Contraception and Family Planning Practice Questions

Q: For a 40 year old hypertensive woman, which one of the following is not recommended for contraception?

NuvaRing. ***NuvaRing*** - **NuvaRing** is a **combined hormonal contraceptive** that releases both estrogen and progestin. - **Estrogen-containing contraception** is generally **contraindicated** or used with caution in women with uncontrolled hypertension due to an increased risk of **cardiovascular events** such as stroke and myocardial infarction. *IUCD* - **Intrauterine contraceptive devices (IUCDs)**, both copper and levonorgestrel-releasing, are considered **safe** and highly effective for women with hypertension. - They do not contain systemic hormones or contain only progestin, which has a minimal impact on blood pressure. *Minipill* - The **minipill** is a **progestin-only oral contraceptive**. - **Progestin-only contraceptives** are safe for women with hypertension as they do not carry the same cardiovascular risks associated with estrogen. *LNG IUD (LNg IUD)* - The **levonorgestrel-releasing intrauterine device (LNG IUD)** is a **progestin-only contraceptive**. - It is **safe** for women with hypertension because the progestin is primarily local, and it does not contain estrogen, thereby avoiding cardiovascular risks.

Q: For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?

Yuzpe regimen. ***Yuzpe regimen*** - The **Yuzpe regimen** uses higher doses of combined oral contraceptive pills, leading to more side effects like nausea and vomiting and generally lower efficacy compared to newer methods. - It involves taking two doses of estrogen and progestin, making it less convenient and less effective, especially after **48 hours**, compared to progestin-only or ulipristal acetate pills. *Levonorgestrel 1.5 mg* - **Levonorgestrel (LNG)** 1.5 mg, taken as a single dose, is a highly effective and widely recommended first-line emergency contraceptive within **72 hours** of unprotected intercourse. - It primarily works by **inhibiting or delaying ovulation**, without causing significant side effects in most women. *LNG IUD* - While an **LNG IUD** can be used as emergency contraception, it is not typically considered a first-line *oral* method; it is placed by a healthcare provider and can provide long-term contraception. - It is effective if inserted within **5 days** of unprotected intercourse, making it a highly effective option that also offers ongoing contraception. *Ulipristal acetate* - **Ulipristal acetate (UPA)** is a highly effective emergency contraceptive, even up to **120 hours (5 days)** after unprotected intercourse. - It works by delaying or inhibiting ovulation and is generally more effective than levonorgestrel, especially when taken more than **72 hours** post-coitally.

Q: Which one of the following is not a contraindication for prescribing combined oral contraceptive pills?

Pelvic inflammatory disease. ***Pelvic inflammatory disease*** - **Pelvic inflammatory disease (PID)** is NOT a contraindication for combined oral contraceptive pills (COCs). - According to **WHO Medical Eligibility Criteria**, PID is classified as **Category 1** (no restriction) for COC use. - COCs do not worsen PID and may actually provide some **protective effect** against ascending genital tract infections. - PID concerns are primarily relevant for **IUD insertion**, not oral contraceptive use. *Viral hepatitis* - **Active viral hepatitis** is a contraindication (WHO Category 3-4) for COCs. - COCs are metabolized in the **liver**, and use during active hepatitis can exacerbate liver damage. - **Severe or acute liver disease** impairs hormone metabolism, increasing risks of adverse effects. *Well-controlled hypertension* - **Hypertension** is generally a contraindication for COCs depending on severity and vascular complications. - **Well-controlled hypertension without vascular disease** is WHO Category 3 (risks usually outweigh benefits). - **Uncontrolled hypertension** (≥160/100 mmHg) or hypertension with vascular disease is **Category 4** (absolute contraindication). - Estrogen in COCs can further elevate blood pressure and increase cardiovascular risks. *Thromboembolic disease* - History of **thromboembolic disease** (DVT, PE, stroke) is an **absolute contraindication** (WHO Category 4) for COCs. - Estrogen in COCs increases synthesis of **clotting factors** (I, VII, X) and decreases anticoagulant proteins, significantly raising **venous thromboembolism risk**.

