26. For ultrasound diagnosis of chronic polyhydramnios, the amniotic fluid index should be more than
A. 6 cm
B. 12 cm
C. 18 cm
D. 25 cm
Ans D
Polyhydramnios (polyhydramnion, hydramnios, polyhydramnios) is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies] It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm
27. Which one defines 'precipitate labour' ?
A. Rate of cervical dilatation > 3 cm / hour
B. Rate of descent of head 2 cm / hour
C. Combined first and second stages of labour < 2 hours
D. All stages of labour completed within 6 hours
Ans C
28. A multigravida with 26 weeks pregnancy presenting with Hb°/o of 6 grams. The ideal management is
A. oral iron therapy
B. parental iron therapy a
C. packed cell transfusion
D. exchange transfusion
Indications for oral iron supplementation
Women with a Hb < 110g/l up until 12 weeks or <105g/l beyond 12 weeks should be offered a trial of therapeutic iron replacement. In the presence of known haemoglobinopathy, serum ferritin should be checked and women offered therapeutic iron replacement if the ferritin is <30 μg/l.
Treatment must begin promptly in the community. Referral to secondary care should be considered if there are significant symptoms and/or severe anaemia (Hb<70g/l) or advanced gestation (>34 weeks) or if there is no rise in Hb at 2 weeks
Parenteral iron should be considered from the 2nd trimester onwards and postpartum period in women with iron deficiency anaemia who fail to respond to or are intolerant of oral iron
29. Couvelaire uterus is a complication of
A. Rupture uterus
B. Torsion of gravid uterus
C. Red degeneration of fibroid
D. Severe form of concealed accidental haemorrhage
Ans D
Couvelaire uterus (also known as uteroplacental apoplexy)[1] is a life threatening condition in which loosening of the placenta (abruptio placentae) causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity.
"Couvelaire uterus" is a phenomenon wherein the retroplacental blood may penetrate through the thickness of the wall of the uterus into the peritoneal cavity. This may occur after abruptio placentae. The hemorrhage that gets into the decidua basalis ultimately splits the decidua, and the haematoma may remain within the decidua or may extravasate into the myometrium (the muscular wall of the uterus). The myometrium becomes weakened and may rupture due to the increase in intrauterine pressure associated with uterine contractions. This may lead to a life-threatening obstetrical emergency
30. Obstetric conjugate is the distance between
A. lower border of symphysis pubis to sacral promontory
B. upper border of symphysis pubis to sacral promontory
C. lower border of symphysis pubis to tip of the coccyx
D. prominent bony projection on the inner surface of pubis to sacral promontory
Ans D
Antero -posterior diameters:
• Anatomical antero-posterior diameter (true conjugate) = 11cm
from the tip of the sacral promontory to the upper border of the symphysis pubis.
• Obstetric conjugate = 10.5 cm
from the tip of the sacral promontory to the most bulging point on the back of symphysis pubis which is about 1 cm below its upper border. It is the shortest antero-posterior diameter.
• Diagonal conjugate = 12.5 cm
i.e. 1.5 cm longer than the true conjugate. From the tip of sacral promontory to the lower border of symphysis pubis.
• External conjugate = 20 cm
from the depression below the last lumbar spine to the upper anterior margin of the symphysis pubis measured from outside by the pelvimeter . It has not a true obstetric importance.
