Contraception and Family Planning Practice Questions

Q: What is the dose of mifepristone in emergency contraception?

10 mg. ***10 mg*** - **10 mg is the WHO-recommended dose** of mifepristone for emergency contraception. - This single dose is **equally effective** as higher doses (25-50 mg) and works primarily by **delaying or inhibiting ovulation**. - It has been validated through **multiple international clinical trials** and is the standard regimen used globally. - When taken within **72-120 hours** of unprotected intercourse, it significantly reduces pregnancy risk. *25 mg* - While 25 mg of mifepristone has been studied for emergency contraception and shows efficacy, it is **not the standard recommended dose**. - The **10 mg dose is preferred** as it achieves similar efficacy with potentially fewer side effects and lower cost. - Some countries may use 25 mg, but **WHO guidelines recommend 10 mg** as the optimal dose. *200 mg* - A 200 mg dose of mifepristone is typically utilized for **medical abortion regimens**, often in combination with a prostaglandin analog (misoprostol). - This dosage achieves a different pharmacological effect, leading to **detachment of the embryo** and uterine contractions. - This is **far higher than needed** for emergency contraception purposes. *200 mcg* - **Mifepristone is not dosed in micrograms** (mcg) for emergency contraception or medical abortion; it is measured in milligrams (mg). - This unit and dosage are more commonly associated with other medications, such as **misoprostol** when used for obstetric indications. - 200 mcg would be 0.2 mg, which is **subtherapeutic** for any mifepristone indication.

Q: After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

6 weeks. ***6 weeks*** - For **non-breastfeeding mothers**, combined oral contraceptives (COCs) are most safely initiated at **6 weeks postpartum** according to WHO Medical Eligibility Criteria. - At 6 weeks postpartum, the risk of **venous thromboembolism (VTE)** has returned to baseline, making this the safest timing (WHO MEC Category 1 - no restriction). - This timing balances both safety and effective contraception for mothers not breastfeeding. *Immediately after delivery* - Starting COCs immediately postpartum significantly increases the risk of **venous thromboembolism (VTE)** due to the hypercoagulable state after delivery. - This timing is contraindicated for combined hormonal methods (WHO MEC Category 3-4). *2 weeks* - At 2 weeks (14 days) postpartum, the VTE risk remains elevated in the early postpartum period. - Combined hormonal contraceptives are generally not recommended before 3 weeks (21 days) postpartum for non-breastfeeding women. - This timing does not meet standard safety guidelines. *12 weeks* - While 12 weeks postpartum is medically safe for initiating COCs, it is unnecessarily delayed. - This extended waiting period increases the risk of unintended pregnancy when effective contraception could be safely provided earlier at 6 weeks.

Q: Absolute contraindication of IUCD is?

Acute PID. ***Acute PID*** - **Acute pelvic inflammatory disease (PID)** is an absolute contraindication for IUCD insertion because the device can potentially worsen the existing infection or spread it further into the uterus and fallopian tubes. - Inserting an IUCD in the presence of acute PID significantly increases the risk of serious complications, including **sepsis** and **infertility**. *Previous history of abortion* - A **previous history of abortion** is generally not an absolute contraindication for IUCD insertion; rather, it may be a relative contraindication depending on factors such as the recency of the abortion or presence of infection risks. - IUCDs can be safely inserted after an abortion if there are no signs of infection and the uterus has involuted sufficiently. *Breast cancer* - **Breast cancer** is primarily a contraindication for **hormonal contraceptives** (like hormonal IUCDs) due to the potential estrogen or progestin sensitivity of certain cancers. - However, **copper IUCDs** (which are non-hormonal) are generally safe to use in patients with a history of breast cancer. *PCOD* - **Polycystic ovary syndrome (PCOS)** is not a contraindication for IUCD insertion; in fact, hormonal IUCDs can sometimes be beneficial in managing symptoms like heavy menstrual bleeding associated with PCOS. - IUCDs do not interfere with the underlying pathophysiology of PCOS.

Q: A woman comes after 96 hours post coitus. Best contraceptive of choice is?

IUCD. ***IUCD*** - An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation. - It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**. - Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus. *Progesterone only pills* - **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse. - At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD. *OCP* - **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods. - Their effectiveness also significantly declines after **72 hours** post-coitus. *Mifepristone* - **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse. - While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception.

