Contraception and Family Planning Practice Questions

Q: Maximum success rate in reversal of sterilization is achieved in cases which follow which technique?

Laparoscopic ring application. **Explanation:** The success of tubal sterilization reversal (tubal re-anastomosis) is primarily determined by the **length of the healthy fallopian tube remaining** and the **extent of tissue destruction** caused during the initial procedure. **Why Laparoscopic Ring Application is Correct:** Laparoscopic sterilization using a **Falope ring (Silastic band)** is a mechanical method that causes minimal tissue damage. It typically destroys only a very small segment (about 1–2 cm) of the fallopian tube. Because a significant length of the tube remains healthy and the blood supply is well-preserved, surgical re-anastomosis has the highest success rate (up to 70–80%) compared to other methods. **Analysis of Incorrect Options:** * **Pomeroy’s Technique:** This is the most common method used during postpartum sterilization. It involves ligating a loop of the tube and excising it. While effective, it destroys a larger segment of the tube (3–4 cm) than a ring, leading to lower reversal success rates. * **Parkland’s Technique:** Similar to Pomeroy’s, this involves mid-segment resection. It ensures the ends are separated to prevent recanalization, but the resulting gap makes surgical reversal more difficult. * **Uchida’s Technique:** This is a complex method involving subserosal stripping and resection. It is highly effective at preventing pregnancy but is the most destructive to the tubal anatomy, making it the most difficult to reverse. **High-Yield Facts for NEET-PG:** * **Best Site for Reversal:** Isthmus-to-isthmus anastomosis yields the highest success. * **Worst Prognosis for Reversal:** Electro-cautery (especially unipolar) causes extensive thermal damage and has the lowest reversal success. * **Pearl:** For a successful reversal, the total remaining length of the fallopian tube should ideally be **>4 cm**. * **Failure Rate:** The failure rate of the Falope ring is approximately 1.7 per 1000 procedures.

Q: All of the following are mechanisms of action of oral contraceptive pills, except:

Interference with placental functioning. **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is to prevent pregnancy by acting on the hypothalamic-pituitary-ovarian axis. **Why Option D is the correct answer:** Oral contraceptive pills are used to **prevent** conception. Placental functioning only begins after successful implantation and the development of the trophoblast. Since COCPs act primarily to prevent fertilization and implantation, they do not have a physiological role in interfering with an established placenta. Therefore, interference with placental functioning is not a mechanism of OCPs. **Analysis of other options:** * **Inhibition of Ovulation (Option A):** This is the **most important** mechanism. The estrogen component suppresses FSH (preventing follicular development), while the progestogen component suppresses the LH surge, thereby preventing ovulation. * **Prevention of Fertilization (Option B):** Progestogens make the cervical mucus thick, viscid, and scanty. This creates a "hostile" environment that inhibits sperm penetration and transport, preventing the sperm from reaching the ovum. * **Interference with Implantation (Option C):** OCPs cause the endometrium to become thin and atrophic (decidualization), making it unreceptive for a blastocyst to implant. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Action:** Suppression of LH surge (Progestogen effect). * **Pearl:** Progestogen-only pills (POPs) primarily act by thickening cervical mucus; they do not consistently inhibit ovulation like COCPs. * **Non-contraceptive benefits:** Reduced risk of ovarian and endometrial cancers, and improvement in dysmenorrhea and menorrhagia. * **Contraindication:** OCPs are strictly contraindicated in smokers >35 years and women with a history of Thromboembolism.

Q: Which of the following is NOT a mechanism of action of intrauterine contraceptive devices (IUCDs)?

