Contraception and Family Planning Practice Questions

Q: Antiprogesterone compound RU-486 is effective for inducing abortion if the duration of pregnancy is what?

63 days. ***63 days*** - **Mifepristone (RU-486)**, an antiprogesterone, is most effective for medical abortion when used within 63 days (9 weeks) of gestation. - Its efficacy decreases and the risk of incomplete abortion or complications increases beyond this timeframe, making surgical options more suitable for later pregnancies. *72 days* - While still relatively early in pregnancy, **mifepristone's efficacy** starts to decline after 63 days, and the recommended window for optimal success of a medical abortion is generally within the first 9 weeks. - Beyond 63 days, the need for **surgical intervention** or repeat doses of misoprostol becomes more likely, and the overall success rate for medical abortion is reduced. *88 days* - By 88 days (approximately 12.5 weeks), medical abortion with mifepristone alone becomes significantly less effective and often requires **surgical evacuation**. - The risk of **incomplete abortion**, heavier bleeding, and other complications substantially increases, highlighting the importance of earlier intervention. *120 days* - At 120 days (approximately 17 weeks), medical abortion with mifepristone would be largely ineffective and unsafe as a primary method for pregnancy termination. - Pregnancies at this stage typically require **surgical procedures** like D&E (dilation and evacuation) due to the size of the fetus and placenta.

Q: Absolute contraindication of IUCD is:

Pelvic tuberculosis. ***Pelvic tuberculosis*** - **Pelvic tuberculosis** is an **absolute contraindication** for intrauterine contraceptive device (IUCD) insertion due to the increased risk of dissemination of the infection and worsening of the disease. - Inserting an IUCD in a patient with active pelvic tuberculosis can lead to severe complications, including **pelvic inflammatory disease (PID)**, abscess formation, and systemic infection. *Endometriosis* - **Endometriosis** is generally not an absolute contraindication for IUCD use, especially for **levonorgestrel-releasing IUCDs**, which are often used to manage symptoms like dysmenorrhea and heavy menstrual bleeding in these patients. - The hormonal effects of some IUCDs can actually be beneficial in reducing the growth of endometrial implants. *Iron deficiency anaemia* - **Iron deficiency anemia** is not an absolute contraindication for IUCDs, particularly the **levonorgestrel-releasing IUCDs**, which reduce menstrual blood loss and can improve iron status. - For copper IUCDs, which can increase menstrual bleeding, a patient with iron deficiency anemia might experience worsening symptoms, but this is a **relative contraindication** that can be managed, not an absolute one. *Dysmenorrhea* - While **dysmenorrhea** can be a concern with some IUCDs, especially copper IUCDs which can sometimes worsen pain, it is not an absolute contraindication. - **Levonorgestrel-releasing IUCDs** are often prescribed to manage and even alleviate dysmenorrhea due to their progesterone-like effects on the endometrium.

Q: Which contraceptive method is considered most effective for couples seeking reliable birth control?

Intrauterine contraceptive device (IUCD). ***Intrauterine contraceptive device (IUCD)*** - **IUCDs** (both hormonal and copper) are considered among the most effective reversible contraceptive methods, with typical use failure rates less than 1%. - Their long-acting nature means no daily effort is required, making them highly reliable for couples seeking **consistent birth control**. *Barrier methods (e.g., condoms)* - While effective when used consistently and correctly, **barrier methods** have a higher typical-use failure rate (around 13-18%) compared to IUCDs due to user error or inconsistent use. - They also provide protection against **STIs**, but are less effective for pregnancy prevention in real-world scenarios. *Combined oral contraceptives (OCPs)* - **OCPs** are highly effective when taken perfectly, but their typical-use failure rate is around 7%, primarily due to missed pills. - They require daily adherence and can have side effects that might impact compliance, making them less reliable than IUCDs for some users. *Progestin-only pill* - The **progestin-only pill** (mini-pill) is effective but requires strict adherence to a daily schedule, ideally at the same time each day, making it very sensitive to missed doses. - Its typical-use failure rate is similar to or slightly higher than combined OCPs due to this strict dosing requirement, making it generally less reliable than IUCDs.

Q: Which of the following reduces the risk of pelvic inflammatory disease (PID)?

Oral contraceptive pills (OCPs). ***Oral contraceptive pills (OCPs)*** - OCPs **thicken cervical mucus**, which creates a barrier that can prevent the ascent of bacteria from the vagina into the upper reproductive tract. - This cervical mucus barrier reduces the risk of cervical infection spreading to the uterus and fallopian tubes, thereby **lowering the incidence of PID**. *Copper T IUCD* - The Copper T IUCD is associated with a **slightly increased risk of PID** in the first few weeks after insertion, especially in women with pre-existing sexually transmitted infections (STIs). - It does not offer protection against ascending infections and can potentially facilitate their spread if the cervical barrier is compromised. *TODAY vaginal sponge* - The TODAY vaginal sponge contains **spermicide and acts as a barrier contraceptive**, but it does not protect against STIs, which are the primary cause of PID. - Some studies suggest that spermicides can **irritate vaginal mucosa**, potentially increasing susceptibility to certain infections. *Spermicidal agents* - Spermicidal agents primarily work by **immobilizing and killing sperm** to prevent pregnancy. - They **do not protect against STIs** and, in some cases, frequent use can cause vaginal and cervical irritation, potentially making the user more vulnerable to infections that can lead to PID.