31. In pregnancy which one of the following heart diseases is associated with the least maternal mortality ?
A. Aortic stenosis
B. Marian syndrome
C. Pulmonary hypertension
D. Patent ductus arteriosus
Ans D
Patent ductus arteriosus — Although predominantly found in females, patent ductus arteriosus (PDA) is of less practical importance as a complication of pregnancy since the clinical diagnosis is simple and because operative or catheter closure is routine and curative in childhood . An asymptomatic young woman with a small or moderate-sized ductus and normal pulmonary arterial pressure can anticipate an uncomplicated pregnancy, apart from the risk of infective endarteritis during delivery
Eisenmenger syndrome : Reported risk of maternal mortality in this disorder has ranged from 30 to 50 percen
A. 6 cm
B. 12 cm
C. 18 cm
D. 25 cm
Ans D
Polyhydramnios (polyhydramnion, hydramnios, polyhydramnios) is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies] It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm
27. Which one defines 'precipitate labour' ?
A. Rate of cervical dilatation > 3 cm / hour
B. Rate of descent of head 2 cm / hour
C. Combined first and second stages of labour < 2 hours
D. All stages of labour completed within 6 hours
Ans C
28. A multigravida with 26 weeks pregnancy presenting with Hb°/o of 6 grams. The ideal management is
A. oral iron therapy
B. parental iron therapy a
C. packed cell transfusion
D. exchange transfusion
Indications for oral iron supplementation
Women with a Hb < 110g/l up until 12 weeks or <105g/l beyond 12 weeks should be offered a trial of therapeutic iron replacement. In the presence of known haemoglobinopathy, serum ferritin should be checked and women offered therapeutic iron replacement if the ferritin is <30 μg/l.
Treatment must begin promptly in the community. Referral to secondary care should be considered if there are significant symptoms and/or severe anaemia (Hb<70g/l) or advanced gestation (>34 weeks) or if there is no rise in Hb at 2 weeks
Parenteral iron should be considered from the 2nd trimester onwards and postpartum period in women with iron deficiency anaemia who fail to respond to or are intolerant of oral iron
29. Couvelaire uterus is a complication of
A. Rupture uterus
B. Torsion of gravid uterus
C. Red degeneration of fibroid
D. Severe form of concealed accidental haemorrhage
Ans D
Couvelaire uterus (also known as uteroplacental apoplexy)[1] is a life threatening condition in which loosening of the placenta (abruptio placentae) causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity.
"Couvelaire uterus" is a phenomenon wherein the retroplacental blood may penetrate through the thickness of the wall of the uterus into the peritoneal cavity. This may occur after abruptio placentae. The hemorrhage that gets into the decidua basalis ultimately splits the decidua, and the haematoma may remain within the decidua or may extravasate into the myometrium (the muscular wall of the uterus). The myometrium becomes weakened and may rupture due to the increase in intrauterine pressure associated with uterine contractions. This may lead to a life-threatening obstetrical emergency
30. Obstetric conjugate is the distance between
A. lower border of symphysis pubis to sacral promontory
B. upper border of symphysis pubis to sacral promontory
C. lower border of symphysis pubis to tip of the coccyx
D. prominent bony projection on the inner surface of pubis to sacral promontory
Ans D
Antero -posterior diameters:
• Anatomical antero-posterior diameter (true conjugate) = 11cm
from the tip of the sacral promontory to the upper border of the symphysis pubis.
• Obstetric conjugate = 10.5 cm
from the tip of the sacral promontory to the most bulging point on the back of symphysis pubis which is about 1 cm below its upper border. It is the shortest antero-posterior diameter.
• Diagonal conjugate = 12.5 cm
i.e. 1.5 cm longer than the true conjugate. From the tip of sacral promontory to the lower border of symphysis pubis.
• External conjugate = 20 cm
from the depression below the last lumbar spine to the upper anterior margin of the symphysis pubis measured from outside by the pelvimeter . It has not a true obstetric importance.
