Abortion Ethics — MCQs
The MTP Act (as currently amended) provides rules for termination of pregnancy till what number of weeks of pregnancy?
A GSP4 woman comes for routine sonography for the first time. She has four daughters and expresses a desire for a boy this time, asking for sex determination. To abide by ethical guidelines, what should you do?
In the context of Indian regulations, what is the minimum number of Medical Termination of Pregnancy (MTP) cases a doctor must have performed to be eligible to perform an MTP?
A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?
A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?
A 14 years old rape victim with 22 weeks of gestation coming to hospital. All of the following can be done except:
MTP cannot be done after :
A district shows declining sex ratio over 3 decades. What is the most appropriate immediate intervention?
After an initial pregnancy resulted in a spontaneous loss in the first trimester, your patient is concerned about the possibility of this recurring. What is the chance of recurrence?
Which of the following is NOT an indication for genetic counseling?
Abortion Ethics Indian Medical PG Practice Questions and MCQs
Question 1: The MTP Act (as currently amended) provides rules for termination of pregnancy till what number of weeks of pregnancy?
- A. 12 weeks
- B. 16 weeks
- C. 20 weeks
- D. 24 weeks (Correct Answer)
Explanation: ***24 weeks*** - The **MTP (Medical Termination of Pregnancy) Act** was amended in 2021 to extend the gestational limit for termination of pregnancy from 20 to **24 weeks** for certain categories of women. - This extension applies to vulnerable groups such as survivors of **sexual assault**, minors, and women with disabilities. *12 weeks* - This was the initial gestational limit under the original MTP Act where the opinion of **one registered medical practitioner (RMP)** was sufficient. - The current amendment has significantly expanded this limit for various circumstances. *16 weeks* - This gestational period is **not explicitly a termination limit** under the MTP Act, either in its original form or its amendments. - The Act generally focuses on limits of 12, 20, and 24 weeks. *20 weeks* - This was the previous upper gestational limit for termination requiring the opinion of **two registered medical practitioners (RMPs)** under the MTP Act before the 2021 amendment. - Beyond this, termination was only permitted under very specific circumstances related to fetal abnormalities or risk to the mother's life.
Question 2: A GSP4 woman comes for routine sonography for the first time. She has four daughters and expresses a desire for a boy this time, asking for sex determination. To abide by ethical guidelines, what should you do?
- A. Check routine ANC and sex for developmental abnormalities and do not reveal gender to the patient (Correct Answer)
- B. Check routine ANC and sex for developmental abnormalities and do reveal gender to the patient
- C. Do reveal gender if a girl
- D. Check only routine ANC, do not check sex
Explanation: ***Check routine ANC and sex for developmental abnormalities and do not reveal gender to the patient*** - It is **illegal** and **unethical** to reveal the sex of the fetus in many countries, including India, to prevent **sex-selective abortions**. - The primary purpose of a routine antenatal ultrasound is to assess fetal **health** and **developmental abnormalities**, not to determine sex for parental preference. *Check routine ANC and sex for developmental abnormalities and do reveal gender to the patient* - Revealing the gender to the patient directly facilitates **sex-selective abortion**, which is medically unethical and illegal due to the potential for harm to the fetus and society. - This practice would violate the **Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act** in India, which prohibits gender determination. *Do reveal gender if a girl* - Revealing the gender, regardless of whether it is a boy or a girl, can lead to **gender-biased selective abortions**, particularly in cultures with a strong preference for male offspring. - This action undermines the ethical principles of **non-maleficence** and **justice** by potentially facilitating harm based on gender preference. *Check only routine ANC, do not check sex* - While the primary focus is routine antenatal care, avoiding the assessment of fetal sex entirely could lead to **missing potential developmental abnormalities** that might be identifiable through observation of external genitalia. - A thorough ultrasound examination routinely includes a visual check of fetal anatomy, which can incidentally reveal gender, but this information should not be shared with the parents for selection purposes.
Question 3: In the context of Indian regulations, what is the minimum number of Medical Termination of Pregnancy (MTP) cases a doctor must have performed to be eligible to perform an MTP?