Inhibition of ovulation. ### Explanation The primary mechanism of action for all Intrauterine Contraceptive Devices (IUCDs) is to create a **spermicidal intrauterine environment**. They do not interfere with the Hypothalamic-Pituitary-Ovarian (HPO) axis; therefore, **inhibition of ovulation is NOT a mechanism of IUCDs.** #### Why the other options are mechanisms of IUCDs: * **Aseptic Inflammation (Option B):** The presence of a foreign body (the IUCD) triggers a sterile inflammatory response in the endometrium. This leads to an increase in macrophages, lymphocytes, and plasma cells, which are toxic to spermatozoa and prevent implantation. * **Increased Uterine Motility (Option A):** The mechanical presence of the device increases uterine and tubal peristalsis, which alters the transport time of the ovum and sperm, preventing fertilization. * **Altered Cervical Mucus (Option C):** This is specifically characteristic of **Hormonal IUCDs (e.g., LNG-IUD/Mirena)**. The progestogen thickens the cervical mucus, making it "hostile" and impenetrable to sperm. #### High-Yield Clinical Pearls for NEET-PG: * **Copper T (Cu-T):** Primarily acts as a spermicide by releasing copper ions that inhibit sperm motility and viability. * **LNG-IUD (Mirena):** Its most important mechanism is thickening cervical mucus and causing endometrial atrophy. * **Ideal Candidate:** Multiparous women in a stable monogamous relationship. * **Most Common Side Effect:** Bleeding (menorrhagia) is the most common reason for removal of Cu-T, whereas pain is the second most common. * **Post-Coital Contraception:** Cu-T 380A is the most effective emergency contraceptive if inserted within 5 days (120 hours) of unprotected intercourse.

Q: Which IUCD has the longest lifespan?

Cu T 380A. **Explanation:** The lifespan of an Intrauterine Contraceptive Device (IUCD) is primarily determined by the amount of active medication or surface area of copper it contains. **Why Cu T 380A is the correct answer:** The **Cu T 380A** is a second-generation copper-bearing IUCD. The "380" signifies that it has a surface area of 380 mm² of copper wire. Due to this high copper content, it has the longest approved clinical lifespan among all commonly used IUCDs. According to WHO and the Government of India guidelines, it is effective for **10 years**. **Analysis of Incorrect Options:** * **Progestasert:** This was the first-generation hormone-releasing IUCD. It contained Progesterone and had a very short lifespan of only **1 year**, requiring annual replacement. * **Mirena (LNG-20):** This is a Levonorgestrel-releasing system. While highly effective, its approved lifespan is currently **5 to 8 years** (depending on the guideline), which is shorter than the Cu T 380A. * **Nova T:** This is a copper device with a silver core to prevent fragmentation. It contains 200 mm² of copper and has a lifespan of **5 years**. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Copper IUCDs act primarily as a **spermicide** by causing a local sterile inflammatory response in the endometrium. * **Ideal Candidate:** The Cu T 380A is the "Gold Standard" for long-term reversible contraception in parous women. * **Emergency Contraception:** Cu T 380A is the **most effective** method of emergency contraception if inserted within 5 days of unprotected intercourse. * **Cu T 375 (Multiload):** Has a lifespan of **5 years**.

Q: Which of the following is NOT used for first-trimester abortion?

Extra-amniotic ethacrydine lactate. **Explanation:** The first trimester of pregnancy is defined as the period up to 12 weeks of gestation. Methods for abortion during this period are categorized into medical and surgical techniques. **Why Option B is Correct:** **Extra-amniotic ethacrydine lactate (Emcredil)** is a method used exclusively for **second-trimester** abortions (13–20 weeks). It acts as a mechanical and chemical irritant, stimulating endogenous prostaglandin release to induce uterine contractions. It is not used in the first trimester because the extra-amniotic space is not sufficiently developed to facilitate the procedure effectively, and simpler, safer alternatives exist for early gestations. **Analysis of Incorrect Options:** * **Mifepristone (Option A):** An anti-progestogen used in medical management. Combined with Misoprostol, it is the gold standard for medical abortion up to 9–10 weeks (70 days) of gestation. * **Suction Evacuation (Option D):** This is the surgical method of choice for the first trimester (up to 12 weeks). It involves aspirating the products of conception using a Karman cannula or electric suction. * **Dilatation and Evacuation (Option C):** While more commonly associated with the early second trimester (13–15 weeks), it is frequently used in the late first trimester (10–12 weeks) when the products of conception are too large for simple suction alone. **High-Yield Clinical Pearls for NEET-PG:** 1. **MVA (Manual Vacuum Aspiration):** Can be used up to 12 weeks; it is highly effective and does not require electricity. 2. **Medical Method Regimen:** 200 mg Mifepristone (oral) followed by 800 mcg Misoprostol (vaginal/sublingual) after 24–48 hours. 3. **Ethacrydine Lactate Caution:** It is contraindicated in patients with a history of previous uterine scars (e.g., C-section) due to the risk of uterine rupture. 4. **Most common complication** of first-trimester suction evacuation is **incomplete abortion**.

Q: When is the Copper T IUD ideally inserted?

