Contraception and Family Planning Practice Questions

Q: Which one of the following is NOT a contraindication for use of Mini pill?

Breast feeding. ***Breastfeeding*** - **Mini-pills**, which contain only progestin, are **safe for use during breastfeeding** as they do not significantly affect milk production or infant health. - They are often the **preferred hormonal contraceptive** for nursing mothers. - WHO Category 1 (no restriction) for breastfeeding women. *Pregnancy* - **Pregnancy** is a **contraindication** for any hormonal contraceptive, including the mini-pill. - The purpose of contraception is to **prevent pregnancy**, making its presence a clear reason not to start or continue the method. - WHO Category 4 (unacceptable health risk). *Thromboembolic disease* - **History of thromboembolic disease is NOT an absolute contraindication** for progestin-only pills (mini-pills). - Unlike combined oral contraceptives that contain estrogen, **mini-pills do not significantly increase the risk of thrombosis** as they lack the estrogen component responsible for clotting effects. - WHO Category 2 (advantages generally outweigh risks) for history of VTE. - This makes mini-pills a **safer alternative** for women with previous thromboembolism who need hormonal contraception. *History of breast cancer* - A **history of breast cancer** is a **contraindication** for hormonal contraceptives, including mini-pills, because steroid hormones can promote the growth of hormone-sensitive cancers. - Current breast cancer: WHO Category 4; past breast cancer with no evidence of disease for 5 years: WHO Category 3. - Alternative non-hormonal contraception methods are recommended in such cases.

Q: Contraindications for insertion of IUDs are all EXCEPT:

During cesarean section. ***During cesarean section*** - Immediate post-placental IUD insertion during cesarean section is **safe and effective** with proper technique and uterine assessment - This timing improves continuation rates by avoiding a separate office visit - WHO and ACOG guidelines support this practice, making it **NOT a contraindication** *Trophoblastic disease* - Gestational trophoblastic disease is a **contraindication** due to increased risk of uterine perforation - IUD insertion can mask disease recurrence and interfere with hCG monitoring - Must wait until complete resolution and hCG normalization *Suspected pregnancy* - IUD insertion in a pregnant uterus can cause **miscarriage, infection, or perforation** - Pregnancy must be **ruled out** before insertion - This is an **absolute contraindication** *Severe dysmenorrhea* - **Copper IUDs** are relatively contraindicated as they can worsen menstrual cramps and bleeding - However, **levonorgestrel-releasing IUDs (LNG-IUS)** are actually therapeutic for dysmenorrhea - As a general contraindication listing (without specifying IUD type), severe dysmenorrhea is traditionally considered a contraindication primarily for copper IUDs

Q: Indications for removal of IUDs are all EXCEPT:

Cyclical menstrual bleeding. ***Cyclical menstrual bleeding*** - **Normal cyclical menstrual bleeding** is an expected physiological event and not an indication for IUD removal. - While IUDs can alter menstrual patterns (e.g., heavier or lighter bleeding), typical cyclical bleeding that is not excessively heavy, painful, or prolonged usually does not warrant removal. *Pregnancy with IUD* - If a **pregnancy occurs with an IUD in situ**, especially in the first trimester, the IUD should ideally be removed to reduce the risk of spontaneous abortion, preterm labor, or infection. - Removal is especially crucial if the strings are visible and accessible; if not, close monitoring is necessary. *Flaring up of salpingitis* - **Salpingitis (pelvic inflammatory disease - PID)** is a serious infection that can be exacerbated or initiated by the presence of an IUD, particularly during insertion or in individuals with pre-existing infections. - A confirmed or suspected flare-up of salpingitis necessitates IUD removal to control the infection and prevent further complications like infertility or ectopic pregnancy. *Perforation of uterus* - **Uterine perforation** is a serious complication that can occur during IUD insertion and requires immediate removal of the device. - Depending on the extent of perforation, it may lead to pain, hemorrhage, infection, or damage to surrounding organs.

Q: What is the pathophysiological mechanism behind the increased risk of pelvic inflammatory disease with intrauterine device (IUD) insertion?

Introduction of vaginal bacteria during insertion procedure. ***Introduction of vaginal bacteria during insertion procedure*** - The **insertion process itself** can introduce bacteria from the vagina and cervix into the uterine cavity, leading to an **ascending infection**. - This risk is primarily associated with the **first 2-3 weeks post-insertion**, after which the risk significantly decreases and is not directly related to the IUD's presence. *Inhibition of local immune responses by copper* - **Copper IUDs** actually induce a **local inflammatory response** in the endometrium, which is part of their contraceptive mechanism. - This inflammation helps to prevent sperm survival and ovum implantation, rather than inhibiting immune responses. *Direct trauma to endometrial tissue* - While insertion can cause minor trauma, this **trauma itself does not directly cause PID** but rather provides a potential entry point for bacteria if disinfection protocols are not meticulously followed. - The risk of infection is primarily from the introduction of bacteria rather than the tissue damage. *Enhancement of bacterial adhesion by IUD string* - Although the **IUD string** could theoretically serve as a pathway for bacteria, studies have not definitively shown it to be a significant independent risk factor for PID beyond the initial insertion period. - The primary risk factor is the **bacterial translocation during the insertion procedure**, not ongoing bacterial ascent via the string.