Q: LNG-20 (Mirena) is a third generation intra uterine device. What are the advantages of its use? 1. Low uterine pregnancy rates 2. Prevents anemia 3. Long effective life of 5 years 4. No effect on incidence of ectopic pregnancy Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - LNG-20 (Mirena) significantly reduces the risk of **uterine pregnancy** due to its local progestin release, which thins the endometrium and thickens cervical mucus. - It often leads to **reduced menstrual blood loss** or even amenorrhea, thereby preventing or improving **anemia** in many users. - Mirena is effectively contraceptive for **up to 5 years**, providing a long-acting reversible contraceptive option. *1, 2 and 4* - While LNG-20 offers low uterine pregnancy rates and can prevent anemia, it **does not eliminate the risk of ectopic pregnancy** and may slightly increase its relative incidence if pregnancy occurs. - Therefore, the statement "no effect on incidence of ectopic pregnancy" is incorrect. *1, 3 and 4* - Although LNG-20 provides low uterine pregnancy rates and a 5-year effective life, the claim of "no effect on incidence of ectopic pregnancy" is **inaccurate**. - LNG-IUDs reduce overall pregnancy risk but if conception does occur, it's more likely to be ectopic than with no contraception. *2, 3 and 4* - LNG-20 does prevent anemia and has a long effective life, but it **does not have no effect on ectopic pregnancy incidence**; rather, it shifts the proportion of pregnancies that are ectopic if contraception fails. - It also provides low uterine pregnancy rates, making the exclusion of statement 1 incorrect.

Q: Tubectomy is commonly performed at which site of fallopian tube?

Isthmus. ***Isthmus*** - The **isthmus** is the **most common site** for tubectomy (tubal ligation) procedures. - It is the preferred location because it is **narrow, straight, and easily accessible** during surgery, making ligation technically simpler. - The isthmus has **relatively less blood supply** compared to other parts of the tube, reducing the risk of bleeding. - Common techniques like the **Pomeroy method** and **Parkland technique** are typically performed at the isthmus. - The narrow diameter ensures **complete occlusion** and reduces the risk of recanalization. *Ampulla* - The **ampulla** is the widest and longest portion of the fallopian tube, located between the isthmus and infundibulum. - It is **rarely chosen** for tubectomy because its wider lumen makes complete occlusion more difficult. - The ampulla has **higher vascularity**, increasing the risk of bleeding during surgery. - Greater risk of **incomplete blockage** and potential for recanalization. *Infundibulum* - The **infundibulum** is the funnel-shaped distal end with fimbriae that opens into the peritoneal cavity. - This site is **almost never used** for tubectomy due to its proximity to the ovary and technical difficulty. - Risk of damage to the fimbriae and ovarian blood supply. *Cornua* - The **cornua** (interstitial portion) passes through the uterine wall. - While sometimes used, it is **less common** than the isthmus due to increased technical difficulty. - Cornual resection carries higher risk of **uterine perforation** and **bleeding** from the uterine vessels. - May be chosen in specific clinical scenarios but not the standard first choice.

Q: The contraceptive choice for a 38 year old woman with chronic hypertension and history of dysmenorrhea and menorrhagia (malignancy ruled out) is:

Levonorgestrel intrauterine device. ***Levonorgestrel intrauterine device*** - The **Levonorgestrel IUD** is an excellent choice as it provides effective contraception while also treating menorrhagia and dysmenorrhea due to its local progesterone release. - It is safe for women with **hypertension** as it is a **non-estrogen-containing method**, avoiding the increased risk of thrombotic events associated with estrogen. *Copper intrauterine device* - While an effective non-hormonal contraceptive, the **copper IUD** can worsen **dysmenorrhea** and **menorrhagia**, which are existing concerns for the patient. - It does not offer any therapeutic benefits for her heavy and painful periods. *Sterilization* - Although it provides permanent and highly effective contraception, **sterilization** does not address the patient's symptoms of **dysmenorrhea** and **menorrhagia**. - It is an irreversible procedure and typically considered when no further childbearing is desired and symptomatic relief is not a primary concern for the contraceptive method itself. *Combined oral contraceptive pills* - **Combined oral contraceptive pills (COCs)** are generally contraindicated or used with caution in women with uncontrolled **hypertension** due to the estrogen component, which can increase the risk of cardiovascular events, including thrombosis. - While COCs can improve dysmenorrhea and menorrhagia, the cardiovascular risks in a 38-year-old with chronic hypertension outweigh these benefits.

