Contraception and Family Planning Practice Questions

Q: The following are the contra-indications to the use of combined oral contraceptive pills, except

bronchial asthma. ***bronchial asthma*** - **Bronchial asthma** is not a contraindication for the use of combined oral contraceptive pills (COCs). COCs do not worsen asthma symptoms or increase the risk of asthma exacerbations. - While some medications can interact with asthma treatment, COCs generally have no significant adverse effects on respiratory function or asthma management. *active viral hepatitis* - **Active viral hepatitis** is a contraindication because COCs are metabolized in the liver, and their use could further impair liver function in a patient with active inflammation. - The liver is crucial for metabolizing estrogens and progestins, and compromised liver function can lead to altered drug levels and increased risk of adverse effects. *history of deep venous thrombosis* - A **history of deep venous thrombosis (DVT)** is a significant contraindication due to the increased risk of **thromboembolism** associated with combined oral contraceptive pills. - Estrogen components in COCs can increase the synthesis of clotting factors and decrease natural anticoagulants, raising the risk of future thrombotic events. *breastfeeding* - **Breastfeeding**, especially during the first six weeks postpartum, is a relative contraindication for combined oral contraceptive pills. - Estrogen in COCs can reduce milk supply and potentially pass into breast milk, affecting the infant. Progestin-only contraceptives are generally preferred for breastfeeding mothers.

Q: Worldwide, which is the most commonly used copper-bearing intrauterine contraceptive device?

Copper T-380. ***Copper T-380*** - The **Copper T-380A (ParaGard)** is the most widely used and effective non-hormonal IUD globally. - Its **380 mm² copper surface area** provides high contraceptive efficacy for up to 10 years. *Copper-7* - This was an earlier generation copper IUD with a **smaller copper surface area** and a distinct 7-shaped design. - It had a higher expulsion rate and was **largely replaced** by more effective T-shaped devices. *GyneFix* - **GyneFix** is a frameless copper IUD consisting of copper sleeves on a surgical thread, which is knotted into the uterine fundus. - While effective, its market penetration and global usage are **significantly less** compared to the Copper T-380. *Copper T-200* - The **Copper T-200** was an earlier T-shaped copper IUD with **200 mm² of copper surface area**. - It had a **shorter lifespan** and lower efficacy compared to the T-380, leading to its obsolescence in many regions.

Q: In a lady with a regular 28-day menstrual cycle, what is the 'safe period'?

First and last seven days. ***First and last seven days*** - In a typical 28-day cycle, **ovulation** usually occurs around day 14. Sperm can survive for up to 5 days, and the egg is viable for about 24 hours. Therefore, avoiding unprotected intercourse from approximately day 7 to day 19 would be considered within the fertile window. The "safe period" refers to days with a lower probability of conception. - The **first seven days** (including menstruation) and the **last seven days** (preceding the next menstrual period) are generally considered the least fertile times, as they are furthest from ovulation. *Initial 14 days* - This period includes the follicular phase, leading up to and including **ovulation**. - The **fertile window** typically encompasses several days before ovulation, the day of ovulation, and the day after, making the initial 14 days a high-risk period, not a safe one. *Later 14 days* - This period includes the **luteal phase** after ovulation has occurred. - While the latter part of this period (days 21-28) is generally less fertile, the days immediately following ovulation (around days 15-18) still carry a risk of conception if the egg is viable or if ovulation was delayed. *First seven days only* - While the first seven days are generally considered a **low-risk period**, relying solely on this neglects the increased risk shortly before and during ovulation. - This option only covers a portion of the "safe period" and does not account for the reduced fertility towards the end of the menstrual cycle.

Q: Combined contraceptive pills give protection from the following EXCEPT:

Cancer of cervix. ***Cancer of cervix*** - Combined oral contraceptives (COCs) do not protect against **cervical cancer**; in fact, long-term use is associated with a slightly **increased risk**, potentially due to increased exposure to **HPV** or hormonal effects on the cervix. - The primary protection against cervical cancer is **HPV vaccination** and regular **cervical screening** (Pap smears). *Cancer of endometrium* - COCs provide significant protection against **endometrial cancer** by causing endometrial atrophy and suppressing cell proliferation, which mitigates the risk posed by unopposed estrogen. - This protective effect is observed even after discontinuing COCs. *Cancer of ovary* - COCs significantly reduce the risk of **ovarian cancer**, particularly epithelial ovarian cancer, through the suppression of ovulation. - The protective effect increases with the duration of COC use and can persist for many years after discontinuation. *Ectopic pregnancy* - COCs are highly effective in preventing **pregnancy** altogether, thereby drastically reducing the risk of both uterine and **ectopic pregnancies**. - While not 100% effective, their contraceptive action makes ectopic pregnancy very rare in users compared to non-users.

Q: Which one of the following is the best contraceptive for a newly married couple who wants to postpone pregnancy for one year?

