Contraception and Family Planning Practice Questions

Q: Which drug is used for mid-trimester abortion?

Mifepristone. **Explanation:** **Mifepristone (Option A)** is the correct answer. It is a potent anti-progestational agent that sensitizes the myometrium to prostaglandins by blocking progesterone receptors. In mid-trimester abortions (13–24 weeks), Mifepristone is used as a pre-treatment (200 mg orally) 24–48 hours before administering prostaglandins (like Misoprostol). This combination significantly shortens the induction-to-abortion interval and increases the success rate compared to using prostaglandins alone. **Analysis of Incorrect Options:** * **Atosiban (Option B):** A competitive antagonist of oxytocin and vasopressin receptors. It is used as a **tocolytic** to suppress preterm labor, not to induce abortion. * **Valethamate (Option C):** An anticholinergic drug previously used as a cervical dilator to "speed up" the first stage of labor. Its use has largely been discontinued due to lack of proven efficacy and side effects (tachycardia, dry mouth). * **Methotrexate (Option D):** A folate antagonist used primarily for the medical management of **unruptured ectopic pregnancy** or early first-trimester medical abortions (off-label). It is not the standard of care for mid-trimester induction. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Mid-trimester:** The combination of **Mifepristone + Misoprostol** is currently the most effective medical method. * **MTP Act (India):** Medical termination is legal up to **24 weeks** for specific categories of women (as per 2021 amendment). * **Surgical Alternative:** Dilatation and Evacuation (D&E) is the surgical method for the second trimester, though medical induction is often preferred for safety. * **Ethacridine Lactate:** Historically used for mid-trimester (extra-amniotic instillation), but now largely replaced by prostaglandins.

Q: Which of the following statements regarding medical abortion is true?

It can be performed up to 9 weeks of gestation.. **Explanation:** **Correct Answer: A. It can be performed up to 9 weeks of gestation.** According to the latest guidelines under the **MTP (Amendment) Act 2021** and the Federation of Obstetric and Gynaecological Societies of India (FOGSI), medical abortion using the combination of Mifepristone and Misoprostol is approved for use up to **63 days (9 weeks)** of gestation. Previously, the limit was 7 weeks, but it has been extended based on clinical efficacy and safety data. **Analysis of Incorrect Options:** * **Option B:** Medical abortion cannot be administered by "any" RMP. It must be prescribed by a **Registered Medical Practitioner (RMP)** as defined under the MTP Act (someone with a recognized medical qualification and specific training/experience in Obstetrics and Gynecology). * **Option C:** Medical abortion is **not** exempted from the MTP Act. It must comply with all legal requirements, including documentation (Form I), maintenance of confidentiality, and being performed at a certified center (or by an RMP with access to a backup facility). * **Option D:** Medical abortion is a method of terminating an established pregnancy. It is **not** used for emergency contraception. Approved emergency contraceptives in India include Levonorgestrel (LNG) 1.5 mg or the Copper-T IUD. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Regimen:** 200 mg Mifepristone (oral) followed by 400 mcg Misoprostol (oral/vaginal/buccal) after 24–48 hours. * **Mechanism:** Mifepristone is an anti-progestogen (detaches embryo); Misoprostol is a PGE1 analogue (induces contractions). * **MTP Act 2021:** Upper limit for abortion in special categories is 24 weeks; no limit for substantial fetal abnormalities (approved by a Medical Board).

Q: Which of the following is NOT a method of contraception during lactation?

Oral contraceptive pills (OCPs). **Explanation:** The correct answer is **C. Oral contraceptive pills (OCPs)**. In the context of lactation, "OCPs" typically refers to **Combined Oral Contraceptive Pills (COCs)** containing both estrogen and progesterone. Estrogen is known to **suppress prolactin levels**, which leads to a significant decrease in the quantity and quality of breast milk. Therefore, COCs are generally avoided during the first 6 months of breastfeeding to prevent interference with infant nutrition. **Analysis of Options:** * **A. Lactational Amenorrhea Method (LAM):** A natural method based on the physiological suppression of ovulation by high prolactin levels. It is effective for up to 6 months if the mother is exclusively breastfeeding and remains amenorrheic. * **B. Intrauterine Device (IUD):** Both Cu-T and LNG-IUS are safe during lactation. They do not affect milk production. Postpartum IUCD (PPIUCD) can be inserted within 48 hours of delivery or after 6 weeks (involution). * **D. Progestin-only pills (POPs/Minipills):** These are the **contraceptives of choice** for breastfeeding mothers who desire oral hormonal contraception. Unlike estrogen, progestins do not affect milk volume or composition. **High-Yield Clinical Pearls for NEET-PG:** * **Timing of COCs:** According to WHO Medical Eligibility Criteria (MEC), COCs are MEC Category 4 (unacceptable risk) before 3 weeks postpartum and Category 3 (risks outweigh benefits) between 3 weeks to 6 months if breastfeeding. * **DMPA (Injectable):** Can be safely started 6 weeks postpartum in lactating women. * **Ideal Contraceptive:** Progestin-only methods (POPs, Implants) or Non-hormonal methods (Barrier, IUDs) are preferred during lactation.