Q: A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present? 1. Post placental insertion of IUCD 2. Post partum ligation 3. Oral contraceptive pill 4. Lap ligation Select the correct answer using the code given below:

1 and 2 only. **1 and 2 only** - **Post-placental insertion of an IUCD** (Intrauterine Contraceptive Device) is a safe and effective immediate contraception option after delivery, as the cervix is still dilated, facilitating insertion. - **Postpartum ligation** (tubal ligation) is a common and highly effective permanent contraception method that can be performed shortly after delivery, often before discharge from the hospital. *2 only* - This option is incomplete as **post-placental IUCD insertion** is also a viable and often preferred immediate post-delivery contraceptive choice. - Limiting options to only postpartum ligation overlooks another readily available and effective method. *1, 2 and 4* - This option includes **lap ligation**, which typically refers to a laparoscopic procedure and is usually not performed immediately postpartum due to the enlarged uterus and increased vascularity, making it less ideal than ligation performed via mini-laparotomy shortly after delivery. - While laparoscopic approaches are possible later, **postpartum mini-laparotomy ligation** (which '2' likely refers to in this context) is the more immediate and common surgical approach. *1 and 3* - This option includes **oral contraceptive pills**, which are generally not recommended for immediate use in the postpartum period, especially for breastfeeding mothers, due to the potential impact on lactation and an increased risk of thromboembolism in the initial weeks after delivery. - **Progestin-only pills** can be considered later in the postpartum period, but combined oral contraceptives are typically delayed.

Q: Which one of the following statements regarding contraception is NOT true?

Vaginal ring is a barrier method. ***Vaginal ring is a barrier method*** - The **vaginal ring** (e.g., NuvaRing) is a **hormonal contraceptive** that releases estrogen and progestin, not a barrier method. - Its mechanism of action involves **inhibiting ovulation** and altering cervical mucus, unlike barrier methods that physically block sperm. *Copper T can be inserted just after delivery* - The **Copper T (IUD)** can be safely inserted immediately after delivery, ideally within **48 hours**, as a **postpartum IUD insertion**. - This timing is often preferred as the cervix is still dilated, and the woman is already in a healthcare setting. *Implanon is a hormonal contraceptive* - **Implanon** (now Nexplanon) is indeed a **hormonal contraceptive**, containing etonogestrel, a progestin. - It is an implantable rod that provides **long-acting reversible contraception (LARC)** for up to three years. *Copper T can be used as post coital contraception* - The **Copper T IUD** is highly effective as **emergency contraception** when inserted within **5 days** of unprotected intercourse. - It works by preventing fertilization or implantation, making it more effective than emergency contraceptive pills.

Q: Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?

LNG-20 (Mirena). ***LNG-20 (Mirena)*** - This **levonorgestrel-releasing IUD** (Mirena) has a very low pregnancy rate (0.2 per 100 women-years). - It significantly **reduces menstrual blood loss** and cramps and is associated with a lower risk of ectopic pregnancies compared to copper IUDs because it thins the endometrial lining, making implantation less likely. *Cu T-380A* - The **Cu T-380A copper IUD** has a slightly higher pregnancy rate (around 0.6-0.8 per 100 women-years) compared to Mirena. - It is known to **increase menstrual blood loss** and dysmenorrhea, which is contrary to the question's criteria. *ML-Cu 375* - The **Multiload Cu 375** is another type of copper IUD, with a pregnancy rate similar to or slightly higher than the TCu-380A. - Like other copper IUDs, it typically **increases menstrual flow** and may worsen menstrual pain. *Progestasert* - **Progestasert** was an early progesterone-releasing IUD that had a higher failure rate and a shorter lifespan (1 year) compared to newer LNG-IUDs. - While it aimed to reduce menstrual blood loss, its **overall efficacy and duration of action** were inferior to the LNG-20 system.