31. In pregnancy which one of the following heart diseases is associated with the least maternal mortality ?
A. Aortic stenosis
B. Marian syndrome
C. Pulmonary hypertension
D. Patent ductus arteriosus
Ans D
Patent ductus arteriosus — Although predominantly found in females, patent ductus arteriosus (PDA) is of less practical importance as a complication of pregnancy since the clinical diagnosis is simple and because operative or catheter closure is routine and curative in childhood . An asymptomatic young woman with a small or moderate-sized ductus and normal pulmonary arterial pressure can anticipate an uncomplicated pregnancy, apart from the risk of infective endarteritis during delivery
Eisenmenger syndrome : Reported risk of maternal mortality in this disorder has ranged from 30 to 50 percen
32. The risk of rupture of lower segment caesarean section scar during labour is
A. more than 10%
B. 5 to 8%
C. about 0.2 to 1.5°/0
D. 4%
Ans C
There is a very small risk that the scar may separate or rupture during a VBAC. About 1 in 300 (0.3%) women attempting a VBAC may experience rupture of the scar on the uterus. Because of this, you will be offered continuous monitoring of your baby's heart beat during your labour if you decide on a VBAC. Studies have shown that the most common sign that a caesarean scar may be separating is a sustained drop in the baby's heart rate. Having continuous monitoring will reduce the risk of an adverse outcome to about 1 in 3,000 (0.03%). (This compares favourably to the over all risk of stillbirth for any pregnancy of 1 in 2,000)
33. Which drug is contraindicated in Malaria with pregnancy ?
A. Quinine
B. Mefloquine
C. Chloroquine
D. Primaquine
Ans D
34. Which one of the following is decreased during normal pregnancy ?
A. Glomerular filtration rate
B. Serum creatinine
C. Tidal volume
D. Plasma fibrinogen
Ans B
the physiologic increase in GFR during pregnancy normally results in a decrease in concentration of serum creatinine, which falls by an average of 0.4 mg/dl to a pregnancy range of 0.4 to 0.8 mg/dl.1 Hence, a serum creatinine of 1.0 mg/dl, although normal in a nonpregnant individual, reflects renal impairment in a pregnant woman
A. Quinine
B. Mefloquine
C. Chloroquine
D. Primaquine
Ans D
34. Which one of the following is decreased during normal pregnancy ?
A. Glomerular filtration rate
B. Serum creatinine
C. Tidal volume
D. Plasma fibrinogen
Ans B
the physiologic increase in GFR during pregnancy normally results in a decrease in concentration of serum creatinine, which falls by an average of 0.4 mg/dl to a pregnancy range of 0.4 to 0.8 mg/dl.1 Hence, a serum creatinine of 1.0 mg/dl, although normal in a nonpregnant individual, reflects renal impairment in a pregnant woman
35. Which placenta praevia is called dangerous placenta praevia ?
A. Type 4
B. Type 3
C. Type 2 posterior
D. Type 1 posterior
Ans C
Type II posterior placenta previa is also known as 'Dangerous Placenta Previa
36. Brenner tumour of ovary is
A. an epithelial tumour
B. a sex cord stromal tumour
C. an unclassified tumour
D. a germ cell tumour
Ans A
Brenner tumors are uncommon tumours that are part of the surface epithelial- stromal tumor group of ovarian neoplasm
Epithelial-stromal tumors are classified on the basis of the epithelial cell type, the relative amounts of epithelium and stroma, the presence of papillary processes, and the location of the epithelial elements. Microscopic pathological features determine whether a surface epithelial-stromal tumor is benign, borderline, or malignant (evidence of malignancy and stromal invasion). Borderline tumors are of uncertain malignant potential.
This group consists of serous, mucinous, endometrioid, clear cell, and brenner (transitional cell) tumors, though there are a few mixed, undifferentiated and unclassified types.
37. The acidity of vagina is due to
A. E. coil
B. Anaerobic streptococci
C. Diphtheroids
D. Doderlein's bacilli
Ans D
Oral contraceptives, steroids, and antibiotics disrupt either the normal flora or the pH which is naturally acidic. This acidic environment is produced by the Doderlein's bacilli which is a normal flora found in the vagina it can be destroyed by broad-spectrum antibiotics (kills pretty much all bacteria). The acidic environment is produced by the Doderlein's bacilli and helps protect the vagina from the invading vaginal infections.
