Contraception and Family Planning Practice Questions

Q: Contraindications for medical abortions are all except :

Age more than 35 years. ***Age more than 35 years*** - Age alone, including being over 35 years old, is **not a contraindication** for a medical abortion. - The decision for medical abortion is based on health status, gestational age, and patient choice, not primarily on age. *Uncontrolled seizure disorder* - An **uncontrolled seizure disorder** can be a relative contraindication due to the stress and potential risks associated with the abortion process, which could trigger seizures. - Prostaglandins used in medical abortion can sometimes **increase uterine contractions and pain**, which may exacerbate a seizure disorder. *Hemoglobin less than 8 gm%* - A **hemoglobin level less than 8 gm%** indicates significant anemia, which increases the risk of complications from blood loss during a medical abortion. - Patients with severe anemia may require **blood transfusion** if significant bleeding occurs, making medical abortion less safe. *Undiagnosed adnexal mass* - An **undiagnosed adnexal mass** can be a contraindication because it might mask an **ectopic pregnancy**, for which medical abortion drugs are not effective and could be dangerous. - It also raises concerns about potential **complications or rupture** of the mass during the abortion process.

Q: Oral contraceptives may provide protection against the following malignancies except :

Cervical cancer. ***Cervical cancer*** - Oral contraceptives (OCPs) are associated with an **increased risk of cervical cancer**, particularly with prolonged use, due to their potential influence on the immune response to **HPV infection**. - OCPs do not provide protection against cervical cancer; instead, they are considered a **risk factor** in its development. *Endometrial cancer* - OCPs, especially with their progestin component, offer significant **protection against endometrial cancer** by counteracting unopposed estrogen effects on the endometrium. - This protective effect is evident after just a few years of use and can persist for decades after discontinuation. *Ovarian cancer* - Oral contraceptive use is well-established to **reduce the risk of ovarian cancer**, with the protective effect increasing with longer duration of use. - This protection is thought to be mediated by the **suppression of ovulation**, thereby reducing the continuous trauma to the ovarian surface epithelium. *None of the options* - This option is incorrect because OCPs do provide protection against several malignancies, specifically endometrial and ovarian cancers, but actually increase the risk of cervical cancer.

Q: During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Combined oral contraceptive pills. ***Combined oral contraceptive pills*** - **Combined oral contraceptive pills (COCs)** contain both **estrogen** and **progestin**, and the synthetic estrogen component can potentially reduce breast milk supply, which is critical during the initial 6 months of breastfeeding. - Estrogen may also alter the composition of breast milk, and there's a theoretical concern about **estrogen excretion into breast milk** affecting the newborn during this vulnerable period. *Norplant* - **Norplant** (levonorgestrel implants) contains only **progestin**, which is generally considered safe for use during breastfeeding from 6 weeks postpartum. - Progestin-only contraceptives do not significantly affect milk supply or infant health. *DMPA* - **DMPA (depot medroxyprogesterone acetate)** is an injectable contraceptive containing only **progestin**. It is considered safe and effective during breastfeeding, typically from 6 weeks postpartum. - It does not negatively impact milk production or infant growth and development. *Progestin only pills* - **Progestin-only pills (POPs)** are safe for use during breastfeeding, usually initiated immediately postpartum or from 6 weeks. - They do not contain estrogen, thereby avoiding the concerns associated with combined oral contraceptives regarding milk supply and infant exposure.

Q: The contraindications for Progestasert include the following except

Previous history of abortion. ***Previous history of abortion*** - A prior history of abortion is generally **not a contraindication** for the insertion of a progestogen-releasing intrauterine device (Progestaert or similar IUDs). - The risk of complications like infection or perforation is not significantly increased in women with a history of abortion, especially if it was a safe procedure. *Previous history of ectopic pregnancy* - A history of **ectopic pregnancy** is a **relative contraindication** for progestogen-only IUDs, as these devices primarily prevent intrauterine pregnancy but can marginally increase the risk of ectopic pregnancy if conception occurs. - While IUDs are highly effective at preventing pregnancy overall, if a pregnancy does occur with an IUD in place, there is a higher chance it will be ectopic. *Pelvic Inflammatory Disease* - **Active or recent Pelvic Inflammatory Disease (PID)** is a **strong contraindication** for IUD insertion due to the increased risk of ascending infection and exacerbation of the condition. - IUD insertion can potentially introduce bacteria into the uterus, worsening an existing infection or causing a new one if the patient is at high risk. *Uterine fibroids* - **Large or distorting uterine fibroids** can be a **contraindication** for IUD insertion, especially if they alter the uterine cavity significantly. - Fibroids can make IUD insertion difficult, increase the risk of perforation, and compromise the effectiveness of the device by preventing proper placement or causing expulsion.

Q: Hormonal contraceptives are contraindicated in women

who have thromboembolic disorders. **who have thromboembolic disorders** - **Estrogen** components of hormonal contraceptives increase the risk of **venous thromboembolism** (VTE), including deep vein thrombosis and pulmonary embolism, especially in women with pre-existing clotting disorders or risk factors. - This increased risk is a major contraindication due to the potential for serious, life-threatening complications. *less than 25 years of age* - Age itself is not a contraindication for hormonal contraceptive use; many young women use them safely and effectively. - The **risk of VTE** from hormonal contraceptives is generally lower in younger women compared to older women, especially those over 35 years old and who smoke. *who are normotensive* - **Normotension** is a normal blood pressure reading, which is not a contraindication for hormonal contraceptive use. - In fact, women with well-controlled hypertension may use some hormonal contraceptives, although close monitoring is often required. *who have anaemia* - **Anemia** is not a contraindication to hormonal contraceptive use and, in some cases, can even be improved by them. - Hormonal contraceptives can reduce menstrual blood loss, thereby potentially improving or preventing **iron-deficiency anemia**.