Q: Which of the following is/are required for a registered medical practitioner to qualify for performing Medical Termination of Pregnancy (MTP), as per revised rules of MTP Act? 1. Certified for assisting at least 25 MTP in an authorized centre 2. Diploma or degree in Obstetrics and Gynaecology 3. House surgeon training for 6 months in Obstetrics and Gynaecology 4. Certified training for 6 months in laparoscopic surgeries Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - As per the **MTP (Amendment) Act 2021 and Rules**, a registered medical practitioner (RMP) can perform MTP if they meet **any one** of the following qualifications: - Assisted at least **25 MTPs** in an authorized center - Hold a **diploma or degree in Obstetrics and Gynaecology** - Completed **house surgeon training for 6 months** in Obstetrics and Gynaecology in a recognized institution - All three statements (1, 2, and 3) represent valid pathways for qualification under the MTP Act, making this the correct answer. *2 only* - While a **diploma or degree in Obstetrics and Gynaecology** is indeed a valid qualification, it is not the *only* pathway recognized by the MTP Act. - Other pathways including practical experience (25 MTPs) and house surgeon training are equally valid qualifications. *1 only* - Assisting at least **25 MTPs** in an authorized center is a valid standalone qualification under the MTP Act. - However, this option is incorrect because statements 2 and 3 are also valid qualifications, not just statement 1 alone. *1, 2 and 4* - **Certified training for 6 months in laparoscopic surgeries** is **not a requirement** for performing MTP under the MTP Act. - While surgical skills are valuable, laparoscopic surgery training is not specifically mandated for MTP qualification, which primarily involves medical and surgical abortion procedures that don't necessarily require laparoscopic techniques.

Question 1

For a 40 year old hypertensive woman, which one of the following is not recommended for contraception?

Accepted Answer

NuvaRing

Answer

IUCD

Answer

Minipill

Answer

LNG IUD (LNg IUD)

Question 2

For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?

Accepted Answer

Yuzpe regimen

Answer

Levonorgestrel 1.5 mg

Answer

LNG IUD

Answer

Ulipristal acetate

Question 3

Which one of the following is not a contraindication for prescribing combined oral contraceptive pills?

Accepted Answer

Pelvic inflammatory disease

Answer

Viral hepatitis

Answer

Well-controlled hypertension

Answer

Thromboembolic disease

Question 4

LNG-20 (Mirena) is a third generation intra uterine device. What are the advantages of its use?

1. Low uterine pregnancy rates
2. Prevents anemia
3. Long effective life of 5 years
4. No effect on incidence of ectopic pregnancy

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 5

Tubectomy is commonly performed at which site of fallopian tube?

Accepted Answer

Isthmus

Answer

Infundibulum

Answer

Ampulla

Answer

Cornua

Question 6

The contraceptive choice for a 38 year old woman with chronic hypertension and history of dysmenorrhea and menorrhagia (malignancy ruled out) is:

Accepted Answer

Levonorgestrel intrauterine device

Answer

Copper intrauterine device

Answer

Sterilization

Answer

Combined oral contraceptive pills

Question 7

A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present?

1. Post placental insertion of IUCD
2. Post partum ligation
3. Oral contraceptive pill
4. Lap ligation

Select the correct answer using the code given below:

Accepted Answer

1 and 2 only

Answer

2 only

Answer

1, 2 and 4

Answer

1 and 3

Question 8

Which one of the following statements regarding contraception is NOT true?

Accepted Answer

Vaginal ring is a barrier method

Answer

Copper T can be inserted just after delivery

Answer

Implanon is a hormonal contraceptive

Answer

Copper T can be used as post coital contraception

Question 9

Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?

Accepted Answer

LNG-20 (Mirena)

Answer

Cu T-380A

Answer

ML-Cu 375

Answer

Progestasert

Question 10

Which of the following is/are required for a registered medical practitioner to qualify for performing Medical Termination of Pregnancy (MTP), as per revised rules of MTP Act?

1. Certified for assisting at least 25 MTP in an authorized centre

2. Diploma or degree in Obstetrics and Gynaecology

3. House surgeon training for 6 months in Obstetrics and Gynaecology

4. Certified training for 6 months in laparoscopic surgeries

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

2 only

Answer

1 only

Answer

1, 2 and 4

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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