Q: Use of OCPs is known to protect against the following malignancies except:

Carcinoma cervix. ***Carcinoma cervix*** - While oral contraceptive pills (OCPs) offer protection against some cancers, they are **not protective against cervical cancer**. - In fact, long-term use of OCPs is considered a **risk factor for cervical cancer**, especially in conjunction with human papillomavirus (HPV) infection. *Colorectal carcinomas* - OCP use has been consistently associated with a **reduced risk of colorectal cancer**. - The protective effect is thought to be mediated by various hormonal mechanisms, including their impact on **bile acid metabolism** and **estrogen receptors in the colon**. *Ovarian carcinoma* - OCPs provide significant and **long-lasting protection against ovarian cancer**. - This protective effect is believed to be due to the **suppression of ovulation**, thereby reducing the continuous trauma and repair of the ovarian epithelium. *Endometrial carcinoma* - OCPs are known to offer substantial **protection against endometrial cancer**. - The progestin component in combined OCPs effectively **counteracts the proliferative effects of estrogen** on the endometrium, reducing the risk of hyperplasia and subsequent cancer.

Q: Contraceptive of choice in a woman with Rheumatic heart disease.

IUCD. ***IUCD*** - **Intrauterine contraceptive devices (IUCDs)** are highly effective and do not involve systemic hormones, making them safe for women with **rheumatic heart disease**. - Both copper and hormonal IUCDs can be used, as they pose no additional risk of **thromboembolism** or worsen cardiac function. *Progesterone only pills* - While generally safer than combined oral contraceptives for women with cardiac issues, **progesterone-only pills** still carry a slight risk of **thrombosis**, especially in women with certain heart conditions. - Their effectiveness can be slightly lower than IUCDs, and adherence to strict daily timing is crucial for optimal contraception. *Condom with spermicidal jelly* - **Condoms with spermicidal jelly** are a barrier method and do not pose any direct risk to a woman with rheumatic heart disease. - However, they have a significantly **higher failure rate** compared to highly effective methods like IUCDs, making them less ideal as a primary contraceptive for a condition where pregnancy could be high-risk. *OCPs* - **Combined oral contraceptive pills (OCPs)** containing both estrogen and progestin are generally **contraindicated** in women with rheumatic heart disease, particularly those with valvular lesions or a history of **embolism**. - Estrogen increases the risk of **thromboembolic events**, which can be dangerous for individuals with compromised cardiac function.

Q: Which drug was traditionally used for extra-amniotic instillation in 2nd trimester medicolegal termination of pregnancy?

Ethacrydine lactate. ***Ethacrydine lactate*** - **Ethacrydine lactate** (Rivanol) is an acridine derivative that was **traditionally the agent of choice** for extra-amniotic instillation in second-trimester medical termination of pregnancy. - It is injected into the extra-amniotic space (between the chorion and uterine wall) where it acts locally to induce uterine contractions and cervical ripening. - The typical dose is 0.1% solution, 100-150 mL instilled extra-amniotically. - Though effective, it has been increasingly replaced by prostaglandins due to better safety profiles and ease of administration. *Hypertonic saline* - **Hypertonic saline** (20% NaCl) was historically used for second-trimester abortions but via **intra-amniotic injection**, NOT extra-amniotic route. - It carried significant risks including hypernatremia, disseminated intravascular coagulation (DIC), cerebral edema, and cardiovascular collapse. - Due to these severe maternal complications, it has been largely abandoned in modern practice. *Prostaglandin* - **Prostaglandins** (PGE2, PGF2α, misoprostol) are currently the **preferred agents** for second-trimester termination. - They can be administered via multiple routes including **extra-amniotic**, intra-amniotic, vaginal, oral, or sublingual. - While prostaglandins CAN be used extra-amniotically, the question asks specifically about the **traditional/classical agent** used for this route, which was ethacrydine lactate. - Modern protocols favor vaginal or oral misoprostol due to convenience and efficacy. *Glucose* - **Glucose** has no abortifacient properties and is not used for pregnancy termination. - It serves only as an energy source and has no effect on uterine contractility or cervical ripening.

