Contraception and Family Planning Practice Questions

Q: What is the use of the instrument shown in the image?

Laparoscopic sterilization. ***Laparoscopic sterilization*** - The image depicts a **laparoscopic clip applicator**, specifically designed for placing clips on structures like the **fallopian tubes** during laparoscopic sterilization procedures. - This instrument is used to permanently occlude the fallopian tubes, preventing the passage of eggs and sperm for effective **contraception**. *Surgical removal of ectopic pregnancy* - While an ectopic pregnancy can be removed laparoscopically, the instrument shown is a **clip applicator**, not typically used for dissecting or excising tissue in such a procedure. - Surgical removal of an ectopic pregnancy often involves **laparoscopic salpingostomy** or **salpingectomy**, which require cutting, grasping, and coagulating instruments. *Induction of abortion* - **Abortion induction** is typically performed using medical methods (medications) or surgical procedures like **dilation and curettage (D&C)** or **manual vacuum aspiration (MVA)**, none of which involve the specific instrument shown. - This instrument is designed for **occlusion** rather than tissue removal related to abortion. *Creating pneumoperitoneum for laparoscopic procedures* - **Pneumoperitoneum** is created using a **Veress needle** to insufflate carbon dioxide into the abdominal cavity, providing a working space for laparoscopic instruments. - The instrument shown is a **clip applicator**, not a needle for gas insufflation.

Q: Which of the following is not used for postcoital contraception?

Danazol. ***Danazol*** - **Danazol** is an androgen derivative primarily used to treat conditions like **endometriosis** and **fibrocystic breast disease** due to its ability to suppress gonadotropin secretion. - It is **not effective** as a postcoital contraceptive as it does not reliably prevent ovulation, fertilization, or implantation when taken after unprotected intercourse. *CuT* - The **copper-T intrauterine device (CuT IUD)** can be inserted within **5 days** of unprotected intercourse as an effective form of emergency contraception. - Its mechanism involves releasing **copper ions** that are toxic to sperm and eggs, inhibiting fertilization and implantation. *Ru 486* - **Mifepristone (RU 486)** is an **anti-progestin** that can be used for emergency contraception (often referred to as the morning-after pill). - It works by delaying or inhibiting ovulation and preventing implantation by altering the **endometrium**. *High dose estrogen* - High doses of **estrogen**, often in combination with progestin (**Yuzpe regimen**), can be used as emergency contraception. - This method primarily works by **disrupting ovulation** and altering the endometrium to prevent implantation.

Q: A 24 year old lactating female with an 18 month old child comes with a history of irregular, heavy bleeding seeking contraceptive advice. Which is the contraceptive of choice?

Progestin-only pill. ***Progestin-only pill*** - The **progestin-only pill (POP)** is the contraceptive of choice for lactating women because it does not affect **breast milk supply** or composition. - It works by thickening cervical mucus and thinning the **endometrium**, which can help reduce heavy bleeding and provide effective contraception. *Copper IUD* - While the **copper IUD** is a highly effective contraceptive, it is known to potentially increase **menstrual bleeding** and cramping. - Given the patient's history of **heavy bleeding**, a copper IUD might worsen her symptoms. *Progestin-only injection* - **Progestin-only injections** like DMPA are highly effective and safe for lactating women, but they can cause **irregular bleeding patterns** initially and are associated with a slower return to fertility. - While an option, the **progestin-only pill** offers more immediate control over menstrual patterns and easier discontinuation if side effects are problematic. *Combined oral contraceptive pill* - **Combined oral contraceptive pills (COCs)** contain both estrogen and progestin. Estrogen can negatively impact **milk production** and may not be suitable for breastfeeding mothers, especially in the first 6 months postpartum. - COCs are generally avoided in lactating women until breastfeeding is well-established or after 6 months to prevent interference with **lactation**.

Q: Which of the following is NOT an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Uterine malformation. ***Uterine malformation*** - While a **uterine malformation** can make IUD placement difficult or increase the risk of expulsion, it is generally considered a **relative contraindication**, not an absolute one. - The decision to place an IUD in such cases depends on the specific type of malformation and the experience of the clinician. *Pregnancy* - **Pregnancy** is an **absolute contraindication** because an IUD offers no protection against pregnancy in an already conceived state and can lead to complications such as miscarriage or ectopic pregnancy if inserted. - Inserting an IUD into a pregnant uterus can cause significant harm to both the mother and the fetus. *Active pelvic infection* - An **active pelvic infection** (e.g., **pelvic inflammatory disease, cervicitis**) is an **absolute contraindication** due to the risk of exacerbating the infection and spreading it further into the uterus and fallopian tubes. - IUD insertion during an active infection can lead to severe complications. *Known allergy to IUD components* - A **known allergy** to any component of the IUD (e.g., copper, plastic) is an **absolute contraindication** to avoid severe allergic reactions. - Allergic reactions can range from localized irritation to systemic responses.

Q: A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy. What are the drugs used for medical termination of pregnancy in this patient?

