlighting the importance of earlier intervention. *120 days* - At 120 days (approximately 17 weeks), medical abortion with mifepristone would be largely ineffective and unsafe as a primary method for pregnancy termination. - Pregnancies at this stage typically require **surgical procedures** like D&E (dilation and evacuation) due to the size of the fetus and placenta.

Question 704: Absolute contraindication of IUCD is:

A. Endometriosis
B. Iron deficiency anaemia
C. Dysmenorrhea
D. Pelvic tuberculosis (Correct Answer)

Explanation: ***Pelvic tuberculosis*** - **Pelvic tuberculosis** is an **absolute contraindication** for intrauterine contraceptive device (IUCD) insertion due to the increased risk of dissemination of the infection and worsening of the disease. - Inserting an IUCD in a patient with active pelvic tuberculosis can lead to severe complications, including **pelvic inflammatory disease (PID)**, abscess formation, and systemic infection. *Endometriosis* - **Endometriosis** is generally not an absolute contraindication for IUCD use, especially for **levonorgestrel-releasing IUCDs**, which are often used to manage symptoms like dysmenorrhea and heavy menstrual bleeding in these patients. - The hormonal effects of some IUCDs can actually be beneficial in reducing the growth of endometrial implants. *Iron deficiency anaemia* - **Iron deficiency anemia** is not an absolute contraindication for IUCDs, particularly the **levonorgestrel-releasing IUCDs**, which reduce menstrual blood loss and can improve iron status. - For copper IUCDs, which can increase menstrual bleeding, a patient with iron deficiency anemia might experience worsening symptoms, but this is a **relative contraindication** that can be managed, not an absolute one. *Dysmenorrhea* - While **dysmenorrhea** can be a concern with some IUCDs, especially copper IUCDs which can sometimes worsen pain, it is not an absolute contraindication. - **Levonorgestrel-releasing IUCDs** are often prescribed to manage and even alleviate dysmenorrhea due to their progesterone-like effects on the endometrium.

Question 705: Billings method of contraception is based on?

A. Change in temperature
B. Change in cervical mucus (Correct Answer)
C. Coitus interruptus
D. Safe period (calendar method)

Explanation: ***Change in cervical mucus*** - The **Billings ovulation method**, also known as the **cervical mucus method**, involves observing changes in the consistency and quantity of cervical mucus. - This method helps identify the **fertile window** by recognizing increased, clear, stretchy mucus around ovulation. *Change in temperature* - This refers to the **basal body temperature (BBT) method**, which tracks the slight rise in body temperature after ovulation. - The Billings method focuses solely on cervical mucus characteristics, not temperature. *Safe period (calendar method)* - The **calendar method** (rhythm method) involves calculating fertile days based on the length of previous menstrual cycles. - While both are natural family planning methods, the Billings method relies directly on physiological signs rather than calculations. *Coitus interruptus* - This is a withdrawal method where the penis is withdrawn from the vagina before ejaculation. - This method is a behavioral contraceptive technique and does not involve monitoring bodily signs like cervical mucus.

Question 706: Which contraceptive method is considered most effective for couples seeking reliable birth control?

A. Combined oral contraceptives (OCPs)
B. Barrier methods (e.g., condoms)
C. Progestin-only pill
D. Intrauterine contraceptive device (IUCD) (Correct Answer)

Explanation: ***Intrauterine contraceptive device (IUCD)*** - **IUCDs** (both hormonal and copper) are considered among the most effective reversible contraceptive methods, with typical use failure rates less than 1%. - Their long-acting nature means no daily effort is required, making them highly reliable for couples seeking **consistent birth control**. *Barrier methods (e.g., condoms)* - While effective when used consistently and correctly, **barrier methods** have a higher typical-use failure rate (around 13-18%) compared to IUCDs due to user error or inconsistent use. - They also provide protection against **STIs**, but are less effective for pregnancy prevention in real-world scenarios. *Combined oral contraceptives (OCPs)* - **OCPs** are highly effective when taken perfectly, but their typical-use failure rate is around 7%, primarily due to missed pills. - They require daily adherence and can have side effects that might impact compliance, making them less reliable than IUCDs for some users. *Progestin-only pill* - The **progestin-only pill** (mini-pill) is effective but requires strict adherence to a daily schedule, ideally at the same time each day, making it very sensitive to missed doses. - Its typical-use failure rate is similar to or slightly higher than combined OCPs due to this strict dosing requirement, making it generally less reliable than IUCDs.

Question 707: Which of the following reduces the risk of pelvic inflammatory disease (PID)?