Combined oral contraceptives. ***Combined oral contraceptives*** - **Combined oral contraceptives (COCs)** offer highly effective, reversible contraception suitable for postponing pregnancy for a specific period like one year. - They provide consistent hormonal regulation, leading to **predictable menstrual cycles** and potential non-contraceptive benefits like reduced dysmenorrhea and acne. - **Easy to initiate and discontinue** without any procedure, which may be preferred by newly married couples. - Typical use effectiveness is around **91%**, with perfect use approaching 99%. *Safe period method* - The **safe period method (rhythm method or natural family planning)** relies on tracking the menstrual cycle to identify fertile days, which is generally considered less reliable for couples prioritizing pregnancy postponement. - Its effectiveness is highly dependent on a **regular menstrual cycle** and strict adherence, making its typical use failure rate higher (12-24%). *Condom with spermicidal cream* - While **condoms with spermicidal cream** offer protection against both pregnancy and sexually transmitted infections, their effectiveness is lower than hormonal methods for preventing pregnancy. - Their typical use **failure rate is around 18%**, which might not be ideal for a couple committed to postponing pregnancy for a full year. *Intrauterine contraceptive device* - An **intrauterine contraceptive device (IUD)** is a highly effective, long-acting reversible contraceptive with >99% effectiveness. - While medically appropriate for any duration including one year, it requires an **insertion procedure** which some newly married couples may prefer to avoid. - For couples seeking **non-invasive contraception** with easier initiation and the flexibility to discontinue without a procedure, COCs may be more acceptable despite slightly lower typical use effectiveness.

Q: A woman using combined oral contraceptive has the following non contraceptive benefits except:

Protection against cervical cancer. ***Protection against cervical cancer*** - Combined oral contraceptives (COCs) have been shown to **increase the risk of cervical cancer**, not protect against it. - This increased risk is thought to be related to persistent **HPV infection** in women using COCs for extended periods. *Protection against PID* - COCs **thicken cervical mucus**, which acts as a barrier, reducing the ascent of bacteria and thus offering some protection against **Pelvic Inflammatory Disease (PID)**. - This effect is a non-contraceptive benefit of COC use. *Protection against ovarian cancer* - The suppression of ovulation by COCs significantly **reduces the risk of ovarian cancer**, with the protective effect increasing with longer duration of use. - This protective effect is one of the well-established non-contraceptive benefits. *Prevention of colorectal malignancy* - Some studies suggest that COCs may offer a **protective effect against colorectal cancer**, although this benefit is less consistently demonstrated compared to ovarian cancer protection. - This is considered a potential non-contraceptive benefit.

Q: Contraceptive options for a 28 year old woman who is breastfeeding a six week old baby, wanting to avoid pregnancy for a longer interval are the following except:

Combined oral contraceptives. ***Combined oral contraceptives*** - **Combined oral contraceptives (COCs)** contain both estrogen and progestin, and the **estrogen component** can reduce milk supply in breastfeeding mothers. - According to WHO Medical Eligibility Criteria, COCs are **Category 4 (unacceptable health risk)** for breastfeeding women <6 weeks postpartum and **Category 3 (risks usually outweigh benefits)** from 6 weeks to <6 months postpartum. - At **6 weeks postpartum**, while technically transitioning from absolute contraindication, COCs remain **not recommended** for breastfeeding women due to potential negative effects on lactation. - Among the options listed, this is the **least suitable** choice for this patient. *IUD- 380A* - The **copper-containing IUD (Cu-380A)** is a highly effective, non-hormonal contraceptive option that can be safely used postpartum, even while breastfeeding. - It does not affect milk supply or composition, making it an excellent choice for long-term contraception. - **WHO MEC Category 1** (no restriction) for breastfeeding women. *LNG-IUD* - The **levonorgestrel-releasing intrauterine device (LNG-IUD)** is a safe and effective hormonal contraceptive for breastfeeding women. - The **progestin** released locally has minimal systemic absorption and generally does not affect milk production or infant health. - **WHO MEC Category 2** (advantages generally outweigh risks) for breastfeeding women at 6 weeks postpartum. *Implanon* - **Implanon (etonogestrel implant)** is a **progestin-only** contraceptive implant that is highly effective and safe for use during breastfeeding. - It does not interfere with milk supply and provides long-acting contraception (up to 3 years). - **WHO MEC Category 2** for breastfeeding women, making it another excellent choice for this patient.

Q: Consider the following statements regarding MTP (Medical Termination of Pregnancy): 1. Suction and evacuation can be done up till 12 weeks. 2. Medical methods can be used up till 10 weeks 3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks Which of the statements given above is/are correct?