Misoprostol and Mifepristone. ***Misoprostol and Mifepristone*** - This combination is the **standard and most effective medical regimen** for termination of pregnancy in the first trimester (up to 9-10 weeks). - **Mifepristone** (200mg) is an **antiprogestin** that blocks progesterone receptors, essential for maintaining pregnancy, followed 24-48 hours later by **Misoprostol** (800mcg), a **prostaglandin analog** that causes cervical ripening and strong uterine contractions. - This regimen has a **95-98% success rate** and is the WHO-recommended protocol. *Misoprostol and Medroxyprogesterone* - **Medroxyprogesterone** is a **progestin**, which would **support and maintain pregnancy** rather than terminate it, making this combination ineffective for medical abortion. - Medroxyprogesterone is used for contraception and menstrual regulation, not pregnancy termination. *Mifepristone and Medroxyprogesterone* - **Medroxyprogesterone** is a progestin and would **directly antagonize the antiprogestin action of Mifepristone**, preventing pregnancy termination. - This combination is pharmacologically contradictory and would not achieve abortion. *Mifepristone and Methotrexate* - **Mifepristone and Methotrexate are not used together** in medical abortion protocols. - **Methotrexate** (antimetabolite) is occasionally used with **Misoprostol** (not Mifepristone) as an alternative regimen, but it is much slower (7-14 days vs 24-48 hours), less effective, and primarily reserved for ectopic pregnancy management. - The standard combination for intrauterine pregnancy termination is Mifepristone + Misoprostol, not Mifepristone + Methotrexate.

Q: Which of the following methods is known as a fimbriectomy procedure?

Kroener procedure. ***Kroener procedure*** - The **Kroener procedure** is a method of **tubal ligation** particularly known as a **fimbriectomy**, where the fimbriated end of the fallopian tube is removed. - This sterilization technique primarily involves excising the **fimbriae**, preventing **ovum capture** and subsequent fertilization. *Uchida procedure* - The **Uchida procedure** involves **injecting a sclerosing solution** under the serosa of the fallopian tube, then excising a small segment and ligating the ends. - This method aims to **bury the fimbriated end** within the broad ligament, but it is not a fimbriectomy. *Irving procedure* - The **Irving procedure** involves **tying and transecting the fallopian tube**, then burying the severed medial end into the posterior wall of the uterus. - This technique is designed to prevent **fistula formation** and recanalization but does not involve fimbriectomy. *Madlener procedure* - The **Madlener procedure** involves **crushing a section** of the fallopian tube, usually a knuckle, and then ligating it. - This method is simpler but has a **higher failure rate** compared to other sterilization techniques and does not involve removal of the fimbriae.

Q: What are the effects of Progesterone-only pills?

All of the options may occur. ***All of the options may occur*** - Progesterone-only pills (POPs) work through **multiple complementary mechanisms** that collectively provide effective contraception. - All three effects occur simultaneously and contribute to the overall contraceptive efficacy of POPs. - Understanding these mechanisms helps explain why POPs are effective despite lower hormone doses compared to combined oral contraceptives. **Mechanism 1: May suppress ovulation** - POPs can **partially suppress ovulation**, preventing the release of an egg. - Traditional POPs suppress ovulation in approximately 40-60% of cycles, while newer desogestrel-containing POPs achieve higher rates (97-99%). - This effect depends on the dose and type of progestin used in the formulation. **Mechanism 2: Thins the lining of the uterus** - Progesterone causes **endometrial atrophy**, making the uterine lining thin and unsuitable for embryo implantation. - This hostile uterine environment acts as a backup contraceptive mechanism if ovulation and fertilization occur. - Endometrial changes occur consistently with POP use. **Mechanism 3: Thickens cervical mucus** - This is the **primary and most consistent mechanism** of POPs. - Progesterone significantly **increases cervical mucus viscosity** and reduces its quantity within hours of administration. - The thickened mucus creates a physical barrier that prevents sperm penetration, motility, and viability.

Q: What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?

24-48 hours. ***24-48 hours*** - The FDA-approved protocol for medical abortion with mifepristone and misoprostol specifies a **24- to 48-hour interval** between the administration of the two drugs. - This timing ensures optimal efficacy as it allows mifepristone to adequately sensitize the uterus to the effects of misoprostol. *48 hours* - While 48 hours falls within the recommended range, specifically stating "48 hours" as the only option is less precise than the **24-48 hour window**. - No specific clinical advantage or disadvantage is generally reported for waiting exactly 48 hours over, for instance, 24 hours. *96 hours* - A 96-hour interval is significantly longer than the **FDA-recommended window** and is not part of the standard, evidence-based protocol. - Delaying misoprostol administration beyond 48 hours may **reduce the effectiveness** of the medical abortion and increase the risk of complications. *72 hours* - A 72-hour interval exceeds the upper limit of the **FDA-recommended window** for optimal efficacy. - While some studies have explored extended intervals, the *standard clinical practice* and FDA guidelines do not endorse 72 hours as the primary recommended interval.

Q: What should be done if 2 OCPs are missed on days 17-18 of the cycle?

