Contraception and Family Planning Practice Questions

Q: Which of the following is NOT a method for inducing mid-trimester abortions?

Menstrual regulation. **Explanation:** The key to answering this question lies in understanding the definition of "mid-trimester." The mid-trimester (second trimester) refers to the period between **13 and 28 weeks** of gestation. **Why Menstrual Regulation (MR) is the correct answer:** Menstrual Regulation is a method used for **very early first-trimester** abortions. It involves the aspiration of the uterine contents using a Karman cannula or a syringe, typically performed within **6 weeks of the Last Menstrual Period (LMP)** (up to 14 days of a missed period). Since it is restricted to the early first trimester, it cannot be used for mid-trimester abortions. **Analysis of incorrect options:** * **Intra-amniotic Saline:** This is a classical method for mid-trimester induction (16–20 weeks). Hypertonic saline (20%) acts by causing fetal demise and releasing endogenous prostaglandins, leading to uterine contractions. * **Intra-amniotic Prostaglandins:** Prostaglandins (like PGF2α) are potent uterine stimulants. Intra-amniotic or extra-amniotic administration is a standard pharmacological approach for second-trimester termination. * **Hysterotomy:** This is a surgical method (similar to a mini-cesarean section) used for mid-trimester abortion when medical induction fails or is contraindicated. **High-Yield Clinical Pearls for NEET-PG:** * **MVA (Manual Vacuum Aspiration):** Used up to 12 weeks (first trimester). * **Medical Method of Abortion (MMA):** Mifepristone + Misoprostol is the gold standard for early medical abortion (up to 9 weeks/63 days as per Indian RMP guidelines). * **Most common method for 2nd-trimester abortion:** Dilatation and Evacuation (D&E) or Medical Induction with Misoprostol. * **Complication of Saline:** Hypernatremia and Coagulopathy (DIC).

Q: A pregnant woman at 8 weeks gestation with an intrauterine contraceptive device (Cu T) in place and three living children requires management. What is the most suitable treatment?

Remove the Cu T and perform permanent sterilization.. ### Explanation The management of a pregnancy with an intrauterine contraceptive device (IUCD) in situ depends on the patient’s desire to continue the pregnancy and the visibility of the IUCD strings. **Why Option B is Correct:** In this scenario, the patient already has **three living children**, which is a significant factor in clinical decision-making regarding family planning. Since the pregnancy is at an early stage (8 weeks), the standard protocol is to **remove the Cu T** immediately to reduce the risk of septic abortion, chorioamnionitis, and preterm labor. Given her parity (three children), she has likely completed her family size. Therefore, **permanent sterilization** (Tubectomy) is the most suitable long-term contraceptive advice to prevent further unintended pregnancies. **Analysis of Incorrect Options:** * **Option A:** Continuing the pregnancy with the Cu T in situ increases the risk of spontaneous abortion (up to 50%) and severe maternal sepsis. If strings are visible, the device should always be removed in the first trimester. * **Option C:** While removing the Cu T is a necessary immediate step, it is an incomplete management plan for a patient with three children who has already experienced a contraceptive failure. It fails to address her future reproductive needs. **NEET-PG High-Yield Pearls:** * **Risk of Ectopic Pregnancy:** While IUCDs do not *cause* ectopic pregnancy, if a woman becomes pregnant with an IUCD in situ, the **relative risk** of that pregnancy being ectopic is higher (approx. 3–4%). * **Strings Visible vs. Not Visible:** If strings are visible in the first trimester, remove the IUCD. If strings are not visible, perform an ultrasound; if the IUCD is intrauterine, it is generally left alone to avoid disrupting the pregnancy. * **Teratogenicity:** There is no evidence that Cu T causes congenital malformations in the fetus.

Q: Which of the following is a benefit of third-generation oral contraceptive pills?

Decreased risk of myocardial infarction. **Explanation:** Oral contraceptive pills (OCPs) have evolved through generations primarily by modifying the type of progestogen used. Third-generation OCPs contain progestogens like **Desogestrel, Gestodene, or Norgestimate**. **Why Option B is Correct:** Third-generation progestogens are more "selective" and possess **lower androgenic activity** compared to second-generation pills (like Levonorgestrel). This results in a more favorable lipid profile, specifically higher HDL (good cholesterol) and lower LDL levels. Consequently, they are associated with a **decreased risk of myocardial infarction (MI)** and stroke compared to older formulations. **Analysis of Incorrect Options:** * **A. Decreased risk of thromboembolism:** This is incorrect. Third-generation OCPs are associated with a **higher risk of Venous Thromboembolism (VTE)**—roughly double the risk of second-generation pills—due to their effect on hepatic synthesis of coagulation factors. * **C & D. Increased risk of breakthrough bleeding/More side effects:** These are incorrect. Because third-generation pills are more potent and less androgenic, they generally offer **better cycle control** (less breakthrough bleeding) and fewer androgenic side effects like acne, hirsutism, and weight gain. **High-Yield Clinical Pearls for NEET-PG:** * **1st Gen:** Norethynodrel (High dose, rarely used now). * **2nd Gen:** Levonorgestrel (Most common, lowest VTE risk, but more androgenic). * **3rd Gen:** Desogestrel, Gestodene (Lowest MI risk, but higher VTE risk). * **4th Gen:** Drospirenone (Anti-mineralocorticoid and anti-androgenic; excellent for PCOS and PMDD). * **Absolute Contraindication:** Smokers >35 years old (due to high MI/stroke risk).

