Obs & Gynae - Contraception 1

Question: 1 of 10
Theme:Contraception
A Cervical mucus
B Prevents implantation
C Prevents ovulation
D Spermicidal
Match the following options with their primary mechanism of action:
Depot progestogen
Cervical mucus

Incorrect - The correct answer is Prevents ovulation

The combined oral contraceptive

Cervical mucus

Incorrect - The correct answer is Prevents ovulation

The combined oral contraceptive pill may delay ovulation or impair the transportation of the ovum, thus
preventing conception.

The emergency contraceptive pill

Cervical mucus

Incorrect - The correct answer is Prevents ovulation

EC (levonorgestrel) also delays ovulation primarily. It was thought to inhibit implantation as well but that
is disputed.

Further reading:
Contraception GP Noteboo

Obs & Gynae - Contraception 2

Question: 2 of 10
Do recognised complications of the intrauterine contraceptive devices include the following?
An increased incidence of endometriosis

Incorrect answer selected

Risk of pelvic inflammatory disease with long term use is 1/1000 women Correct
Spontaneous expulsion in 30% during the first year
Incorrect answer selected
The rate of pelvic inflammatory disease is dependent on the type of copper IUCD inserted
Incorrect answer selected
Uterine perforation in up to 0.12/1000 insertions
Incorrect answer selected
Introduction of infection at the time of insertion is a risk but not endometriosis.
Women should be taught to feel the coil threads to ensure that it has not been dislodged.
Expulsion rates between 3-15/100 women at one year are quoted.
Uterine perforation occurs in 1.2/1000 insertions.

Question: 3 of 10
Are the following statements about methods of contraception correct?
Cervical caps are associated with an increase of cervical ectopy Incorrect answer selected
Expulsion rates of IUCDs decrease with increased age

Correct

Female sterilisation has a higher failure rate than male sterilisation Correct
IUCD use increases the incidence of ectopic pregnancy

Incorrect answer selected

Most diaphragms are impregnated with nonoXynol-9

Incorrect answer selected

There is no association between caps and ectopy.

It may reduce the failure rate if a spermacide is used as well as a diaphragm but they are not routinely
impregnated with it.
Female sterilisation has a failure rate of 0-0.5 per 100 woman years compared with 0-0.2 for male
sterilisation.
Ectopics are more common in IUCD related pregnancies but the number of pregnancies are significantly
reduced.

Obs & Gynae - Contraception 3

Question: 4 of 10
Are the following statements regarding female sterilisation true?
Culdoscopic approach is advised for post partum sterilisations

Incorrect answer selected

Hysteroscopic methods of tubal ligation are very effective

Incorrect answer selected
Modified Pomeroy's technique rather than Filshie clip may be preferable for post partum
sterilisation
Correct
Trainees should have a minimal access skills module training before operating without supervision
Incorrect answer selected
Trainees should have performed at least 10 occlusion procedures before operating without
supervision
Incorrect answer selected
Trainees should have performed at least 25 laparoscopic occlusion procedures before operating without
supervision.
Culdoscopic approach is not advisable.
Hysteroscopic methods are under evaluation.
Further reading:
Female sterilisation RCOG.

Question: 5 of 10
Are the following statements regarding female sterilisation true?
Diathermy should not be used as a primary method

Correct

Local anaesthetic infiltration to the tube is not recommended

Incorrect answer selected
Minilaparotomy should be used in all women with a previous history of three caesarean sections
Incorrect answer selected
The laparoscopic approach is preferred to the minilaparotomy
Correct
The laparoscopic approach under local anaesthesia is safe

Correct

The laparoscopic approach under local anaesthesia is safe although infrequently practised in the United
Kingdom.
Local anaesthetic infiltration to the tube should be done when using mechanical devices for occlusion.
Clips are preferred for occlusion as the failure rate and particularly risk of ectopic pregnancy has been
shown to be lower than diathermy.