Q: A pregnant lady delivers a healthy baby via normal delivery. What is the earliest time at which an intrauterine contraceptive device (IUCD) can be inserted?

Within 48 hours. ***Within 48 hours*** - **Immediate postpartum insertion** (within 48 hours of delivery) is considered safe and effective, with high client satisfaction and continuation rates. - While there's a slightly higher risk of **expulsion** compared to later insertions, it provides immediate contraception for women who might not return for follow-up. *After 6 weeks* - This is a common time for postpartum check-ups and a traditional window for IUCD insertion, after the uterus has largely involuted. - However, it is not the **earliest possible time**, as immediate postpartum insertion is also an option. *After 3 months* - Delaying IUCD insertion until three months postpartum is unnecessarily late if the woman desires contraception sooner. - This longer delay could increase the risk of an **unintended pregnancy** during the interim. *After 1 month* - Insertion at one month postpartum is also a safe option, after early uterine involution. - However, similar to the six-week option, it is not the **earliest possible time** for insertion.

Q: Tubectomy is typically performed on which part of the fallopian tube and why?

Isthmus - narrowest. ***Isthmus - narrowest*** - The **isthmus** is preferred for tubectomy because its **narrowest diameter** and thick muscular wall make it easier to ligate and minimize recanalization. - Its narrow lumen also reduces the chances of spontaneous rejoining and pregnancy, ensuring a more effective and permanent sterilization. *Ampulla - uniform thickness of muscle* - The **ampulla** is a wider, more distensible part of the fallopian tube, making it **less suitable for ligation** due to a higher risk of recanalization. - While tubular muscle thickness is a factor, the **ampulla's larger lumen** makes it less ideal for effective and permanent occlusion compared to the isthmus. *Ampulla - widest* - The **ampulla's wider diameter** increases the technical difficulty of creating a secure and permanent occlusion, as ligating a broad segment is less effective. - A wider lumen makes **spontaneous recanalization** more likely, compromising the contraceptive efficacy of the procedure. *Isthmus - uniform thickness of muscle* - While the isthmus does have a relatively **uniform and thick muscular wall**, it is the **narrowness of the lumen** that is the primary reason for its selection in tubectomy. - The consistency of its muscle is a contributing factor to its robustness, but the **small caliber** is key to preventing recanalization.

Q: All of the following can be used in first-trimester medical termination of pregnancy (MTP), except

Extra-amniotic instillation of ethacridine lactate. ***Extra-amniotic instillation of ethacridine lactate*** - **Extra-amniotic instillation of ethacridine lactate** is a method primarily used for **second-trimester** pregnancy terminations. - Its mechanism involves causing inflammation and contraction of the uterus, which is less effective and carries higher risks in the first trimester. *Manual vacuum aspiration* - **Manual vacuum aspiration (MVA)** is a common and effective surgical method for **first-trimester MTP**. - It involves using a syringe and cannula to remove the uterine contents directly. *Dilatation and curettage* - **Dilatation and curettage (D&C)** is another standard surgical procedure used for **first-trimester MTP**. - It involves dilating the cervix and using a curette to scrape the uterine lining and remove the pregnancy tissue. *Mifepristone + misoprostol* - The combination of **mifepristone and misoprostol** is the most common and effective medical method for **first-trimester MTP**. - **Mifepristone** blocks progesterone, while **misoprostol** causes uterine contractions and cervical ripening, expelling the pregnancy.

Q: Which of the following is not a long-acting reversible contraceptive method?

Combined oral contraceptives. ***Combined oral contraceptives*** - While effective, **combined oral contraceptives** require daily adherence and are not typically classified as long-acting due to their need for frequent, consistent administration. - Their mechanism involves **exogenous hormones** that suppress ovulation and thicken cervical mucus, but their contraceptive effect relies on continuous daily intake. *Implanon* - **Implanon** (etonogestrel implant) is a **subdermal contraceptive implant** that provides effective contraception for up to three years. - It works by slowly releasing progestin, making it a **long-acting reversible contraceptive (LARC)**. *Copper T* - The **Copper T intrauterine device (IUD)** is a non-hormonal LARC that can prevent pregnancy for **up to 10 years**. - It acts by creating an inflammatory reaction in the uterus that is toxic to sperm and eggs, preventing fertilization. *Depo-Provera injection* - The **Depo-Provera injection** (medroxyprogesterone acetate) is a progestin-only contraceptive given every **3 months**. - While it offers extended protection, it is **not universally classified as a LARC** by major guidelines (WHO, ACOG, CDC), which typically reserve this designation for IUDs and implants that do not require regular clinic visits.