38. Human Chorionic Gonadotrophic (HOG) levels are increased in all of the following, EXCEPT
A. Complete mole
B. Partial mole
C. Endodermal sinus tumour
D. Choriocarcinoma
Ans C
The histology of EST is variable, but usually includes malignant endodermal cells. These cells secrete alpha-fetoprotein (AFP), which can be detected in tumor tissue, serum, cerebrospinal fluid, urine and, in the rare case of fetal EST, in amniotic fluid. When there is incongruence between biopsy and AFP test results for EST, the result indicating presence of EST dictates treatment.[1] This is because EST often occurs as small "malignant foci" within a larger tumor, usually teratoma, and biopsy is a sampling method; biopsy of the tumor may reveal only teratoma, whereas elevated AFP reveals that EST is also present. GATA-4, a transcription factor, also may be useful in the diagnosis of EST.
. Human chorionic gonadotropin can be used as a tumor marker, as its β subunit is secreted by some cancers including seminoma, choriocarcinoma, germ cell tumors, hydatidiform mole formation, teratoma with elements of choriocarcinoma, and islet cell tumor. For this reason a positive result in males can be a test for testicular cancer. The normal range for men is between 0-5 mIU/mL. Combined with alpha-fetoprotein, β-HCG is an excellent tumor marker for the monitoring of germ cell tumors
39. All are causes of deep dyspareunia EXCEPT
A. Fixed retroverted uterus
B. Prolapsed ovaries in pouch of Douglas
C. Senile atrophy of vagina due to menopause
D. Endometriosis of rectovaginal septum
Ans C
40. The following artery does not contribute to form the azygous arteries of vagina.
A. Vaginal branch of uterine artery
B. Inferior vesical
C. Internal pudendal
D. Middle rectal
Ans B
The Arterial Supply of the Vagina
• The vaginal artery is usually a branch of the uterine artery.
• It may, however, arise from the internal iliac artery.
• The 2 vaginal arteries anastomose with each other and with the cervical branch of the uterine artery.
• The internal pudendal artery and vaginal branches of the middle rectal artery also supply the vagina (branches of the internal iliac arteries).
These arteries form anterior and posterior azygos arteries to supply the vaginal wall
The uterine artery supplies branches to the cervix uteri and others which descend on the vagina; the latter anastomose with branches of the vaginal arteries and form with them two median longitudinal vessels—the vaginal branches of uterine artery (or azygos arteries of the vagina)—one of which runs down in front of and the other behind the vagina.
The vaginal artery (a. vaginalis) usually corresponds to the inferior vesical in the male; it descends upon the vagina, supplying its mucous membrane, and sends branches to the bulb of the vestibule, the fundus of the bladder, and the contiguous part of the rectum. It assists in forming the azygos arteries of the vagina, and is frequently represented by two or three branches.
The middle rectal artery usually arises with the inferior vesical artery, a branch of the internal iliac artery. It is distributed to the rectum, anastomosing with the inferior vesical artery, superior rectal artery, and inferior rectal artery.
In males, the middle rectal artery may give off branches to the prostate and the seminal vesicles, while in females it gives off branches to the vagina.
AZYGOS ARTERY OF VAGINA
This artery arises from the vaginal artery and anastomoses with vaginal branches of the uterine artery to complete the anastomotic longitudinal channel running from the ovary to the vagina in the broad ligament and mesosalpinx. This anastomosis is mainly responsible for the vaginal cycle that is normally in synchrony with ovarian cycle. But a blockage of the anastomotic channel could lead to abnormal vaginal cyclicity. The branches of the azygos vessels also anastomose with the perineal branches from the internal pudendal artery in the perineum
41. Lymphatics from Glans of clitoris drain directly into
A. internal iliac
B. external iliac
C. superficial inguinal
D. gland of cloquet
Ans b
The glans penis, the glans clitoris, labia minora, and the terminal inferior end of the vagina drain into deep inguinal nodes and external iliac nodes
42. In Mayer Rokitansky Kuster Hauser syndrome the following features are present, EXCEPT
A. Well developed breasts
B. Absence of vagina
C. Mullerian agenesis
D. Inguinal testis
Ans D
The following may be observed in patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome:
• Primary amenorrhea and possible cyclic abdominal pain
o These symptoms are common in individuals with Mayer-Rokitansky-Kuster-Hauser syndrome.