Q: For how many consecutive days should a woman take hormonal oral contraceptive pills to effectively prevent ovulation?

7 days. ### Explanation **Correct Answer: C. 7 days** **Medical Concept:** The primary mechanism of Combined Oral Contraceptive Pills (COCPs) is the suppression of the Hypothalamic-Pituitary-Ovarian (HPO) axis. Estrogen inhibits **FSH** (preventing follicular development), while Progestin inhibits the **LH surge** (preventing ovulation). To achieve therapeutic levels sufficient to suppress the HPO axis and ensure no "escape ovulation" occurs, it takes **7 consecutive days** of active hormonal intake. This is known as the **"7-day rule."** If a woman starts the pill after the 5th day of her menstrual cycle, she must use a backup method (like condoms) for the first 7 days. **Analysis of Incorrect Options:** * **A (3 days) & B (5 days):** These durations are insufficient to consistently suppress the mid-cycle LH surge. While some follicular inhibition begins, the risk of ovulation remains high if unprotected intercourse occurs. * **D (9 days):** While 9 days would certainly prevent ovulation, it exceeds the minimum clinical requirement. In medical exams, the "earliest" or "standard" threshold is sought, which is 7 days. **High-Yield Clinical Pearls for NEET-PG:** * **Missed Pill Rule:** If **two or more** pills are missed (48 hours or more since the last pill was taken), the 7-day rule applies again—the patient must use backup contraception for the next 7 days. * **Vomiting/Diarrhea:** If severe vomiting occurs within **2 hours** of pill intake, it is considered a missed dose. * **Quick Start Method:** If the pill is started at any time other than Day 1–5 of the cycle, the 7-day rule is mandatory. * **Most Critical Pills:** The pills at the **beginning and end** of a pack are the most critical to take on time to prevent the HPO axis from "waking up" during the hormone-free interval.

Q: Which of the following is a side effect of oral contraceptive pills?

Carbohydrate intolerance. **Explanation:** **Carbohydrate intolerance** is a known metabolic side effect of Combined Oral Contraceptive Pills (COCPs). The progestogen component (especially older 19-nortestosterone derivatives) increases peripheral insulin resistance and decreases glucose tolerance. While modern low-dose pills have a minimal impact on healthy individuals, they can unmask latent diabetes or worsen glycemic control in predisposed women. **Analysis of Incorrect Options:** * **A. Dysmenorrhea:** COCPs are actually a **treatment** for dysmenorrhea. They inhibit ovulation and reduce endometrial prostaglandin production, leading to less painful menses. * **B. Hyperprolactinemia:** COCPs do not typically cause significant elevations in prolactin. While estrogen can stimulate lactotrophs, it does not lead to clinical hyperprolactinemia or galactorrhea in standard doses. * **D. Endometriosis:** COCPs are a **first-line medical management** for endometriosis. By inducing a pseudo-pregnancy state and causing endometrial atrophy, they reduce the growth and vascularity of ectopic endometrial tissue. **High-Yield Clinical Pearls for NEET-PG:** * **Lipid Profile:** Estrogen increases HDL (good) and decreases LDL, but it also increases **Triglycerides**. * **Cancer Risk:** COCPs **decrease** the risk of Ovarian and Endometrial cancers (protective effect persists for years) but may slightly **increase** the risk of Cervical and Breast cancers. * **Coagulation:** The estrogen component increases clotting factors (II, VII, IX, X) and decreases Antithrombin III, increasing the risk of **Venous Thromboembolism (VTE)**. * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of VTE, smokers >35 years, and active liver disease.

Q: A 19-year-old woman desires medical termination of pregnancy at 6 weeks of gestation. Which of the following is an appropriate procedure to perform this termination?