2 only. **2 only** - **Medical methods** for abortion, primarily using medications like **mifepristone** and **misoprostol**, are generally recommended and most effective for pregnancies up to **10 weeks of gestation**. - Beyond 10 weeks, the success rate decreases, and the risk of complications increases, making surgical methods more appropriate. *1 only* - **Suction and evacuation**, also known as **vacuum aspiration**, is a surgical method typically performed for pregnancies up to **14-16 weeks** of gestation, not limited to 12 weeks. - After 12 weeks, the procedure may be referred to as D&C (dilation and curettage) or D&E (dilation and evacuation), depending on the gestational age and technique used. *2 and 3* - While statement 2 is correct, statement 3 is incorrect because **Manual Vacuum Aspiration (MVA)** using a syringe can be safely and effectively used for pregnancies up to **10-12 weeks** of gestation, not just up to 6 weeks. - MVA is a versatile and often preferred method for early pregnancy termination due to its simplicity and effectiveness. *1 and 3* - Both statements 1 and 3 are incorrect in their specified gestational limits. Suction and evacuation can be performed beyond 12 weeks, and MVA can be used beyond 6 weeks, up to 10-12 weeks.

Q: Which of the following is NOT a method of second Trimester abortion?

Intra-amniotic KCl instillation. ***Intra-amniotic KCl instillation*** - Intra-amniotic KCl instillation is **NOT an abortion method** but rather a **feticide procedure** used to induce fetal demise before the actual termination. - It involves injecting potassium chloride directly into the fetal heart or amniotic sac to cause fetal asystole, and **must be followed by another method** (medical induction or D&E) to complete the abortion. - It is used primarily in **late second trimester and beyond** when legally or ethically required to ensure fetal demise prior to expulsion, but is **not a standalone abortion method**. *Hysterotomy* - Hysterotomy is a **surgical method** of abortion that involves making an incision in the uterus (similar to cesarean section) to remove the fetus. - While rarely used today due to **higher maternal morbidity** compared to D&E or medical methods, it **remains a recognized second-trimester abortion method**. - It may be considered in specific situations such as failed medical abortion, cervical pathology preventing D&E, or when other methods are contraindicated. *Mifepristone and PGE1* - This combination is a **standard medical abortion method** for the second trimester. - Mifepristone (antiprogestogen) sensitizes the uterus to prostaglandins, and PGE1 (misoprostol) induces uterine contractions and cervical ripening. - It is **safe, effective, and commonly used** for second-trimester medical termination. *PGE2 analog* - **Prostaglandin E2 analogs** (such as dinoprostone) are established methods for second-trimester abortion. - They induce uterine contractions and cervical ripening, and can be administered vaginally, extra-amniotically, or intravenously. - They are a **standard medical induction method** for second-trimester termination.

Question 1

The following are the contra-indications to the use of combined oral contraceptive pills, except

Accepted Answer

bronchial asthma

Answer

active viral hepatitis

Answer

history of deep venous thrombosis

Answer

breastfeeding

Question 2

Worldwide, which is the most commonly used copper-bearing intrauterine contraceptive device?

Accepted Answer

Copper T-380

Answer

Copper-7

Answer

GyneFix

Answer

Copper T-200

Question 3

In a lady with a regular 28-day menstrual cycle, what is the 'safe period'?

Accepted Answer

First and last seven days

Answer

Initial 14 days

Answer

Later 14 days

Answer

First seven days only

Question 4

Combined contraceptive pills give protection from the following EXCEPT:

Accepted Answer

Cancer of cervix

Answer

Cancer of endometrium

Answer

Cancer of ovary

Answer

Ectopic pregnancy

Question 5

Which one of the following is the best contraceptive for a newly married couple who wants to postpone pregnancy for one year?

Accepted Answer

Combined oral contraceptives

Answer

Safe period method

Answer

Condom with spermicidal cream

Answer

Intrauterine contraceptive device

Question 6

Regimen for medical abortion upto 7 weeks of gestation as per Government of India guidelines includes:

Accepted Answer

200 mg of mifepristone on D1 followed by 800 µg of misoprostol on D3

Answer

400 mg of mifepristone on D1 followed by 400 µg of misoprostol on D3

Answer

400 mg of mifepristone on D1 followed by 800 µg of misoprostol on D3

Answer

200 mg of mifepristone on D1 followed by 400 µg of misoprostol on D3

Question 7

A woman using combined oral contraceptive has the following non contraceptive benefits except:

Accepted Answer

Protection against cervical cancer

Answer

Protection against PID

Answer

Protection against ovarian cancer

Answer

Prevention of colorectal malignancy

Question 8

Contraceptive options for a 28 year old woman who is breastfeeding a six week old baby, wanting to avoid pregnancy for a longer interval are the following except:

Accepted Answer

Combined oral contraceptives

Answer

IUD- 380A

Answer

LNG-IUD

Answer

Implanon

Question 9

Consider the following statements regarding MTP (Medical Termination of Pregnancy):

1. Suction and evacuation can be done up till 12 weeks.
2. Medical methods can be used up till 10 weeks
3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks
Which of the statements given above is/are correct?

Accepted Answer

2 only

Answer

1 only

Answer

2 and 3

Answer

1 and 3

Question 10

Which of the following is NOT a method of second Trimester abortion?

Accepted Answer

Intra-amniotic KCl instillation

Answer

Hysterotomy

Answer

Mifepristone and PGE1

Answer

PGE2 analog

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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