Q: A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

OCP. ***OCP*** - **Oral Contraceptive Pills (OCPs)** are a highly effective method that also help regulate **menstrual cycles** due to their hormonal content. - They provide effective contraception while simultaneously addressing the symptom of **irregular menstruation** in a newly married woman. *Barrier method* - **Barrier methods** like condoms are effective for contraception but do not address or regulate irregular menstrual cycles. - Their effectiveness depends heavily on consistent and correct use with each act of intercourse. *Calendar method* - The **calendar method** relies on tracking the menstrual cycle to predict fertile windows and is unreliable with **irregular menstruation**. - It would be ineffective as a contraceptive for a woman with unpredictable cycle lengths, leading to a high risk of unintended pregnancy. *Progesterone only pills* - **Progesterone-only pills** (POPs) can be used for contraception, but they may cause or exacerbate **menstrual irregularities**. - While effective in preventing pregnancy, they do not offer the cycle-regulating benefits that combination OCPs do for women with irregular periods.

Q: The contraceptive which is contraindicated in DVT is?

OCP. ***OCP*** - **Oral contraceptive pills (OCPs)**, especially those containing estrogen, increase the risk of **venous thromboembolism (VTE)**, including deep vein thrombosis (DVT). - Estrogen promotes a **hypercoagulable state** by increasing clotting factors and decreasing natural anticoagulants. *Barrier method* - **Barrier methods** like condoms or diaphragms are non-hormonal and act physically to prevent sperm from reaching the egg. - They have **no systemic effects** on coagulation and are safe for individuals with DVT. *Non hormonal IUCD* - **Non-hormonal intrauterine contraceptive devices (IUCDs)**, such as copper IUCDs, prevent conception primarily by causing a local inflammatory reaction in the uterus. - They do not release hormones and therefore **do not affect coagulation** or increase DVT risk. *Billing's method* - The **Billing's ovulation method** (cervical mucus method) is a natural family planning technique based on observing changes in cervical mucus. - It involves no medications or devices and thus has **no impact on DVT risk**.

Question 1

Which one of the following is NOT a contraindication for use of Mini pill?

Accepted Answer

Breast feeding

Answer

Pregnancy

Answer

Thromboembolic disease

Answer

History of breast cancer

Question 2

Contraindications for insertion of IUDs are all EXCEPT:

Accepted Answer

During cesarean section

Answer

Trophoblastic disease

Answer

Suspected pregnancy

Answer

Severe dysmenorrhea

Question 3

Indications for removal of IUDs are all EXCEPT:

Accepted Answer

Cyclical menstrual bleeding

Answer

Pregnancy with IUD

Answer

Flaring up of salpingitis

Answer

Perforation of uterus

Question 4

What is the pathophysiological mechanism behind the increased risk of pelvic inflammatory disease with intrauterine device (IUD) insertion?

Accepted Answer

Introduction of vaginal bacteria during insertion procedure

Answer

Inhibition of local immune responses by copper

Answer

Direct trauma to endometrial tissue

Answer

Enhancement of bacterial adhesion by IUD string

Question 5

A pregnant lady delivers a healthy baby via normal delivery. What is the earliest time at which an intrauterine contraceptive device (IUCD) can be inserted?

Accepted Answer

Within 48 hours

Answer

After 6 weeks

Answer

After 3 months

Answer

After 1 month

Question 6

Tubectomy is typically performed on which part of the fallopian tube and why?

Accepted Answer

Isthmus - narrowest

Answer

Ampulla - uniform thickness of muscle

Answer

Ampulla - widest

Answer

Isthmus - uniform thickness of muscle

Question 7

All of the following can be used in first-trimester medical termination of pregnancy (MTP), except

Accepted Answer

Extra-amniotic instillation of ethacridine lactate

Answer

Manual vacuum aspiration

Answer

Dilatation and curettage

Answer

Mifepristone + misoprostol

Question 8

Which of the following is not a long-acting reversible contraceptive method?

Accepted Answer

Combined oral contraceptives

Answer

Implanon

Answer

Copper T

Answer

Depo-Provera injection

Question 9

A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

Accepted Answer

OCP

Answer

Barrier method

Answer

Calendar method

Answer

Progesterone only pills

Question 10

The contraceptive which is contraindicated in DVT is?

Accepted Answer

OCP

Answer

Barrier method

Answer

Non hormonal IUCD

Answer

Billing's method

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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