Q: What is the most common site of ligation by laparoscopic ring in female sterilization?

Isthmus. ***Isthmus*** - The **isthmic portion** of the fallopian tube is the most common and preferred site for laparoscopic ring application (e.g., Falope ring or Yoon ring) in female sterilization. - This segment is chosen because it is relatively **straight**, has a **narrow lumen**, and possesses a **thick muscular wall**, making it ideal for occlusion and effective contraception. *Fimbrial* - The **fimbrial end** is the most distal part of the fallopian tube, characterized by finger-like projections that capture the ovum. - Ligation at this site is less common due to its **delicate structure** and proximity to the ovary, increasing the risk of **ovarian damage** or incomplete occlusion. *Cornual* - The **cornual portion** is the segment of the fallopian tube that passes through the muscular wall of the uterus. - This site is generally avoided for ring application due to the **risk of uterine perforation** and increased **bleeding** from the uterine arteries within the myometrium. *Ampullary* - The **ampullary portion** is the widest and longest part of the fallopian tube, where fertilization typically occurs. - Its **dilated lumen** and **tortuous nature** make it less suitable for secure and effective ring placement, as the ring may not fully occlude the tube.

Q: What is the absolute contraindication of oral contraceptive pills (OCPs)?

Carcinoma of the breast. ***Carcinoma of the breast*** - OCPs contain **estrogen and progesterone**, which can stimulate the growth of **hormone-sensitive breast cancers**. - Therefore, a history of or current **breast cancer** is an absolute contraindication to OCP use. *Dysmenorrhoea* - **Dysmenorrhoea** (painful menstruation) is often effectively treated or alleviated by OCPs due to their ability to suppress ovulation and reduce prostaglandin production. - It is not a contraindication; rather, it is a common indication for OCP use. *Hypertension* - **Uncontrolled severe hypertension** (≥160/100 mmHg) is an absolute contraindication to OCP use. - However, the term "hypertension" alone typically refers to mild or well-controlled hypertension, which is a relative contraindication with careful monitoring. - OCPs can sometimes **increase blood pressure**, requiring careful risk-benefit assessment for individuals with existing hypertension. *Endometriosis* - **Endometriosis** is often managed and its symptoms improved by OCPs, as they help suppress endometrial growth and reduce menstrual flow. - OCPs are a common and effective treatment for endometriosis, not a contraindication.

Q: What is the IUCD of choice in women with menorrhagia?

Progesterone containing IUCD. ***Progesterone containing IUCD*** - **Progesterone-releasing IUCDs** (e.g., **Mirena**) are known to significantly reduce menstrual blood loss by causing **endometrial atrophy**. - This type of IUCD can effectively treat **menorrhagia** (heavy menstrual bleeding) and can even be used in some cases of **adenomyosis**. *Copper-T 200* - **Copper-containing IUCDs** generally **increase menstrual blood loss** and cramping, making them unsuitable for women with menorrhagia. - The **copper** evokes a local inflammatory reaction in the uterus, which can exacerbate heavy bleeding. *Copper-T 380A* - Similar to other **copper IUCDs**, the **Copper-T 380A** works by causing a local inflammatory reaction and releasing copper ions, which can lead to **increased menstrual bleeding**. - It would therefore worsen rather than improve menorrhagia. *Lippe's loop* - **Lippe's loop** is an older, non-medicated plastic IUCD that is no longer widely used and is associated with **increased menstrual bleeding** and cramping. - Its mechanism of action does not involve hormone release, and it does not offer any benefit for reducing menorrhagia.

Q: After the rise of temperature, the unsafe period lasts for what duration in the basal body temperature method?

72 hours. ***72 hours*** - In the **basal body temperature (BBT) method**, the temperature rise indicates that **ovulation has already occurred** due to progesterone secretion from the corpus luteum. - The unsafe period continues for **3 consecutive days (72 hours)** after the temperature rise to ensure the rise is **sustained and not a transient spike**, confirming entry into the infertile luteal phase. - After 3 days of sustained elevated temperature, the ovum is no longer viable, and the woman enters the safe (infertile) period until the next menstrual cycle. *24 hours* - While the **ovum viability** is approximately 12-24 hours after ovulation, the BBT method requires observation of a **sustained temperature rise** for reliability. - Limiting the observation to 24 hours after a single temperature elevation could lead to false identification of the safe period if the rise was transient or measurement error occurred. *48 hours* - This duration provides a longer observation period than 24 hours but is still insufficient for the BBT method's standard protocol. - The **3-day rule (72 hours)** is the established guideline to confirm a sustained temperature elevation and reliable entry into the post-ovulatory infertile phase. *120 hours* - This period (5 days) is excessively long after the confirmed **basal body temperature (BBT) rise**. - Once the temperature has remained elevated for 3 consecutive days (72 hours), the fertile period has definitively ended, making a 120-hour unsafe period unnecessarily restrictive and impractical.