o The patient undergoes puberty with normal thelarche and adrenarche; however, menses do not begin.
o Patients may report cyclic abdominal pain due to cyclic endometrial shedding without a patent drainage pathway.
• Because ovarian function is normal, patients experience all bodily changes associated with menstruation and puberty.
o Normal secondary female sexual characteristics are present after puberty.
o Height is normal.
o Speculum examination of the vagina may be impossible or difficult because of the degree of vaginal agenesis.
o The vulva, labia majora, labia minora, and clitoris are normal.
o A palpable sling of tissue may be present at the level of the peritoneal reflection.
43. In a 24 year old nulliparous woman with third degree utero vaginal prolapse, the operation of choice is
A. Purandare's cervico pexy
B. Shirodkar's sling operation
C. Le Fort's repair
D. Extended Manchester operation
Ans b
Extended Manchester operation : for cervical elongation
Le Fort's repair : for older women
44. The following feature is NOT present in Kallman's syndrome
A. Bilateral absence of vas deference
B. Anosmia
C. Colour blindness
D. Gonadotrophin deficiency
Ans A ( Cis also possible )
• It is normally difficult to distinguish a case of KS/HH from a straightforward constitutional delay of puberty. However if a boy or girl has not started puberty by either 14 (girls) or 15 (boys) and they have one of the non-reproductive features then a referral to reproductive endocrinologist might be advisable.
• Reproductive features
o Failure to start or fully complete puberty in both men and women
o Lack of testicular development in men; size <3 ml
o Primary amenorrhoea or failure to start menstruation in women
o Poorly defined secondary sexual characteristics in both men and women.
o Infertility
• Non-reproductive features
o Hypogonadotropic hypogonadism (a lack of the pituitary hormones luteinizing hormone and follicle-stimulating hormone)
o Congenital (present from birth)
o Total lack of sense of smell (anosmia) or markedly reduced sense of smell (hyposmia). This is the defining feature of Kallmann syndrome; it is not seen in other cases of HH. Approximately 50% of HH cases occur with anosmia and can be termed as Kallmann syndrome.
o Cleft palate or other craniofacial defects.
o Unilateral renal agenesis or aplasia; absence or non-functioning of one of the kidneys
o Cryptorchidism; un-descended testicles at birth, occurs in 30% of KS/HH cases
o Micropenis, occurs in less than 5 to 10% of KS/HH cases
o Neural hearing defects
o Synkinesis or mirror movements of hands
o Dental defects
o Normally normal stature, but can have an increase in height if treatment is delayed due to the lack of testosterone or oestrogen causing excess bone growth in the arms and legs
At one stage it was thought that colour blindness was linked to KS/HH but this has proved not to be the case.
Patients with KS/HH lack a surge of GnRH, LH and FSH that occurs between birth and six months of age.[12] This surge is particularly important in infant boys as it helps with testicular descent into the scrotum. A small percentage of boys with KS/HH will be born with micropenis and/or undescended testes, both of which should be treated and corrected in the first year of life. The surge of GnRH/LH/FSH in non KS/HH children gives detectable levels of testosterone in boys and oestrogen & progesterone in girls. The lack of this surge can sometimes be used as a diagnostic tool if KS/HH is suspected in a newborn boy, but is not distinct enough for diagnosis in girls.
