Informed Consent in Obstetrics and Gynecology — MCQs
For medical termination of pregnancy, consent is given by-
False about MTP is -
Miscarriage due to medical negligence is seen under which IPC?
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 doctor is not held guilty of negligence if
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?
What is a successful regimen for medical termination of pregnancy in the first trimester?
For Medical Termination of Pregnancy (MTP), whose consent should be obtained?
All of the following drugs are used in the medical termination of early pregnancy, EXCEPT:
Informed Consent in Obstetrics and Gynecology Indian Medical PG Practice Questions and MCQs
Question 1: For medical termination of pregnancy, consent is given by-
- A. Guardian
- B. Husband of the lady
- C. Concerned lady (Correct Answer)
- D. Both husband and wife
Explanation: ***Concerned lady*** - For a medical termination of pregnancy, **informed consent** must be given directly by the woman seeking the procedure. - This upholds her **autonomy** and right to make decisions regarding her own body and healthcare. *Guardian* - A guardian's consent is typically required only if the woman is a **minor** or is otherwise **legally incapacitated** and unable to provide consent herself. - In most cases, an adult woman is presumed to be competent to consent for her own medical procedures. *Husband of the lady* - The husband's consent is **not legally required** for a medical termination of pregnancy, as it is the woman's fundamental right to decide. - Requiring a husband's consent would infringe upon the woman's **bodily autonomy** and reproductive rights. *Both husband and wife* - While open communication with a spouse is often encouraged, **joint consent** from both the husband and wife is not a legal prerequisite for a medical termination of pregnancy. - The ultimate decision-making authority rests solely with the **pregnant woman**.
Question 2: False about MTP is -
- A. Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks
- B. Consent of husband is must (Correct Answer)
- C. >16 weeks, hysterotomy can be done
- D. Illegal if >20 weeks of pregnancy
Explanation: ***Consent of husband is must*** - The **Medical Termination of Pregnancy (MTP) Act** (amended in 2021) in India explicitly states that **only the consent of the pregnant woman** is required for an abortion. - The husband's consent is **not legally necessary** and cannot be a barrier to accessing MTP services. - **This statement is FALSE**, making it the correct answer to this negation question. *Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks* - This statement is **TRUE**; for pregnancies between **12 and 20 weeks**, the opinion of **two registered medical practitioners** is required. - For pregnancies between **20 and 24 weeks**, two registered medical practitioners are required for specific vulnerable categories of women. *>16 weeks, hysterotomy can be done* - **Hysterotomy** is a surgical procedure similar to a mini-C-section, used in specific cases for MTP, often in later gestations or when other methods are contraindicated. - While exact gestational limits vary by clinical judgment and local regulations, it is indeed a method considered for **later second-trimester terminations**, including those beyond 16 weeks, under proper medical indication. - **This statement is TRUE**. *Illegal if >20 weeks of pregnancy* - This statement was largely true under the **MTP Act of 1971**, which set the upper limit for MTP at 20 weeks. - However, the **MTP (Amendment) Act of 2021** has expanded this limit, allowing termination up to **24 weeks for specific categories of women** and in cases of substantial fetal abnormalities, there is **no upper gestational limit** for termination. - **This statement is now FALSE** as per the 2021 amendments, though it requires contextual understanding.
Question 3: Miscarriage due to medical negligence is seen under which IPC?