During menstruation. **Explanation:** The ideal time for the insertion of a Copper T Intrauterine Device (IUD) is **during menstruation** (specifically within the first 7 days of the cycle). This timing is preferred for three primary clinical reasons: 1. **Exclusion of Pregnancy:** It provides the highest certainty that the woman is not pregnant, preventing accidental insertion during an early gestation. 2. **Ease of Insertion:** The cervical os is naturally slightly dilated during menses, making the procedure technically easier and less painful. 3. **Reduced Side Effects:** Post-insertion bleeding or spotting is masked by the menstrual flow, leading to better patient compliance. **Analysis of Incorrect Options:** * **A. Just before menstruation:** This is the least ideal time. The risk of inserting the IUD into an early (luteal phase) pregnancy is high. Furthermore, the cervix is firm and closed, increasing the risk of pain and uterine perforation. * **C. Just after menstruation:** While acceptable if pregnancy is strictly ruled out, the cervical os begins to close, making insertion slightly more difficult than during active menses. * **D. On the 14th day of the cycle:** This coincides with ovulation. Insertion at this stage carries a risk of "luteal phase pregnancy" where fertilization may have already occurred. **High-Yield Clinical Pearls for NEET-PG:** * **Post-Partum Insertion:** Can be done within 48 hours (PPIUCD) or after 6 weeks (involution complete). * **Post-Abortal:** Can be inserted immediately after a first-trimester abortion. * **Emergency Contraception:** Copper T is the most effective emergency contraceptive if inserted within **5 days** of unprotected intercourse. * **Mechanism:** Primarily **spermicidal**; it causes a sterile inflammatory response in the endometrium and alters cervical mucus.

Q: All of the following agents are used for emergency contraception, EXCEPT?

Misoprostol. **Explanation:** The correct answer is **Misoprostol**. Emergency contraception (EC) is intended to prevent pregnancy after unprotected intercourse by inhibiting or delaying ovulation or preventing fertilization. **Why Misoprostol is the correct answer:** Misoprostol is a **Prostaglandin E1 (PGE1) analogue**. Its primary roles in obstetrics include medical abortion (in combination with Mifepristone), induction of labor, and management of postpartum hemorrhage (PPH) due to its potent uterine-contracting properties. It does **not** prevent conception or inhibit ovulation, making it ineffective as an emergency contraceptive. **Analysis of other options:** * **Combined Oral Contraceptive Pills (COCs):** Used in the **Yuzpe Regimen** (two doses of 100 mcg Ethinylestradiol + 0.5 mg Levonorgestrel, 12 hours apart). While effective, it is less preferred now due to high rates of nausea and vomiting. * **Levonorgestrel (LNG):** The current "Gold Standard" for hormonal EC (e.g., i-Pill, 72-H). It is taken as a single dose of **1.5 mg** within 72 hours. It works primarily by delaying the LH surge and inhibiting ovulation. * **Mifepristone:** An anti-progestin that can be used for EC in low doses (**10–25 mg**). It is highly effective with fewer side effects than the Yuzpe regimen. **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective EC:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days (120 hours) of unprotected intercourse. * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) used as a single 30 mg dose; it is effective up to 120 hours and is superior to LNG in efficacy. * **Time Frame:** Most hormonal ECs are licensed for use within 72 hours, but Ulipristal and Copper-T are effective up to 120 hours.

Q: The best contraceptive method in a patient with heart disease is:

Double barrier. **Explanation:** In patients with heart disease, the primary goal of contraception is to avoid methods that increase hemodynamic stress, risk of thromboembolism, or infective endocarditis. **Why Double Barrier is the Correct Answer:** The **Double Barrier method** (e.g., condom plus diaphragm/spermicide) is considered the safest because it is **non-hormonal and non-invasive**. It carries zero risk of thromboembolism, does not alter blood pressure, and poses no risk of pelvic infection or vasovagal syncope. While it has a higher failure rate than hormonal methods, in the context of cardiac safety, it is the preferred choice to avoid systemic complications. **Why Other Options are Incorrect:** * **IUCD (Intrauterine Contraceptive Device):** It is generally avoided in cardiac patients due to the risk of **vasovagal shock** during insertion. Furthermore, there is a theoretical risk of pelvic infections leading to **Infective Endocarditis**, particularly in patients with valvular heart disease. * **Tubectomy:** This is a surgical procedure requiring anesthesia and often involves creating a pneumoperitoneum (in laparoscopy), which can severely compromise cardiac output and venous return. It is considered too high-risk for many cardiac patients. * **Oral Pills (Combined Oral Contraceptives):** These are strictly **contraindicated** in most heart diseases because the estrogen component increases the risk of **thromboembolism**, hypertension, and fluid retention, which can precipitate heart failure. **High-Yield Clinical Pearls for NEET-PG:** * **Progesterone-only pills (POPs)** or implants are safer than COCs if a hormonal method is needed, as they lack estrogen. * If a cardiac patient requires sterilization, **Vasectomy** (of the partner) is the safest permanent method. * For IUCD insertion in cardiac patients (if absolutely necessary), **prophylactic antibiotics** are recommended to prevent endocarditis.