Q: Which method of Medical Termination of Pregnancy is not used in the first trimester of pregnancy?

Intrauterine instillation of hypertonic saline. **Explanation:** The correct answer is **A. Intrauterine instillation of hypertonic saline.** Medical Termination of Pregnancy (MTP) methods are categorized based on the gestational age. The first trimester is defined as up to 12 weeks (though medical methods are often used up to 9–10 weeks). **Why Option A is correct:** Intrauterine instillation of hypertonic saline (or urea/prostaglandins) is a **second-trimester** method (usually 15–20 weeks). It involves injecting a 20% saline solution into the amniotic sac to induce fetal demise and uterine contractions. It is **never** used in the first trimester because the amniotic sac is too small to safely access via transabdominal amniocentesis, and the risk of systemic toxicity (hypernatremia) is high. **Why the other options are incorrect:** * **B. Suction and Evacuation:** This is the **gold standard surgical method** for first-trimester MTP (up to 12 weeks). It is quick, safe, and effective. * **C & D. Mifepristone and Misoprostol:** These are the primary drugs used in **Medical MTP**. According to current protocols, a combination of 200 mg Mifepristone (anti-progestogen) followed by 800 mcg Misoprostol (prostaglandin E1 analogue) is highly effective for terminating pregnancies up to 9–10 weeks. **High-Yield NEET-PG Pearls:** * **MTP Act (India) Update:** MTP can now be performed up to **24 weeks** for specific categories of women (e.g., survivors of sexual assault, minors, fetal anomalies). * **Best Surgical Method (<12 weeks):** Suction Evacuation. * **Best Surgical Method (12–15 weeks):** Dilatation and Evacuation (D&E). * **Most common complication of MTP:** Incomplete abortion. * **Hypertonic Saline Risk:** Can cause "Water Intoxication" or Consumption Coagulopathy (DIC).

Q: What is the recognized method for identifying a missed Intrauterine Device (IUD)?

Ultrasound (USG). **Explanation:** The management of a "missed IUD" (when strings are not visible on per-vaginal examination) follows a specific diagnostic hierarchy. **1. Why Ultrasound (USG) is the Correct Answer:** USG is the **first-line investigation** of choice for a missed IUD. It is highly sensitive, non-invasive, and does not involve ionizing radiation. The primary clinical goal is to determine if the IUD is **intrauterine** (malpositioned or rotated) or **extrauterine** (perforated into the peritoneal cavity). If the USG shows an empty uterine cavity, the IUD is considered "lost," and further imaging is required. **2. Analysis of Incorrect Options:** * **X-ray (Abdomen/Pelvis):** This is the **second-line** investigation. It is performed only if the USG fails to locate the IUD within the uterus. An X-ray helps identify an extrauterine IUD (perforation) but cannot definitively confirm if an IUD is inside the uterine cavity versus behind it. * **Barium Meal:** This is used to visualize the upper gastrointestinal tract (esophagus, stomach, duodenum). It has no role in pelvic imaging or IUD localization. * **CT Scan:** While highly accurate, it is not the "recognized" initial method due to high cost and significant radiation exposure. It is reserved for complex cases of organ perforation. **Clinical Pearls for NEET-PG:** * **Step 1:** Check for strings. If absent, perform **USG**. * **Step 2:** If USG is empty, perform **X-ray Erect Abdomen & Pelvis** (to rule out expulsion vs. perforation). * **X-ray Marker:** If an IUD is seen on X-ray, a lateral view or a uterine sound insertion during X-ray can help localize its relation to the uterus. * **Pregnancy:** Always rule out pregnancy in cases of a missed IUD, as the device may have been expelled or the pregnancy may have displaced the strings.

Q: Suction evacuation as MTP is best done up to how many weeks of gestation?