- A. Sec 304A IPC (Correct Answer)
- B. Sec 310 IPC
- C. Sec 312 IPC
- D. Sec 314 IPC
Explanation: ***Sec 304A IPC*** - This section specifically deals with **causing death by negligence** (rash or negligent acts not amounting to culpable homicide). - **Medical negligence causing miscarriage** falls under this section as it involves an unintentional harm due to negligent medical practice. - This is the appropriate section when there is no voluntary intent to cause miscarriage, but harm results from professional negligence. *Sec 312 IPC* - This section deals with **voluntarily causing miscarriage**, requiring intentional/voluntary act. - It applies when a person **intentionally** causes a woman to miscarry (criminal abortion). - Medical **negligence** does not constitute a voluntary act in the legal sense, so Sec 312 does not apply to negligence cases. *Sec 310 IPC* - This section is related to **thuggee**, defining someone who habitually commits robbery or child-stealing by murder. - It has no relevance to medical negligence or miscarriage. *Sec 314 IPC* - This section deals with **death caused by an act done with intent to cause miscarriage**. - It applies when an intentional act to cause miscarriage results in the death of the woman. - This requires criminal intent, not negligence.
Question 4: 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 5: A doctor is not held guilty of negligence if
- A. He has not obtained informed consent from patient
- B. He has exercised reasonable care and skill (Correct Answer)
- C. Others suffer disease from his patient
- D. He fails to give proper instructions
Explanation: ***He has exercised reasonable care and skill*** - A doctor is not held guilty of **negligence** if they have acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art (**Bolam test**). - This implies employing the **degree of care, diligence, and skill** that a reasonably competent practitioner would use under similar circumstances. *He has not obtained informed consent from patient* - Failure to obtain **informed consent** can lead to liability for **battery** (unlawful touching) or negligence, especially if the patient can prove they would not have undergone the procedure had they been properly informed of the risks. - Ethical and legal standards mandate that patients provide **voluntary, informed consent** before medical interventions. *Others suffer disease from his patient* - A doctor's primary responsibility is to their patient; however, there are situations where a **duty to warn** third parties exists, especially in cases of foreseeable harm from a communicable disease or dangerous psychiatric patient. - Failure to warn when such a **duty is established** could lead to negligence claims if specific harm to identifiable third parties occurs. *He fails to give proper instructions* - Providing **clear and adequate post-operative or post-treatment instructions** is a fundamental part of a doctor's duty of care. - Failure to give proper instructions can result in **patient harm** and can be grounds for a negligence claim if it leads to complications or a poor outcome.
Question 6: 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 7: 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).
Question 8: What is a successful regimen for medical termination of pregnancy in the first trimester?
- A. Misoprostol
- B. Mifepristone
- C. RU486
- D. All of the above (Correct Answer)
Explanation: The medical termination of pregnancy (MTP) in the first trimester (up to 10 weeks or 70 days of gestation) is most effectively achieved using a combination of **Mifepristone** and **Misoprostol**. ### **Explanation of the Correct Answer** The correct answer is **"All of the above"** because the regimen relies on the synergistic action of these drugs: * **Mifepristone (Option B) & RU486 (Option C):** These are the same drug. RU486 is the pharmacological designation for Mifepristone. It is an **anti-progestogen** that binds to progesterone receptors, leading to decidual necrosis, cervical softening, and sensitization of the uterus to prostaglandins. * **Misoprostol (Option A):** This is a **Prostaglandin E1 (PGE1) analogue**. It induces uterine contractions and cervical ripening, leading to the expulsion of the products of conception. ### **Why individual options are not "wrong" but incomplete:** While Mifepristone or Misoprostol can be used alone, their efficacy is significantly lower when used as monotherapy. The **WHO-recommended gold standard** is the combined regimen, which has a success rate of over 95-98%. Since RU486 and Mifepristone are synonyms, and both are used alongside Misoprostol, "All of the above" is the most accurate choice. ### **High-Yield Clinical Pearls for NEET-PG:** * **Standard Regimen:** 200 mg Mifepristone (oral) followed 24–48 hours later by 800 mcg Misoprostol (vaginal, buccal, or sublingual). * **MTP Act (India) Update:** Medical termination is legal up to **24 weeks** under specific conditions, but the medical (drug-based) regimen is most commonly used up to **9-10 weeks**. * **Side Effects:** The most common side effect of Misoprostol is diarrhea and shivering; the most common complication of MTP is incomplete abortion. * **Contraindications:** Suspected ectopic pregnancy, chronic adrenal failure, and long-term corticosteroid therapy.
