Contraception and Sterilization MCQs

Actions of the progesterone component of combined oral contraceptives: Suppresses ovulation by its inhibitory action on the pituitary and the hypothalamus. This is predominantly achieved by estrogens but even by progesterone. Causes atrophic changes in the endometrium and prevents nidation even if fertilization occurs. Acts on the cervical mucus, making it thick and tenacious and impenetrable by sperms. The third-generation progestogens have a higher affinity for progesterone receptor and have a role in inhibiting ovulation. The main function of progestogens in combined pills is to counteract the undesirable effects of estrogen such as endometrial hyperplasia and heavy withdrawal bleeding. Reference: SK Chaudhary 7 th /ed pp 125-126, 14.

Ans, C. Clip method The Falope sialistic ring destroys 2-3 cm fallopian tube. The Hulka& Filshie clips destroya smaller segment (3-4mm)' thus preserving the potential of successful reversal of surgery. The failure rate varies between .2 and 15%"

Cancers/cysts Uterine cancer Ovarian cancers Fibroid uterus (Progesterone only pills) Ovarian cysts Benign breast diseases Benign disease of genital tract Endometriosis (if used continuously) PID (here Salpingitis) Ectopic pregnancy (as it decreases incidence of PID) They decrease ovulation thus, are helpful in Dysmenorrhea, premenstrual tension and Mittelschmerz syndrome. By decreasing blood loss they are helpful in menorrhagia and polymenorrhea. Acne and hirsutism (especially those containing desogestrel) OCPs are also beneficial in: DUB Hormone therapy for hypothalamic amenorrhea Prevention of menstrual porphyria. Reference: Shaw 15 th /ed pp 231-232; Dutta Obs 6 th /ed p 545; Harrison 17 th /ed p 563

Naegeles formula is not used to calculate EDD but USG is done and CRL is used in cases of: Previous history of use of OCP prior to conception. Irregular cycles Patient doesn't remember her LMP Patient was breast feeding The best parameter to measure gestational age is Crown Rump Length(CRL).It is measured in the first trimester. 1 st trimester: CRL 2 nd trimester: Biparietal diameter(BPD)>Head circumference 3 rd Trimester: Femoral length

Lutein cysts are usually bilateral and caused by excessive chorionic gonadotropin secreted in cases of gestational trophoblastic tumors. -These may also be formed with administration of gonadotropins or even clomiphene to induce ovulation. These are usually lined either by theca lutein cells called theca lutein cyst or by granulosa lutein cells, called granulosa lutein cyst. Spontaneous regression is expected within a few weeks following effective therapy of the tumors with the gonadotropin level returning back to normal. Reference : Dutta Gynae 6 th /ed pg 290

Patients taking OCP's and presenting with abdominal pain and psychiatric problems, diagnosis is undoubtedly acute intermittent porphyria as OCP's can precipitate porphyria. Reference: Harrison 17 th /ed p 2439

LARC method of contraception are Long acting Reversible contraceptive methods: LARC methods include: LARC Infection: DMPA/NET-en Implants-Implanon, Norplant IUCD: CuT, LNG IUCD. Transdermal patches Vaginal ring Reference: Leon Speroff 7 th /ed p 842; 8 th /ed p 926

Ans. A. Contraception om 1316. All of the following occurs because of prostaglandin use except? a) Excess water retention b) Flushes c) Increased motility of bowel d) Nausea Correct Answer - A Ans, A. Excess water retention Disadvantages & side effects of prostaglandins