Suction and evacuation. **Explanation:** The patient is at **6 weeks of gestation**, which falls within the **first trimester** (up to 12 weeks). For surgical termination of pregnancy in the first trimester, **Suction and Evacuation (S&E)** is the gold standard and the procedure of choice. **1. Why Suction and Evacuation is Correct:** Suction and evacuation (also known as vacuum aspiration) is preferred because it is faster, safer, and associated with fewer complications (like uterine perforation or excessive blood loss) compared to traditional sharp curettage. At 6 weeks, the products of conception are small enough to be easily removed via a 5–6 mm Karman cannula or electric suction. **2. Why Other Options are Incorrect:** * **Dilation and Curettage (D&C):** This involves sharp curettage of the uterine walls. It is no longer recommended as a primary method for MTP due to higher risks of trauma, Asherman syndrome, and increased pain. * **Hypertonic extra-amniotic saline infusion:** This is a method used for **second-trimester** abortions (usually 16–20 weeks). It is rarely used today due to the risk of "water intoxication" and the availability of safer prostaglandins. * **15-methyl Beta-prostaglandin (Carboprost):** This is typically used for second-trimester inductions or for managing postpartum hemorrhage (PPH). It is not a primary standalone method for a 6-week MTP. **Clinical Pearls for NEET-PG:** * **MTP Act (India):** Medical termination is legal up to **24 weeks** under specific conditions. * **Medical MTP:** Up to **9 weeks (63 days)**, the regimen of choice is **Mifepristone (200mg oral) followed by Misoprostol (800mcg vaginal/oral)** 24–48 hours later. * **Surgical MTP:** Suction evacuation is the method of choice for **7–12 weeks**. * **Manual Vacuum Aspiration (MVA):** Can be performed up to 12 weeks and does not require electricity, making it ideal for low-resource settings.

Q: Which of the following is not used in emergency contraception?

Levonorgestrel intrauterine device. **Explanation:** The correct answer is **A. Levonorgestrel intrauterine device (LNG-IUD)**. In emergency contraception (EC), the goal is to prevent pregnancy *after* unprotected intercourse but *before* implantation. The LNG-IUD (e.g., Mirena) is **not** used for this purpose because its primary mechanism involves thickening cervical mucus and thinning the endometrial lining over time; it does not reliably prevent fertilization or implantation immediately after a single act of intercourse. **Analysis of Options:** * **Copper T intrauterine device (Option D):** This is the **most effective** method of EC (99% efficacy). It can be inserted up to 5 days (120 hours) after unprotected intercourse. It acts by causing a sterile inflammatory response that is toxic to sperm and ova, and prevents implantation. * **Oral Levonorgestrel (Option C):** Known as the "morning-after pill" (1.5 mg single dose), it is effective up to 72 hours. It works primarily by delaying or inhibiting ovulation. * **Oral Mifepristone (Option B):** In low doses (10–25 mg), this anti-progestogen is used as an effective EC by delaying ovulation and altering the endometrium. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The Copper T 380A is the most effective EC and provides ongoing contraception for 10 years. * **Ulipristal Acetate:** A selective progesterone receptor modulator (30 mg) is now considered the first-line oral EC, effective up to 120 hours. * **Yuzpe Regimen:** An older method using combined OCPs (Ethinylestradiol + Levonorgestrel); it is less effective and has more side effects (nausea/vomiting) than LNG alone. * **Timing:** All oral ECs are more effective the sooner they are taken ("Time is Tissue").

Q: What is the most appropriate contraceptive method for a lactating mother during the first six months postpartum?

Progestin-only pills. **Explanation:** The choice of contraception in a lactating mother is primarily governed by the effect of hormones on breast milk production and the timing of postpartum recovery. **Why Progestin-only pills (POPs) are the correct choice:** POPs (also known as the "Minipill") are considered the ideal hormonal contraceptive during the first six months of lactation. Unlike estrogen, **progestins do not suppress lactation**; in fact, some studies suggest they may slightly increase milk volume. They do not affect the quality or composition of breast milk, making them safe for the infant. **Analysis of Incorrect Options:** * **Combined Oral Contraceptive Pills (COCPs):** These contain **estrogen**, which is known to suppress milk production (hypogalactia) and reduce the duration of lactation. They also increase the risk of thromboembolism in the early postpartum period. * **Intrauterine Contraceptive Device (IUCD):** While highly effective, the risk of uterine perforation is significantly higher (up to 6–10 times) in lactating mothers due to a soft, involuting uterus and high oxytocin levels. While it can be used, POPs are often preferred as the first-line hormonal choice in the early months. * **Rhythm Method:** This is highly unreliable during lactation because ovulation often precedes the return of menstruation, making it difficult to predict fertile windows. **High-Yield NEET-PG Pearls:** * **Lactational Amenorrhea Method (LAM):** Effective only if the mother is exclusively breastfeeding, is amenorrheic, and the baby is <6 months old. * **Timing:** POPs can be started at 6 weeks postpartum in breastfeeding women (WHO MEC Category 1). * **DMPA (Injectable):** Also safe for lactating mothers but may cause irregular bleeding. * **Postpartum IUCD (PPIUCD):** Best inserted within 48 hours of delivery or after 6 weeks to minimize expulsion/perforation risks.