Q: All of the following are advantages of depot progestogen contraception EXCEPT:

It provides good cycle control.. **Explanation:** The correct answer is **C (It provides good cycle control)** because depot progestogen (DMPA) is notorious for causing **menstrual irregularities**. Since it contains only progestogen and no estrogen, the endometrium becomes thin and unstable. This leads to breakthrough bleeding, spotting, or most commonly, **amenorrhea** (seen in 50-70% of users after one year). Therefore, it does not provide "good cycle control." **Analysis of other options:** * **Option A:** Progestogen-only contraceptives do not interfere with the quantity or quality of breast milk. In fact, they may slightly increase milk production, making them the preferred choice for **lactating mothers** (can be started 6 weeks postpartum). * **Option B:** The standard dose of **DMPA (Depot Medroxyprogesterone Acetate)** is **150 mg intramuscularly every 3 months (12 weeks)**. It works primarily by suppressing ovulation via the HPO axis. * **Option C:** By effectively suppressing ovulation, DMPA significantly reduces the absolute risk of both intrauterine and **ectopic pregnancies**. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Primarily inhibits ovulation (suppresses LH surge) and increases cervical mucus viscosity. * **Return of Fertility:** There is a **delayed return to fertility** (average 7–10 months after the last injection). * **Side Effects:** Weight gain (most common reason for discontinuation) and a reversible decrease in **Bone Mineral Density (BMD)**. * **Antara Program:** Under India’s public health program, DMPA is marketed as the **"Antara"** injection.

Question 1

Maximum success rate in reversal of sterilization is achieved in cases which follow which technique?

Accepted Answer

Laparoscopic ring application

Answer

Pomeroy's technique

Answer

Parkland's technique

Answer

Uchida's technique

Question 2

All of the following are mechanisms of action of oral contraceptive pills, except:

Accepted Answer

Interference with placental functioning

Answer

Inhibition of ovulation

Answer

Prevention of fertilization

Answer

Interference with implantation of fertilized ovum

Question 3

Which of the following is NOT a mechanism of action of intrauterine contraceptive devices (IUCDs)?

Accepted Answer

Inhibition of ovulation

Answer

Increased uterine motility

Answer

Aseptic inflammation

Answer

Altered cervical mucus

Question 4

Which IUCD has the longest lifespan?

Accepted Answer

Cu T 380A

Answer

Progestasert

Answer

Mirena

Answer

Nova T

Question 5

Which of the following is NOT used for first-trimester abortion?

Accepted Answer

Extra-amniotic ethacrydine lactate

Answer

Mifepristone

Answer

Dilatation and evacuation

Answer

Suction evacuation

Question 6

When is the Copper T IUD ideally inserted?

Accepted Answer

During menstruation

Answer

Just before menstruation

Answer

Just after menstruation

Answer

On the 14th day of the cycle

Question 7

Absolute contraindications of oral contraceptive pills (OCPs) include all of the following EXCEPT:

Accepted Answer

Thyroid disorder

Answer

Ischemic heart disease

Answer

Hepatoma

Answer

Breast cancer

Question 8

All of the following agents are used for emergency contraception, EXCEPT?

Accepted Answer

Misoprostol

Answer

Combined Pill

Answer

Levonorgestrel

Answer

Mifepristone

Question 9

The best contraceptive method in a patient with heart disease is:

Accepted Answer

Double barrier

Answer

IUCD

Answer

Tubectomy

Answer

Oral pills

Question 10

All of the following are advantages of depot progestogen contraception EXCEPT:

Accepted Answer

It provides good cycle control.

Answer

It can be given to lactating mothers.

Answer

A 150mg dose is effective for a period of 12 weeks.

Answer

It prevents ectopic pregnancy.

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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