Q: What is the sequence of events in termination of pregnancy by medical method?

Mifepristone — Misoprostol — Bleeding — USG. ***Mifepristone — Misoprostol — Bleeding — USG*** - The process begins with **mifepristone**, a progesterone receptor antagonist that **blocks progesterone action**, leading to **cervical softening** and **sensitization of the uterus to prostaglandins**. - This is followed by **misoprostol** (24-48 hours later), a prostaglandin analogue, which **induces uterine contractions** and causes **expulsion of uterine contents**, leading to bleeding. A follow-up **ultrasound (USG)** after 2 weeks confirms completion. *Mifepristone — Misoprostol — USG — Bleeding* - While mifepristone and misoprostol are correctly sequenced, the **bleeding** typically occurs *before* the follow-up ultrasound, as it's the clinical sign of successful expulsion. - The ultrasound would be performed *after* the expected expulsion and bleeding to confirm complete termination and rule out complications. *Misoprostol — Mifepristone — USG — Bleeding* - This sequence is incorrect because **mifepristone must be given first** to block progesterone and prepare the uterus. - Administering **misoprostol before mifepristone** would be less effective as the uterus would not be primed for cervical softening and increased sensitivity to prostaglandins. *Mifepristone — Bleeding — Misoprostol — USG* - While mifepristone is given first, **significant bleeding** typically occurs *after* the administration of misoprostol, which actively induces contractions and expels the uterine contents. - This sequence incorrectly places **bleeding before misoprostol**, implying it happens immediately after mifepristone alone, which is not the typical response.

Q: Mini pill should be started on the

first day of the cycle. ***first day of the cycle*** - Starting the **mini-pill** (progestin-only pill) on the **first day of the menstrual cycle** ensures **immediate contraceptive protection** without need for backup contraception. - Current guidelines allow starting within the **first 5 days of the cycle** for immediate protection, but day 1 is the most conservative and traditional recommendation. - The mini-pill works primarily through **cervical mucus thickening** (which occurs within 48 hours) and may inconsistently suppress ovulation in some women. *fifth day of the cycle* - Starting on the fifth day of the cycle **can still provide immediate protection** according to current guidelines, as it falls within the acceptable first 5-day window. - However, for maximum certainty and following traditional teaching, day 1 remains the preferred recommendation. - If started after day 5, **backup contraception for 48 hours** would be needed. *second day of the cycle* - Starting on the second day falls within the **first 5 days of the cycle** and provides immediate contraceptive protection according to current evidence-based guidelines. - The **first day** is traditionally emphasized in older guidelines and remains the most conservative approach. - No backup contraception needed when started within this timeframe. *third day of the cycle* - Starting on the third day is within the **first 5-day window** where immediate protection is achieved. - However, traditional teaching (especially relevant for this 2010 exam question) emphasized starting on **day 1** for optimal compliance and immediate efficacy. - Modern guidelines confirm no backup needed if started within first 5 days of true menstrual bleeding.

Question 1

Contraindications for medical abortions are all except :

Accepted Answer

Age more than 35 years

Answer

Uncontrolled seizure disorder

Answer

Hemoglobin less than 8 gm%

Answer

Undiagnosed adnexal mass

Question 2

Oral contraceptives may provide protection against the following malignancies except :

Accepted Answer

Cervical cancer

Answer

Endometrial cancer

Answer

Ovarian cancer

Answer

None of the options

Question 3

During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Accepted Answer

Combined oral contraceptive pills

Answer

Norplant

Answer

DMPA

Answer

Progestin only pills

Question 4

A man underwent vasectomy, but 6 months later his wife was 16 week pregnant. What is the most likely cause ?

Accepted Answer

Failure to use additional contraception in postoperative period

Answer

Recanalisation of vas

Answer

Pregnancy antedating vasectomy

Answer

Failure of operative procedure

Question 5

Following are the contraindications for laparoscopic female sterilization except :

Accepted Answer

Hiatus hernia

Answer

Respiratory dysfunction

Answer

Heart disease

Answer

Obesity

Question 6

What is the recommendation for use of Levonorgestrel for the purpose of emergency contraception ?

Accepted Answer

Two tablets of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 96 hours

Answer

One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 72 hours

Answer

None of the options

Answer

One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 120 hours

Question 7

The contraindications for Progestasert include the following except

Accepted Answer

Previous history of abortion

Answer

Previous history of ectopic pregnancy

Answer

Pelvic Inflammatory Disease

Answer

Uterine fibroids

Question 8

Hormonal contraceptives are contraindicated in women

Accepted Answer

who have thromboembolic disorders

Answer

less than 25 years of age

Answer

who are normotensive

Answer

who have anaemia

Question 9

What is the sequence of events in termination of pregnancy by medical method?

Accepted Answer

Mifepristone — Misoprostol — Bleeding — USG

Answer

Mifepristone — Misoprostol — USG — Bleeding

Answer

Misoprostol — Mifepristone — USG — Bleeding

Answer

Mifepristone — Bleeding — Misoprostol — USG

Question 10

Mini pill should be started on the

Accepted Answer

first day of the cycle

Answer

fifth day of the cycle

Answer

second day of the cycle

Answer

third day of the cycle

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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