Q: A 30-year-old woman who has had one pregnancy and one live birth desires contraception for 6 months. She experiences dysmenorrhea and has a history of complicated migraine. Ultrasound reveals multiple uterine fibroids. What is the most appropriate contraceptive method for her?

Vaginal diaphragm. ### Explanation The correct answer is **C. Vaginal diaphragm**. **1. Why Vaginal Diaphragm is the Correct Choice:** The patient requires short-term contraception (6 months) and has several contraindications to other methods. A vaginal diaphragm is a barrier method that provides non-hormonal, temporary protection. It is ideal here because it does not interfere with her menstrual cycle or exacerbate her underlying medical conditions (migraine and fibroids). **2. Why Other Options are Incorrect:** * **Copper T 200 (IUD):** This is contraindicated because the patient has **dysmenorrhea** and **uterine fibroids**. Copper IUDs typically increase menstrual blood flow and worsen cramping. Furthermore, fibroids can distort the uterine cavity, making IUD insertion difficult or increasing the risk of expulsion. * **Oral Contraceptive Pills (OCPs):** The patient has a history of **complicated migraine** (migraine with aura). Combined OCPs are **Category 4 (Absolute Contraindication)** according to WHO Medical Eligibility Criteria due to the significantly increased risk of ischemic stroke. * **Tubal Sterilization:** This is a permanent method of contraception. The patient specifically requested contraception for only **6 months**, making surgical sterilization inappropriate. **3. Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindication) for OCPs:** Age >35 and smoking ≥15 cigarettes/day, history of DVT/PE, ischemic heart disease, stroke, and **migraine with aura**. * **Fibroids & Contraception:** Distorted uterine cavity is a Category 4 contraindication for both Copper IUDs and LNG-IUS (Mirena). * **Barrier Methods:** These are the safest options for women with multiple systemic comorbidities, though they have higher "typical use" failure rates compared to LARC (Long-Acting Reversible Contraception).

Question 1

What is the best contraceptive method for a newly married, healthy couple?

Accepted Answer

Oral contraceptive pills

Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Natural methods

Question 2

Which drug is used for mid-trimester abortion?

Accepted Answer

Mifepristone

Answer

Atosiban

Answer

Valethamate

Answer

Methotrexate

Question 3

Which of the following statements regarding medical abortion is true?

Accepted Answer

It can be performed up to 9 weeks of gestation.

Answer

It can be administered by any registered medical practitioner.

Answer

It is exempted from the control of the MTP Act.

Answer

It is an approved method of emergency contraception in India.

Question 4

Which of the following is NOT a method of contraception during lactation?

Accepted Answer

Oral contraceptive pills (OCPs)

Answer

Lactational amenorrhea method

Answer

Intrauterine device (IUD)

Answer

Progestin-only pills (Minipills)

Question 5

For how many consecutive days should a woman take hormonal oral contraceptive pills to effectively prevent ovulation?

Accepted Answer

7 days

Answer

3 days

Answer

5 days

Answer

9 days

Question 6

Which of the following is a side effect of oral contraceptive pills?

Accepted Answer

Carbohydrate intolerance

Answer

Dysmenorrhea

Answer

Hyperprolactinemia

Answer

Endometriosis

Question 7

A 19-year-old woman desires medical termination of pregnancy at 6 weeks of gestation. Which of the following is an appropriate procedure to perform this termination?

Accepted Answer

Suction and evacuation

Answer

Dilation and curettage

Answer

Hypertonic extra-amniotic saline infusion

Answer

15-methyl Beta-prostaglandin injection

Question 8

Which of the following is not used in emergency contraception?

Accepted Answer

Levonorgestrel intrauterine device

Answer

Oral mifepristone

Answer

Oral levonorgestrel

Answer

Copper T intrauterine device

Question 9

What is the most appropriate contraceptive method for a lactating mother during the first six months postpartum?

Accepted Answer

Progestin-only pills

Answer

Intrauterine contraceptive device (IUCD)

Answer

Combined oral contraceptive pills

Answer

Rhythm method

Question 10

A 30-year-old woman who has had one pregnancy and one live birth desires contraception for 6 months. She experiences dysmenorrhea and has a history of complicated migraine. Ultrasound reveals multiple uterine fibroids. What is the most appropriate contraceptive method for her?

Accepted Answer

Vaginal diaphragm

Answer

Copper T 200 (IUD)

Answer

Oral contraceptive pills

Answer

Tubal sterilization

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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