- A. 10
- B. 15
- C. 25 (Correct Answer)
- D. 35
Explanation: ***25*** - As per the **MTP Act of India (1971)**, a registered medical practitioner needs to have assisted in or performed a minimum of **25 medical termination of pregnancies** in an approved training center to be certified to perform MTPs independently. - This regulation ensures a certain level of practical experience and competence before a doctor can perform this procedure. *10* - This number is **insufficient** according to Indian MTP regulations for a doctor to be eligible to perform MTPs independently. - The required practical experience is set higher to ensure adequate skill and safety for the procedure. *15* - This number also **falls short** of the minimum requirement stipulated by the Indian MTP Act. - The legislative framework emphasizes a more extensive practical exposure for practitioners. *35* - While performing 35 MTPs would certainly meet the experience requirement, it is **not the minimum specified** by the Indian MTP regulations. - The law requires a lower threshold of practical experience, which is 25 cases.
Question 4: A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?
- A. Incomplete abortion
- B. Complete abortion
- C. Inevitable abortion
- D. Threatened abortion (Correct Answer)
Explanation: ***Threatened abortion*** - This diagnosis is characterized by **vaginal bleeding** in the first half of pregnancy with a **closed internal os** and evidence of fetal viability on ultrasound. - The fundal height being consistent with gestational age also indicates ongoing pregnancy, despite the bleeding. *Inevitable abortion* - This condition is indicated by vaginal bleeding accompanied by a **dilated cervix (open internal os)**, suggesting that the pregnancy cannot be salvaged. - While bleeding is present, the **closed internal os** in the given scenario rules out inevitable abortion. *Incomplete abortion* - This involves vaginal bleeding, an **open internal os**, and the **partial expulsion of pregnancy tissue**, with some products of conception remaining in the uterus. - The presentation does not include an open os or retained products of conception, as the fetus is viable and the os is closed. *Complete abortion* - This occurs when **all products of conception have been expelled** from the uterus, characterized by an initially open os that subsequently closes, and often a decrease in bleeding. - The presence of a **viable fetus** and a closed os clearly rules out a complete abortion.
Question 5: A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?
- A. One doctor is involved
- B. MTP done in 2nd trimester only when mother's life is in danger
- C. MTP can be carried out up to 24 weeks (Correct Answer)
- D. MTP cannot be more than 20 weeks
Explanation: ***MTP can be carried out up to 24 weeks*** - The **Medical Termination of Pregnancy (Amendment) Act, 2021**, allows termination of pregnancy up to **24 weeks** for certain vulnerable groups, including survivors of sexual assault and minors. - As a 14-year-old victim of sexual assault, she falls under the category which permits MTP up to 24 weeks. *One doctor is involved* - For pregnancies between 12 and 20 weeks, the opinion of **two registered medical practitioners** is required for MTP. - Beyond 20 weeks up to 24 weeks, as in this case, the opinion of **two registered medical practitioners** is also mandatory. *MTP done in 2nd trimester only when mother's life is in danger* - While danger to the mother's life is a valid reason for MTP, the **MTP Act 2021** has expanded the grounds for MTP in the second trimester (beyond 12 weeks) to include other categories like **sexual assault survivors** and **minors**, even if the mother's life is not immediately in danger. - The primary consideration here is the **vulnerability** of the pregnant person, not solely imminent danger to life. *MTP cannot be more than 20 weeks* - This statement is incorrect as per the **Medical Termination of Pregnancy (Amendment) Act, 2021**. - The Act raised the upper gestation limit from 20 to **24 weeks** for specific categories of women, including victims of sexual assault and minors, aligning with the current case.