12 weeks. **Explanation:** **Suction Evacuation (Vacuum Aspiration)** is the gold standard surgical method for Medical Termination of Pregnancy (MTP) in the **first trimester**. * **Why 12 weeks is correct:** Up to 12 weeks of gestation, the products of conception are small enough to be safely aspirated through a Karman’s cannula or a rigid suction tip. Beyond 12 weeks, the fetal bones begin to ossify and the placenta becomes more vascular, significantly increasing the risk of incomplete evacuation, uterine perforation, and heavy hemorrhage if suction alone is used. * **Why other options are incorrect:** * **9 weeks:** While suction evacuation is safe at 9 weeks, it is not the *upper limit*. Medical methods (Mifepristone + Misoprostol) are often preferred up to 7–9 weeks, but suction remains effective until 12 weeks. * **18 and 24 weeks:** These fall into the second trimester. For these gestations, **Dilatation and Evacuation (D&E)** or medical induction (using Prostaglandins) are the methods of choice, as suction alone is insufficient to remove the larger fetal parts. **High-Yield Clinical Pearls for NEET-PG:** 1. **MVA vs. EVA:** Manual Vacuum Aspiration (MVA) is typically used up to **10 weeks** (using a 60ml syringe), while Electric Vacuum Aspiration (EVA) is preferred between **10–12 weeks** due to consistent pressure. 2. **Pressure:** The ideal pressure for EVA is **600 mmHg**. 3. **Cannula Size:** The size of the Karman’s cannula (in mm) should generally correspond to the weeks of gestation (e.g., 8mm for 8 weeks). 4. **MTP Act (India):** Recent amendments allow MTP up to **24 weeks** for specific categories of women, but the *surgical technique* of suction evacuation remains limited to the first trimester.

Q: Which of the following is a barrier method of contraception?

Spermicide. **Explanation:** The correct answer is **C. Spermicide**. Barrier methods of contraception work by physically or chemically preventing sperm from entering the uterine cavity and reaching the oocyte. Spermicides (such as Nonoxynol-9) act as a **chemical barrier** by disrupting the sperm cell membrane, thereby immobilizing or killing them before they can pass through the cervix. Other common barrier methods include condoms (male and female), diaphragms, and cervical caps. **Analysis of Incorrect Options:** * **A. Oral contraceptive pill:** This is a **hormonal method**. It primarily works by inhibiting ovulation through the suppression of FSH and LH, and secondarily by thickening cervical mucus. * **B. Intrauterine device (IUD):** This is an **intrauterine contraceptive device**. While it prevents fertilization, its mechanism is primarily mediated through a sterile inflammatory response in the endometrium (Copper-T) or hormonal changes (LNG-IUD), rather than acting as a mechanical barrier. * **D. Tubectomy:** This is a **permanent/surgical method** of sterilization. It involves the surgical ligation or occlusion of the fallopian tubes to prevent the union of sperm and ovum. **NEET-PG High-Yield Pearls:** * **Nonoxynol-9** is the most common spermicide used globally. * **Dual Protection:** Condoms are the only barrier method that provides significant protection against both pregnancy and **STIs/HIV**. * **Failure Rates:** Barrier methods generally have higher "typical use" failure rates compared to LARC (Long-Acting Reversible Contraception) like IUDs. * **Ideal Use:** Spermicides are most effective when used in combination with mechanical barriers like a diaphragm.

Question 1

Which of the following is the safest method of sterilization in the immediate postpartum period?

Accepted Answer

Minilaparotomy

Answer

Laparoscopy

Answer

Hysteroscopic method

Answer

None of the above

Question 2

Which of the following is NOT a method for inducing mid-trimester abortions?

Accepted Answer

Menstrual regulation

Answer

Intra-amniotic saline

Answer

Intra-amniotic prostaglandins

Answer

Hysterotomy

Question 3

What is the best contraceptive method for a 22-year-old married nulliparous woman?

Accepted Answer

Oral Contraceptive Pills (OCPs)

Answer

Condom

Answer

Tubectomy

Answer

Rhythm method

Question 4

A pregnant woman at 8 weeks gestation with an intrauterine contraceptive device (Cu T) in place and three living children requires management. What is the most suitable treatment?

Accepted Answer

Remove the Cu T and perform permanent sterilization.

Answer

Continue the pregnancy and remove the Cu T during delivery.

Answer

Remove the Cu T.

Answer

None of the above.

Question 5

What is the main mechanism of combined oral contraceptive pills (OCPs)?

Accepted Answer

Feedback inhibition of the pituitary, preventing the LH surge

Answer

Changes in cervical mucus

Answer

Decreased motility and secretion of the fallopian tube

Answer

Prevention of ovulation

Question 6

Which of the following is a benefit of third-generation oral contraceptive pills?

Accepted Answer

Decreased risk of myocardial infarction

Answer

Decreased risk of thromboembolism

Answer

Increased risk of breakthrough bleeding

Answer

More side effects

Question 7

Which method of Medical Termination of Pregnancy is not used in the first trimester of pregnancy?

Accepted Answer

Intrauterine instillation of hypertonic saline

Answer

Suction and evacuation

Answer

Mifepristone

Answer

Misoprostol

Question 8

What is the recognized method for identifying a missed Intrauterine Device (IUD)?

Accepted Answer

Ultrasound (USG)

Answer

X-ray

Answer

Barium meal

Answer

CT Scan

Question 9

Suction evacuation as MTP is best done up to how many weeks of gestation?

Accepted Answer

12 weeks

Answer

9 weeks

Answer

18 weeks

Answer

24 weeks

Question 10

Which of the following is a barrier method of contraception?

Accepted Answer

Spermicide

Answer

Oral contraceptive pill

Answer

Intrauterine device

Answer

Tubectomy

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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