A. Copper T IUCD
B. TODAY vaginal sponge
C. Spermicidal agents
D. Oral contraceptive pills (OCPs) (Correct Answer)

Explanation: ***Oral contraceptive pills (OCPs)*** - OCPs **thicken cervical mucus**, which creates a barrier that can prevent the ascent of bacteria from the vagina into the upper reproductive tract. - This cervical mucus barrier reduces the risk of cervical infection spreading to the uterus and fallopian tubes, thereby **lowering the incidence of PID**. *Copper T IUCD* - The Copper T IUCD is associated with a **slightly increased risk of PID** in the first few weeks after insertion, especially in women with pre-existing sexually transmitted infections (STIs). - It does not offer protection against ascending infections and can potentially facilitate their spread if the cervical barrier is compromised. *TODAY vaginal sponge* - The TODAY vaginal sponge contains **spermicide and acts as a barrier contraceptive**, but it does not protect against STIs, which are the primary cause of PID. - Some studies suggest that spermicides can **irritate vaginal mucosa**, potentially increasing susceptibility to certain infections. *Spermicidal agents* - Spermicidal agents primarily work by **immobilizing and killing sperm** to prevent pregnancy. - They **do not protect against STIs** and, in some cases, frequent use can cause vaginal and cervical irritation, potentially making the user more vulnerable to infections that can lead to PID.

Question 708: What is the most common site of ligation by laparoscopic ring in female sterilization?

A. Fimbrial
B. Cornual
C. Ampullary
D. Isthmus (Correct Answer)

Explanation: ***Isthmus*** - The **isthmic portion** of the fallopian tube is the most common and preferred site for laparoscopic ring application (e.g., Falope ring or Yoon ring) in female sterilization. - This segment is chosen because it is relatively **straight**, has a **narrow lumen**, and possesses a **thick muscular wall**, making it ideal for occlusion and effective contraception. *Fimbrial* - The **fimbrial end** is the most distal part of the fallopian tube, characterized by finger-like projections that capture the ovum. - Ligation at this site is less common due to its **delicate structure** and proximity to the ovary, increasing the risk of **ovarian damage** or incomplete occlusion. *Cornual* - The **cornual portion** is the segment of the fallopian tube that passes through the muscular wall of the uterus. - This site is generally avoided for ring application due to the **risk of uterine perforation** and increased **bleeding** from the uterine arteries within the myometrium. *Ampullary* - The **ampullary portion** is the widest and longest part of the fallopian tube, where fertilization typically occurs. - Its **dilated lumen** and **tortuous nature** make it less suitable for secure and effective ring placement, as the ring may not fully occlude the tube.

Question 709: What is the absolute contraindication of oral contraceptive pills (OCPs)?

A. Dysmenorrhoea
B. Carcinoma of the breast (Correct Answer)
C. Endometriosis
D. Hypertension

Explanation: ***Carcinoma of the breast*** - OCPs contain **estrogen and progesterone**, which can stimulate the growth of **hormone-sensitive breast cancers**. - Therefore, a history of or current **breast cancer** is an absolute contraindication to OCP use. *Dysmenorrhoea* - **Dysmenorrhoea** (painful menstruation) is often effectively treated or alleviated by OCPs due to their ability to suppress ovulation and reduce prostaglandin production. - It is not a contraindication; rather, it is a common indication for OCP use. *Hypertension* - **Uncontrolled severe hypertension** (≥160/100 mmHg) is an absolute contraindication to OCP use. - However, the term "hypertension" alone typically refers to mild or well-controlled hypertension, which is a relative contraindication with careful monitoring. - OCPs can sometimes **increase blood pressure**, requiring careful risk-benefit assessment for individuals with existing hypertension. *Endometriosis* - **Endometriosis** is often managed and its symptoms improved by OCPs, as they help suppress endometrial growth and reduce menstrual flow. - OCPs are a common and effective treatment for endometriosis, not a contraindication.

Question 710: After the rise of temperature, the unsafe period lasts for what duration in the basal body temperature method?

A. 24 hours
B. 48 hours
C. 72 hours (Correct Answer)
D. 120 hours

Explanation: ***72 hours*** - In the **basal body temperature (BBT) method**, the temperature rise indicates that **ovulation has already occurred** due to progesterone secretion from the corpus luteum. - The unsafe period continues for **3 consecutive days (72 hours)** after the temperature rise to ensure the rise is **sustained and not a transient spike**, confirming entry into the infertile luteal phase. - After 3 days of sustained elevated temperature, the ovum is no longer viable, and the woman enters the safe (infertile) period until the next menstrual cycle. *24 hours* - While the **ovum viability** is approximately 12-24 hours after ovulation, the BBT method requires observation of a **sustained temperature rise** for reliability. - Limiting the observation to 24 hours after a single temperature elevation could lead to false identification of the safe period if the rise was transient or measurement error occurred. *48 hours* - This duration provides a longer observation period than 24 hours but is still insufficient for the BBT method's standard protocol. - The **3-day rule (72 hours)** is the established guideline to confirm a sustained temperature elevation and reliable entry into the post-ovulatory infertile phase. *120 hours* - This period (5 days) is excessively long after the confirmed **basal body temperature (BBT) rise**. - Once the temperature has remained elevated for 3 consecutive days (72 hours), the fertile period has definitively ended, making a 120-hour unsafe period unnecessarily restrictive and impractical.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

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