Question 6: A 14 years old rape victim with 22 weeks of gestation coming to hospital. All of the following can be done except:
- A. Male doctor can examine her with female attendant
- B. UPT not required
- C. Gynecologist can abort the fetus upon the patient request
- D. No need to collect vaginal swab (Correct Answer)
Explanation: ***No need to collect vaginal swab (INCORRECT STATEMENT - This CANNOT be said)*** - Collecting a **vaginal swab is MANDATORY** in all cases of sexual assault for **forensic evidence collection** to identify the perpetrator through DNA analysis. - This is a **medico-legal requirement** and must be done even if pregnancy has occurred, as it provides crucial evidence for prosecution. - The statement "no need to collect vaginal swab" is completely wrong, making it the correct answer to this "except" question. *Male doctor can examine her with female attendant (Can be done)* - It is **legally permissible and ethical** for a male doctor to examine a female patient in the presence of a **female attendant**. - This ensures patient comfort, privacy protection, and safeguards the doctor against false allegations. - This is standard medical practice in sensitive situations like sexual assault. *UPT not required (Can be done/said)* - A 14-year-old presenting with **22 weeks of gestation** has clinically evident pregnancy through abdominal examination and ultrasound. - Urine pregnancy test (UPT) is **not necessary** at this advanced gestational age as pregnancy is already confirmed. - Resources should focus on comprehensive care rather than redundant testing. *Gynecologist can abort the fetus upon the patient request (Can be done)* - Under the **Medical Termination of Pregnancy (MTP) Amendment Act 2021**, termination is permissible up to **24 weeks for rape survivors**. - For a minor, **consent of guardian** and opinion of **two registered medical practitioners** is required. - At 22 weeks, this patient is within the legal timeframe for termination given the circumstances of sexual assault.
Question 7: MTP cannot be done after :
- A. 24 weeks (Correct Answer)
- B. 28 weeks
- C. 12 weeks
- D. 20 weeks
Explanation: ***24 weeks*** - As per the **MTP (Amendment) Act, 2021**, 24 weeks is the **upper gestational limit** for medical termination of pregnancy in special categories of women. - MTP can be performed **up to 24 weeks** with the opinion of two registered medical practitioners for specific categories: rape survivors, victims of incest, minors, women with physical/mental disabilities, and cases of fetal abnormalities. - Beyond 24 weeks, MTP is permitted **only for substantial fetal abnormalities** diagnosed by a Medical Board, with no specified upper limit for such exceptional cases. - For general MTP purposes and examination context, **24 weeks is the definitive upper limit** beyond which termination cannot be routinely performed. *28 weeks* - There is **no specific mention of 28 weeks** as a cut-off in the MTP Act. - This is not a legally recognized gestational age limit for MTP in India. - While MTP may theoretically be performed beyond 24 weeks for substantial fetal abnormalities, 28 weeks is not the defined limit. *20 weeks* - Under the **MTP (Amendment) Act, 2021**, MTP up to 20 weeks can be performed with the opinion of **one registered medical practitioner** for all women. - This was the **original upper limit** under the MTP Act, 1971, but has since been extended to 24 weeks for special categories. - This is not the absolute upper limit under current legislation. *12 weeks* - MTP before 12 weeks is considered the **safest period** and can be performed with minimal procedural complexity. - This represents an **early gestational age**, well within the permissible limits for MTP. - This is definitely not the upper limit beyond which MTP cannot be performed.
Question 8: A district shows declining sex ratio over 3 decades. What is the most appropriate immediate intervention?
- A. Female education program
- B. PCPNDT Act enforcement (Correct Answer)
- C. Women empowerment schemes
- D. Economic incentives
Explanation: ***PCPNDT Act enforcement*** - The **PCPNDT (Pre-Conception and Pre-Natal Diagnostic Techniques) Act enforcement** directly addresses the illegal practice of **sex-selective abortion**, which is the primary driver of declining sex ratios in India. - Strengthening its implementation ensures that prenatal diagnostic techniques are not misused for sex determination, thus protecting the female fetus. - This is an **immediate regulatory intervention** that can have rapid impact through legal penalties and monitoring. *Female education program* - While **female education** is crucial for long-term societal change and empowering women, its impact on the sex ratio would be gradual and not an immediate intervention. - It addresses root causes like gender discrimination but doesn't directly stop the immediate practices leading to sex-selective abortions. *Women empowerment schemes* - **Women empowerment schemes** contribute to improving the status of women in society over time. - However, similar to education programs, these schemes are **long-term strategies** and may not provide the immediate impact needed to reverse a rapidly declining sex ratio. *Economic incentives* - **Economic incentives** (like conditional cash transfers for girl children) might encourage families to value female children more, but their effectiveness in immediately halting sex-selective practices is debatable and often insufficient alone. - They may address financial reasons for sex preference but do not directly prevent the illegal acts of sex determination and abortion.