Q: MTP cannot be done after:

28 weeks. ***28 weeks*** - The Medical Termination of Pregnancy (MTP) Act was amended in 2021, and the upper gestation limit for MTP was increased to **24 weeks** in special cases. However, MTP at 28 weeks' gestation is **not permitted**, as fetal viability is significantly higher, and legal restrictions are stricter. - Beyond 24 weeks, an MTP is only permitted in cases of **substantial fetal anomalies** diagnosed by a Medical Board, making 28 weeks generally non-permissible for routine MTP. *20 weeks* - The initial MTP Act of 1971 allowed MTP up to **20 weeks of gestation** with specific conditions, including a risk to the mother's life or health, or fetal abnormalities. - This limit was extended in certain circumstances by the 2021 amendment, but 20 weeks is generally within the permissible limit for MTP. *12 weeks* - MTP can be performed up to **12 weeks of gestation** based on the opinion of one registered medical practitioner under the MTP Act. - This period is considered safer and less complex for termination procedures. *24 weeks* - The MTP (Amendment) Act of 2021 expanded the gestation limit for MTP to **24 weeks** for specific categories of women, including survivors of sexual assault, minors, women with disabilities, and those with a change in marital status during pregnancy. - This limit requires the opinion of **two registered medical practitioners**.

Q: Which one of the following methods of MTP is associated with the complication of coagulopathy:

Hypertonic saline. ***Hypertonic saline*** - Intra-amniotic instillation of **hypertonic saline** can lead to **disseminated intravascular coagulation (DIC)** due to its toxic effect on fetal endothelial cells and release of thromboplastin-like substances from the placenta. - This method is associated with a higher risk of **coagulopathy**, specifically a decrease in fibrinogen levels, which is a severe complication. - This technique is now largely abandoned due to these serious complications. *Ethacridine lactate (Rivanol)* - **Ethacridine lactate** is an **antiseptic and abortifacient** used for second-trimester MTP via intra-amniotic instillation. - While it can cause prolonged labor and cervical trauma, it is **not primarily associated with coagulopathy** as a major complication compared to hypertonic saline. - Its main adverse effects include fever, gastrointestinal disturbances, and prolonged induction-abortion interval. *Aspirotomy (Vacuum aspiration)* - **Vacuum aspiration** is a surgical method to empty the uterus, and while it carries general risks of infection or uterine perforation, it is **not directly linked to coagulopathy**. - It is one of the safer and more common methods for first-trimester termination. *Prostaglandins* - **Prostaglandins** such as misoprostol or dinoprostone are commonly used for medical and surgical abortion, inducing uterine contractions. - While they have various side effects (nausea, vomiting, diarrhea), they are **not primarily associated with systemic coagulopathy** as a direct complication.

Question 1

What is the dose of mifepristone in emergency contraception?

Accepted Answer

10 mg

Answer

25 mg

Answer

200 mcg

Answer

200 mg

Question 2

After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

Accepted Answer

6 weeks

Answer

Immediately after delivery

Answer

2 weeks

Answer

12 weeks

Question 3

Absolute contraindication of IUCD is?

Accepted Answer

Acute PID

Answer

Previous history of abortion

Answer

Breast cancer

Answer

PCOD

Question 4

A woman comes after 96 hours post coitus. Best contraceptive of choice is?

Accepted Answer

IUCD

Answer

Progesterone only pills

Answer

OCP

Answer

Mifepristone

Question 5

A 10-week pregnant woman presents for termination of pregnancy. What is the best method of abortion?

Accepted Answer

Vacuum aspiration

Answer

Misoprostol + mifepristone

Answer

Methotrexate and misoprostol

Answer

Dilatation and curettage

Question 6

Use of OCPs is known to protect against the following malignancies except:

Accepted Answer

Carcinoma cervix

Answer

Colorectal carcinomas

Answer

Ovarian carcinoma

Answer

Endometrial carcinoma

Question 7

Contraceptive of choice in a woman with Rheumatic heart disease.

Accepted Answer

IUCD

Answer

Progesterone only pills

Answer

Condom with spermicidal jelly

Answer

OCPs

Question 8

Which drug was traditionally used for extra-amniotic instillation in 2nd trimester medicolegal termination of pregnancy?

Accepted Answer

Ethacrydine lactate

Answer

Hypertonic saline

Answer

Prostaglandin

Answer

Glucose

Question 9

MTP cannot be done after:

Accepted Answer

28 weeks

Answer

20 weeks

Answer

12 weeks

Answer

24 weeks

Question 10

Which one of the following methods of MTP is associated with the complication of coagulopathy:

Accepted Answer

Hypertonic saline

Answer

Ethacrydine lactate

Answer

Aspirotomy

Answer

Prostaglandins

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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