Q: Which of the following is an absolute contraindication for intrauterine contraceptive devices (IUCDs)?

Puerperal sepsis. ***Puerperal sepsis*** - **Puerperal sepsis** is an **absolute contraindication** for IUCD insertion as it indicates an active, severe infection of the reproductive tract. - Inserting an IUCD in this context significantly increases the risk of spreading the infection, leading to more severe systemic complications like **septicemia**. *Current sexually transmitted disease (STD)* - While a **current STD** is a contraindication for IUCD insertion, it is generally considered a **relative contraindication**. - The IUCD can be inserted once the STD has been **diagnosed and appropriately treated**, reducing the risk of pelvic inflammatory disease (PID). *Uterine anomaly* - A **uterine anomaly** (e.g., severe bicornuate uterus) can make IUCD insertion difficult or ineffective, as it may prevent proper placement or increase the risk of expulsion. - This is typically a **relative contraindication**; suitability depends on the specific anomaly and can be assessed by a healthcare provider. *No absolute contraindications exist* - This statement is incorrect because several conditions, such as **pregnancy**, **active pelvic inflammatory disease (PID)**, and **puerperal sepsis**, are recognized as **absolute contraindications** for IUCD insertion. - These conditions pose significant health risks if an IUCD is inserted.

Q: With the use of DMPA contraceptive, the side effects are all of the following except:

Change in quantity and quality of breast milk. ***Change in quantity and quality of breast milk*** - **DMPA (depot medroxyprogesterone acetate)** has **no significant impact** on the quality or quantity of breast milk. It is considered safe for use in breastfeeding mothers. - Progestin-only contraceptives like DMPA do not interfere with lactation and can be used without affecting infant feeding or growth. - **WHO MEC Category 2** for breastfeeding women after 6 weeks postpartum, indicating benefits generally outweigh risks. *Weight gain* - **Weight gain** is a common side effect reported by many users of DMPA due to its hormonal effects, particularly increased appetite and fluid retention. - Studies have shown an average **weight increase of 2-5 kg** over the first year of use, with continued weight gain in long-term users. *Irregular bleeding* - **Irregular bleeding**, including spotting, prolonged bleeding, or amenorrhea, is a very common side effect, especially during the initial months of DMPA use. - This is due to the hormonal influence on the **endometrial lining**, causing unpredictable shedding. - Approximately **40-50% of users develop amenorrhea** by one year of use. *Decreased bone mineral density* - **Decreased bone mineral density (BMD)** is a well-documented side effect of DMPA, prompting an FDA black box warning. - The decrease is generally **reversible after discontinuation**, with BMD recovery occurring over 2-3 years. - This effect is due to the **hypoestrogenic state** induced by DMPA, affecting calcium metabolism and bone remodeling.

Question 1

Antiprogesterone compound RU-486 is effective for inducing abortion if the duration of pregnancy is what?

Accepted Answer

63 days

Answer

72 days

Answer

88 days

Answer

120 days

Question 2

Absolute contraindication of IUCD is:

Accepted Answer

Pelvic tuberculosis

Answer

Endometriosis

Answer

Iron deficiency anaemia

Answer

Dysmenorrhea

Question 3

Which contraceptive method is considered most effective for couples seeking reliable birth control?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Combined oral contraceptives (OCPs)

Answer

Barrier methods (e.g., condoms)

Answer

Progestin-only pill

Question 4

Which of the following reduces the risk of pelvic inflammatory disease (PID)?

Accepted Answer

Oral contraceptive pills (OCPs)

Answer

Copper T IUCD

Answer

TODAY vaginal sponge

Answer

Spermicidal agents

Question 5

What is the most common site of ligation by laparoscopic ring in female sterilization?

Accepted Answer

Isthmus

Answer

Fimbrial

Answer

Cornual

Answer

Ampullary

Question 6

What is the absolute contraindication of oral contraceptive pills (OCPs)?

Accepted Answer

Carcinoma of the breast

Answer

Dysmenorrhoea

Answer

Endometriosis

Answer

Hypertension

Question 7

What is the IUCD of choice in women with menorrhagia?

Accepted Answer

Progesterone containing IUCD

Answer

Copper-T 200

Answer

Copper-T 380A

Answer

Lippe's loop

Question 8

After the rise of temperature, the unsafe period lasts for what duration in the basal body temperature method?

Accepted Answer

72 hours

Answer

24 hours

Answer

48 hours

Answer

120 hours

Question 9

Which of the following is an absolute contraindication for intrauterine contraceptive devices (IUCDs)?

Accepted Answer

Puerperal sepsis

Answer

Current sexually transmitted disease (STD)

Answer

Uterine anomaly

Answer

No absolute contraindications exist

Question 10

With the use of DMPA contraceptive, the side effects are all of the following except:

Accepted Answer

Change in quantity and quality of breast milk

Answer

Weight gain

Answer

Irregular bleeding

Answer

Decreased bone mineral density

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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