Both a and b. ***Both a and b*** - When **two OCPs are missed** on days 17-18 (Week 3) of the cycle, the recommended approach combines two actions to restore contraceptive protection. - The woman should **take two pills on the next two days** to compensate for the missed doses and restore hormonal levels quickly. - Additionally, **backup contraception should be used for at least 7 days** to ensure contraceptive effectiveness, as the missed pills during Week 3 could compromise protection and increase the risk of ovulation. - Both actions together address the hormonal gap and provide adequate contraceptive coverage. *Take 2 pills on the next 2 days* - While this action helps **reestablish hormone levels** after missing two pills, it is **insufficient on its own**. - Without concurrent backup contraception, there remains a risk of **ovulation** and **unintended pregnancy** during the recovery period. - This must be combined with backup contraceptive methods for 7 days. *Use back up contraceptive* - Using **backup contraception** is essential because missing two pills in Week 3 increases the risk of **ovulation**. - However, backup contraception alone without resuming the pill regimen (with catch-up dosing) would not adequately restore the hormonal cycle. - Both resuming pills appropriately and using backup methods are necessary. *Continue taking single pill per day* - Simply continuing with one pill per day without any catch-up dosing would leave a **hormonal gap** from the two missed pills. - This approach does not compensate for the **missed active hormones**, leaving inadequate hormone levels for contraceptive protection. - Without catch-up dosing and backup contraception, the risk of **ovulation** and **pregnancy** remains significantly elevated.

Q: The best method for inducing mid trimester abortion is :

Prostaglandins. ***Prostaglandins*** - **Prostaglandins** (e.g., dinoprostone, misoprostol) are highly effective in inducing uterine contractions and cervical ripening, making them the preferred method for **mid-trimester abortion**. - They can be administered through various routes (vaginal, oral, buccal) and offer a good balance of efficacy and safety for this gestational age. - Prostaglandins are considered the **current gold standard** for second-trimester medical termination of pregnancy. *Injection of Hypertonic Saline* - Historically used, but **intra-amniotic hypertonic saline** carries significant risks, including hypernatremia, disseminated intravascular coagulation (DIC), and uterine rupture. - It has largely been replaced by safer and more effective methods like prostaglandins due to its adverse event profile. - This method is now considered obsolete in most clinical settings. *Ethacrydine Lactate* - **Ethacrydine lactate** (ethacridine lactate/Rivanol) is an antiseptic agent that was historically used for mid-trimester abortion via intra-amniotic injection. - While it was effective in inducing abortion, it has been largely abandoned due to complications, prolonged induction time, and the availability of safer alternatives. - It is **not the preferred method** compared to prostaglandins, which have better safety profiles and efficacy. *Dilation and Curettage (D&C)* - **Dilation and curettage (D&C)** is primarily used for first-trimester abortions or for managing incomplete abortions and miscarriages. - In the mid-trimester, the uterus is larger and the fetal tissue is more substantial, making D&C less safe and often requiring extensive dilation or potentially leading to complications like uterine perforation or hemorrhage. - **Dilation and evacuation (D&E)** may be used in mid-trimester but requires specialized training and equipment.

Question 1

What is the use of the instrument shown in the image?

Accepted Answer

Laparoscopic sterilization

Answer

Surgical removal of ectopic pregnancy

Answer

Induction of abortion

Answer

Creating pneumoperitoneum for laparoscopic procedures

Question 2

Which of the following is not used for postcoital contraception?

Accepted Answer

Danazol

Answer

CuT

Answer

Ru 486

Answer

High dose estrogen

Question 3

A 24 year old lactating female with an 18 month old child comes with a history of irregular,    heavy bleeding seeking contraceptive advice. Which is the contraceptive of choice?

Accepted Answer

Progestin-only pill

Answer

Copper IUD

Answer

Progestin-only injection

Answer

Combined oral contraceptive pill

Question 4

Which of the following is NOT an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Accepted Answer

Uterine malformation

Answer

Pregnancy

Answer

Active pelvic infection

Answer

Known allergy to IUD components

Question 5

A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy.    What are the drugs used for medical termination of pregnancy in this patient?

Accepted Answer

Misoprostol and Mifepristone

Answer

Misoprostol and Medroxyprogesterone

Answer

Mifepristone and Medroxyprogesterone

Answer

Mifepristone and Methotrexate

Question 6

Which of the following methods is known as a fimbriectomy procedure?

Accepted Answer

Kroener procedure

Answer

Uchida procedure

Answer

Irving procedure

Answer

Madlener procedure

Question 7

What are the effects of Progesterone-only pills?

Accepted Answer

All of the options may occur

Answer

May suppress ovulation

Answer

Thins the lining of the uterus

Answer

Thickens cervical mucus

Question 8

What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?

Accepted Answer

24-48 hours

Answer

96 hours

Answer

48 hours

Answer

72 hours

Question 9

What should be done if 2 OCPs are missed on days 17-18 of the cycle?

Accepted Answer

Both a and b

Answer

Take 2 pills on the next 2 days

Answer

Continue taking single pill per day

Answer

Use back up contraceptive

Question 10

The best method for inducing mid trimester abortion is :

Accepted Answer

Prostaglandins

Answer

Dilation and Curettage (D&C)

Answer

Injection of Hypertonic Saline

Answer

Ethacrydine Lactate

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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