OG20.1-3,OG21.1-2,OG22.1-2 | Medical Termination and Contraception — Practice Quiz

Correct. Under the 2021 amendment, MTP between 20 and 24 weeks requires the opinion of TWO RMPs. The woman's being a rape survivor places her in one of the specified categories eligible for this extended limit, but the two-opinion requirement still applies.

MTP Act 1971 amended 2021: ≤20 weeks = one RMP opinion; 20–24 weeks for specified categories = two RMP opinions; >24 weeks only for substantial foetal abnormality via State Medical Board.

Not correct. The MTP Amendment Act 2021 created a two-tier structure: up to 20 weeks needs ONE RMP's opinion; between 20 and 24 weeks (for specified categories including rape survivors) needs TWO RMPs' opinions. No court order is required.

Correct. The WHO and FOGSI-recommended regimen for medical abortion up to 9–10 weeks is mifepristone 200 mg orally followed by misoprostol 800 µg (vaginal, sublingual, or buccal) after a 24–48 hour interval. This achieves >95% complete expulsion.

First-trimester medical MTP: mifepristone 200 mg orally, then misoprostol 800 µg vaginally/sublingually at 24–48 h. Effective up to 9–10 weeks. Methotrexate is for ectopic, not uterine MTP.

Not correct. The standard regimen is mifepristone 200 mg orally + misoprostol 800 µg 24–48 h later. Methotrexate is used for ectopic pregnancy, not intrauterine termination. The misoprostol-only regimen is less effective. Mifepristone 600 mg is an older higher dose; same-day administration reduces efficacy.

Correct. Under the MTP Act, for women under 18 years (minors), guardian consent is mandatory. The patient's own assent should also be sought and documented, but the legally valid consent must come from the guardian.

MTP consent: competent adult woman consents herself; no partner/husband permission needed. Minors (<18 yr) and women of unsound mind require guardian consent. Confidentiality must still be maintained.

Not correct. The MTP Act explicitly requires guardian consent for minors (under 18). The woman's own willingness is important, but the legal requirement for guardian consent cannot be waived. Partner consent is never required under the 2021 Act for any adult woman.

Correct. The PCPNDT Act 1994 prohibits communication of foetal sex in any form — whether incidentally mentioned, deliberately disclosed, or communicated through signs or coded language. Even an offhand remark during a legitimate scan constitutes an offence.

PCPNDT Act 1994: any communication of foetal sex — direct, indirect, verbal, or non-verbal — is an offence. The most common prosecution scenario is an offhand remark during a routine scan, not a deliberate sex-selection service.

Not correct. The PCPNDT Act prohibits communication of foetal sex regardless of intent or circumstances. An incidental mention during an anomaly scan is still an offence. The prohibition covers both pre-conception (PC) and pre-natal (PNDT) contexts.

Correct. Breastfeeding less than 6 weeks postpartum is WHO MEC Category 4 for COC — an absolute contraindication. The oestrogen component suppresses lactation and neonatal oestrogen exposure is a concern. Migraine without aura alone would be Category 2 (COC advantages outweigh risks), but the breastfeeding <6 weeks is the overriding MEC 4 condition.

WHO MEC 4 for COC includes: breastfeeding <6 weeks postpartum, migraine with aura, smokers ≥35 yr. Breastfeeding <6 weeks is MEC 4; breastfeeding 6 weeks to 6 months is MEC 3. The POP (progestogen-only pill) is MEC 1 for breastfeeding women.

Not correct. The critical factor here is breastfeeding less than 6 weeks postpartum, which is WHO MEC Category 4 (absolute contraindication) for COC because oestrogen suppresses lactation and carries neonatal risk. After 6 months of breastfeeding, COC moves to MEC 2.

Correct. Migraine with aura is WHO MEC Category 4 for COC at any age because oestrogen triples ischaemic stroke risk in this group. She must not receive COC regardless of other risk factors or concurrent medications. Offer POP, IUCD, or barrier methods.

Migraine WITH aura = COC WHO MEC Category 4 (absolute contraindication) due to tripled ischaemic stroke risk. Migraine WITHOUT aura = MEC 2 (benefits generally outweigh risks). This distinction is a high-yield exam trap.

Not correct. Migraine with aura (classic migraine with focal neurological symptoms) is WHO MEC Category 4 — an absolute contraindication to oestrogen-containing contraception, not merely a caution. Note: migraine WITHOUT aura is MEC 2 in women under 35.

Correct. The copper IUCD is the most effective emergency contraception, with >99% efficacy, and can be inserted up to 5 days (120 hours) after unprotected intercourse. At 60 hours post-coitus, it is the most effective option and also provides ongoing contraception.

Emergency contraception: LNG 1.5 mg most effective ≤72 h (can use to 120 h); ulipristal 30 mg effective up to 120 h and superior to LNG after 72 h; copper IUCD (up to 120 h) is most effective overall (>99%). IUCD also provides ongoing long-term contraception.

Not correct. Levonorgestrel (Plan B) is optimally effective within 72 hours but efficacy declines by 60 hours. Ulipristal acetate is effective up to 120 hours and better than LNG after 72 h, but the copper IUCD is the single most effective emergency contraceptive method and remains valid at 60 hours.

Correct. A malpositioned or incompletely deployed device must be removed and replaced with a new device. Attempting to manipulate the arms in situ risks uterine trauma and does not restore the copper surface area required for contraceptive efficacy.

IUCD insertion principles: if deployment is incomplete or the device is malpositioned on insertion, remove immediately and insert a fresh device. The most common cause of early failure is failure to reach the fundus — the T must lie at the fundal apex.

Not correct. An incompletely deployed IUCD has reduced contraceptive efficacy and an increased expulsion risk. It should be removed and replaced immediately with a new sterile CuT 380A. Waiting for spontaneous correction or a delayed ultrasound check is not appropriate.

Correct. The description — clear-to-white, odourless, mid-cycle increase, pH 4.2 — is consistent with physiological leucorrhoea. The mid-cycle surge is driven by peak oestrogen stimulating cervical mucus. No treatment is required; reassurance and genital hygiene advice are sufficient.

Physiological vaginal discharge: clear/white, odourless, pH ≤4.5, increases mid-cycle (oestrogen peak) and in the luteal phase. pH and odour are the two bedside discriminators — pH ≤4.5 plus no offensive smell essentially excludes BV and trichomoniasis.

Not correct. The pH ≤4.5 and absence of odour effectively exclude bacterial vaginosis (pH >4.5, fishy odour) and trichomoniasis (pH >4.5, offensive discharge). The cyclical pattern and normal pH point to physiological leucorrhoea, not a pathological syndrome.

Correct. The clinical picture (frothy yellow-green discharge, offensive odour, dyspareunia, pH >4.5, flagellated motile organisms on wet mount) is diagnostic of Trichomonas vaginalis infection. First-line treatment is metronidazole 2 g orally as a single dose; the partner must be treated simultaneously as T. vaginalis is a sexually transmitted infection.

T. vaginalis: frothy yellow-green discharge, offensive, dyspareunia, pH >4.5, flagellated motile organisms on wet mount. Treatment: metronidazole 2 g single dose; partner treatment mandatory (STI). Clotrimazole is for Candida — a common error to avoid.

Not correct. The wet mount showing flagellated motile organisms confirms T. vaginalis, not Candida (hyphae/pseudohyphae) or BV (clue cells). Trichomoniasis requires metronidazole; antifungals and doxycycline are ineffective. Partner treatment is mandatory to prevent re-infection.