Question 9: For Medical Termination of Pregnancy (MTP), whose consent should be obtained?
- A. Male partner
- B. Male and female partners
- C. Female patient (Correct Answer)
- D. No consent is needed
Explanation: **Explanation:** In accordance with the **Medical Termination of Pregnancy (MTP) Act, 1971** (and its subsequent amendments), the decision to terminate a pregnancy rests solely with the pregnant woman. **1. Why the Correct Answer is Right:** The underlying medical and legal concept is **bodily autonomy**. Under the MTP Act, the only consent required for a major woman (above 18 years of age) or a woman who is not mentally ill is her own written consent. The law recognizes that the physical and psychological burden of pregnancy is borne by the woman; therefore, she has the final authority over her reproductive choices. **2. Why Incorrect Options are Wrong:** * **Options A & B:** Legally, the **consent of the husband or male partner is NOT required**. A doctor cannot be sued for performing an MTP without the husband's consent, provided the woman has consented. Requiring a partner's permission would violate the woman’s right to privacy and self-determination. * **Option D:** Informed consent is a mandatory legal and ethical prerequisite for any surgical or medical intervention. Performing an MTP without consent constitutes criminal assault and medical negligence. **3. High-Yield Clinical Pearls for NEET-PG:** * **Minors (<18 years) or Mentally Ill:** In these specific cases, written consent from the **guardian** is mandatory. * **Confidentiality:** The MTP Act mandates that the identity of the woman must be kept strictly confidential. * **Provider Requirement:** For MTP up to 12 weeks, the opinion of **one** Registered Medical Practitioner (RMP) is needed. From 12 to 20 weeks (and up to 24 weeks for specific categories), the opinion of **two** RMPs is required. * **Marital Status:** The 2021 Amendment now includes "unmarried women" under the clause for contraceptive failure, ensuring equal access to MTP regardless of marital status.
Question 10: All of the following drugs are used in the medical termination of early pregnancy, EXCEPT:
- A. Methotrexate
- B. Mifepristone
- C. Misoprostol
- D. Medroxyprogesterone (Correct Answer)
Explanation: ### Explanation The medical termination of pregnancy (MTP) involves the use of pharmacological agents to induce the evacuation of the products of conception. **Why Medroxyprogesterone is the Correct Answer:** **Medroxyprogesterone acetate (DMPA)** is a synthetic progestin used primarily as a **long-acting injectable contraceptive** or for treating conditions like endometriosis and abnormal uterine bleeding. In early pregnancy, progesterone is essential for maintaining the decidua and pregnancy viability. Therefore, a progestin like Medroxyprogesterone would theoretically support, rather than terminate, a pregnancy. **Analysis of Other Options:** * **Mifepristone (RU-486):** An anti-progestational agent that binds to progesterone receptors, leading to decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins. It is the first-line drug for medical MTP. * **Misoprostol:** A PGE1 analogue that causes cervical ripening and potent uterine contractions to expel the products of conception. It is typically administered 24–48 hours after Mifepristone. * **Methotrexate:** A folate antagonist that inhibits DNA synthesis in rapidly dividing cells. It is used as a second-line agent for medical MTP (often in combination with Misoprostol) and is the drug of choice for the medical management of **unruptured ectopic pregnancy**. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Act (India):** Medical termination is legal up to **24 weeks** under specific conditions. * **WHO Recommended Regimen (<9 weeks):** Mifepristone 200 mg orally followed by Misoprostol 800 mcg (vaginal/buccal/sublingual). * **Ectopic Pregnancy:** Methotrexate is indicated if the gestational sac is **<4 cm**, no fetal heart rate is present, and β-hCG is **<5000 mIU/mL**. * **Side Effects:** Misoprostol commonly causes diarrhea and shivering; Mifepristone can cause heavy bleeding.
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