Question 9: After an initial pregnancy resulted in a spontaneous loss in the first trimester, your patient is concerned about the possibility of this recurring. What is the chance of recurrence?
- A. Depends on the genetic makeup of the prior abortus
- B. Is no different than it was prior to the miscarriage (Correct Answer)
- C. Is increased to approximately 50%
- D. Is increased most likely to greater than 50%
Explanation: ### Explanation **Correct Answer: B. Is no different than it was prior to the miscarriage** **1. Why Option B is Correct:** Spontaneous abortion (miscarriage) is a common event, occurring in approximately 10–15% of clinically recognized pregnancies. The vast majority (up to 50–70%) of isolated first-trimester losses are due to **sporadic chromosomal abnormalities** (e.g., autosomal trisomies), which are random events. Statistically, after a **single** spontaneous loss, the risk of a subsequent miscarriage remains approximately **15–20%**, which is essentially the same as the baseline risk for the general population. The risk only begins to rise significantly after two or more consecutive losses. **2. Why Other Options are Wrong:** * **Option A:** While the genetic makeup of the abortus explains *why* that specific pregnancy failed, it does not dictate the recurrence risk for the next pregnancy unless a parental balanced translocation is present (which is rare and not the default assumption after a single loss). * **Options C & D:** These options overestimate the risk. A 50% recurrence risk is not reached even after three consecutive losses. After two losses, the risk rises to ~25–30%, and after three, it reaches ~33–45%. **3. Clinical Pearls for NEET-PG:** * **Most common cause of first-trimester abortion:** Fetal genetic factors (Chromosomal anomalies). * **Most common specific chromosomal anomaly:** Autosomal Trisomy (Trisomy 16 is the most common specific trisomy). * **Recurrent Pregnancy Loss (RPL):** Defined by the ASRM as **two or more** failed clinical pregnancies. Investigations for RPL are generally not indicated after a single isolated loss. * **Prognosis:** Even after 3 losses, the most likely outcome for the next pregnancy is a live birth (approx. 60–70% success rate without intervention).
Question 10: Which of the following is NOT an indication for genetic counseling?
- A. Parental age greater than 45 years (Correct Answer)
- B. Maternal age greater than 35 years
- C. Incest
- D. Previous child having dysmorphology
Explanation: ### Explanation **1. Why Option A is the correct answer:** In the context of standard obstetric guidelines (ACOG/RCOG), the primary trigger for genetic counseling regarding chromosomal abnormalities is **Advanced Maternal Age (AMA)**, defined as **≥35 years** at the time of delivery. While advanced paternal age (often cited as >40 or >45) is associated with a slight increase in *de novo* autosomal dominant mutations (e.g., Achondroplasia), it is **not** a standard, standalone indication for formal genetic counseling in the same way maternal age is. The term "Parental age" in Option A is a distractor because it generalizes both parents; specifically, paternal age alone does not mandate the same level of screening as maternal age. **2. Analysis of Incorrect Options:** * **B. Maternal age >35 years:** This is a classic indication. At age 35, the risk of a mid-trimester amniocentesis-related loss roughly equals the risk of Down Syndrome (1 in 270), making counseling and screening essential. * **C. Incest (Consanguinity):** Consanguineous unions significantly increase the risk of autosomal recessive disorders. Counseling is mandatory to discuss carrier screening and pedigree analysis. * **D. Previous child with dysmorphology:** Any previous offspring with structural defects, intellectual disability, or metabolic disorders requires genetic evaluation to determine the recurrence risk (e.g., translocation Down Syndrome vs. Trisomy 21). **3. NEET-PG High-Yield Pearls:** * **Advanced Maternal Age (AMA):** Defined as **≥35 years**. * **Most common chromosomal abnormality in AMA:** Trisomy 21 (Down Syndrome). * **Paternal Age Effect:** Associated with "Point Mutations" (e.g., Apert syndrome, Achondroplasia) rather than chromosomal non-disjunction. * **Indications for Prenatal Diagnosis:** Previous child with chromosomal anomaly, parental balanced translocation, ultrasound-detected fetal anomalies, and positive biochemical screening (Triple/Quadruple markers).
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free