Obs & Gynae - Contraception 4

Question: 6 of 10
Are the following statements regarding female sterilisation performed at caesarean true?
Double clips bilaterally should be used

Incorrect answer selected

Patients should be counselled and agree at least one week prior to the procedure Correct
Pomeroys technique should be routinely used

Incorrect answer selected

The failure rate is higher compared with elective sterilisation

Correct

The regret rate is higher than for elective sterilisation

Correct

There is no evidence to support the use of double clips on each side.

Clips have proven to be effective and therefore a Pomeroy technique is not necessarily the routine choice.
Clips rather than diathermy may possibly reduce the failure rate but especially the rate of ectopic
pregnancy.
It was estimated that of every 1000 women undergoing tubal sterilisation about four would have
experienced a pregnancy after one year, about eight after four years, and about 10 after seven years.

Question: 7 of 10
A 19-year-old woman had unprotected sexual intercourse 24 hours ago. Her last menstrual period was five
days ago.
Which of the following contraceptive options are appropriate for her?
Give her 1.50 mg of levenogestrel (Levonelle )

Correct

Insertion of Mirena coil.

Incorrect answer selected

Perform a pregnancy test.

Incorrect answer selected

Reassurance that she may not be ovulating.

Incorrect answer selected

Start combined oral contraceptive pill.

Incorrect answer selected

Mirena coil takes seven days to cause sufficient endometrial thinning to prevent pregnancy hence a copper
coil would be a better option.
Although, it is not normal to ovulate at day five of a menstrual cycle, sperm can remain viable up to seven
days in the genital tract.

Obs & Gynae - Contraception 5

Question: 8 of 10
Regarding combined oral contraception, are the following true or false?
Is associated with a fivefold increased risk of VTE
Is contraindicated in women with sickle cell disease (SCD)

Correct
Incorrect answer selected

Is used by approximately 18% of women in the UK who require contraception Correct

Should be discontinued at least six weeks prior to major surgery

Incorrect answer selected

The risk of VTE is related to the oestrogen dose

Incorrect answer selected

The pill is used in approximately 18% of women requiring contraception at any one time. It is however far
more popular amongst younger women (16-30).
The risks of venous thromboembolism (VTE) are related to the oestrogenic component although there is no
clarity regarding the dose per se and it may relate to the thrombophilic risk of the individual.
It should be discontinued four weeks prior to major surgery.
Despite the dogma that OCPs cannot be used in SCD the evidence suggests otherwise.

Question: 9 of 10
Are the following true regarding the levonorgestrel IUS?
Can be used to treat endometrial hyperplasia

Correct

Causes a sustained inhibition of ovulation

Incorrect answer selected
Insertion results in stromal decidualisation and inactive endometrial glands within 30 days
Incorrect answer selected
Its main contraceptive action is mediated by the altered cervical mucus Incorrect answer selected
Menstruation usually occurs within 30 days of removal

Correct

Seventy five percent of women using the intrauterine system (IUS) continue to ovulate.
The main contraceptive effect is through endometrial suppression.
The typical morphological changes occur within 90 days of insertion.
If it is used to treat hyperplasia then follow up assessment of the endometrium is necessary.

Obs & Gynae - Contraception 6

Question: 10 of 10
Are the following true concerning mifepristone?
Mifepristone plus a prostaglandin produces abortion in more than 95% of pregnancies before eight
weeks
Correct
Mifepristone plus prostaglandin is equally effective in the first and second trimesters in inducing
abortion
Correct
Medical abortion with mifepristone carries a higher risk of infection than vacuum aspiration
Incorrect answer selected
Mifepristone has been used to shrink fibroids
Correct
Mifepristone has been used in some types of psychiatric illness

Correct

Mifepristone, a progesterone antagonist, has an approximate 95% success rate at inducing abortion and is
effective in both first and second trimesters. The main side effects are pain and bleeding.
In less than 1% of cases blood transfusion is required.
Prostaglandin administration is associated with gastrointestinal upset, with vomiting and diarrhoea, which
may be seen with this treatment.
There have been a number of reports of low dose mifepristone being used to shrink fibroids.
There have also been reports of its use in selected forms of depressive illness and it also has an effect on
reducing hypercortisolism.