45. All of the following are present in polycystic ovary syndrome EXCEPT
A. Elevated luteinizing hormone
B. Elevated androstenedione
C. Raised serum hormone binding globulin
D. Raised serum insulin
Ans C
SHBG and polycystic ovarian syndrome (PCOS)
Sex hormone binding globulin (SHBG) is a protein that binds to both testosterone and estradiol. Its amount can vary widely in patients, and if the SHBG is either low or high, the amount of active (bioavailable) testosterone can vary widely. Therefore, it is very important to measure SHBG in all patients being evaluated for polycystic ovarian syndrome, as well as other patients such as patients with hypopituitarism.
SHBG is reduced in insulin resistance and actually a very good marker for insulin resistance. Many women with polycystic ovarian syndrome have a high-normal or even a normal total testosterone but have a low SHBG because they have insulin resistance. Therefore, their bioavailable testosterone is often on the high side.
46. After 72 hours of unprotected coitus, the emergency contraception of choice is
A. Levonorgestrel
B. Premarin
C. Yuzpe method
D. Copper T
Ans d
Copper upto 5 days
A. Bilateral absence of vas deference
B. Anosmia
C. Colour blindness
D. Gonadotrophin deficiency
Ans A ( Cis also possible )
• It is normally difficult to distinguish a case of KS/HH from a straightforward constitutional delay of puberty. However if a boy or girl has not started puberty by either 14 (girls) or 15 (boys) and they have one of the non-reproductive features then a referral to reproductive endocrinologist might be advisable.
• Reproductive features
o Failure to start or fully complete puberty in both men and women
o Lack of testicular development in men; size <3 ml
o Primary amenorrhoea or failure to start menstruation in women
o Poorly defined secondary sexual characteristics in both men and women.
o Infertility
• Non-reproductive features
o Hypogonadotropic hypogonadism (a lack of the pituitary hormones luteinizing hormone and follicle-stimulating hormone)
o Congenital (present from birth)
o Total lack of sense of smell (anosmia) or markedly reduced sense of smell (hyposmia). This is the defining feature of Kallmann syndrome; it is not seen in other cases of HH. Approximately 50% of HH cases occur with anosmia and can be termed as Kallmann syndrome.
o Cleft palate or other craniofacial defects.
o Unilateral renal agenesis or aplasia; absence or non-functioning of one of the kidneys
o Cryptorchidism; un-descended testicles at birth, occurs in 30% of KS/HH cases
o Micropenis, occurs in less than 5 to 10% of KS/HH cases
o Neural hearing defects
o Synkinesis or mirror movements of hands
o Dental defects
o Normally normal stature, but can have an increase in height if treatment is delayed due to the lack of testosterone or oestrogen causing excess bone growth in the arms and legs
At one stage it was thought that colour blindness was linked to KS/HH but this has proved not to be the case.
Patients with KS/HH lack a surge of GnRH, LH and FSH that occurs between birth and six months of age.[12] This surge is particularly important in infant boys as it helps with testicular descent into the scrotum. A small percentage of boys with KS/HH will be born with micropenis and/or undescended testes, both of which should be treated and corrected in the first year of life. The surge of GnRH/LH/FSH in non KS/HH children gives detectable levels of testosterone in boys and oestrogen & progesterone in girls. The lack of this surge can sometimes be used as a diagnostic tool if KS/HH is suspected in a newborn boy, but is not distinct enough for diagnosis in girls.
45. All of the following are present in polycystic ovary syndrome EXCEPT
A. Elevated luteinizing hormone
B. Elevated androstenedione
C. Raised serum hormone binding globulin
D. Raised serum insulin
Ans C
SHBG and polycystic ovarian syndrome (PCOS)
Sex hormone binding globulin (SHBG) is a protein that binds to both testosterone and estradiol. Its amount can vary widely in patients, and if the SHBG is either low or high, the amount of active (bioavailable) testosterone can vary widely. Therefore, it is very important to measure SHBG in all patients being evaluated for polycystic ovarian syndrome, as well as other patients such as patients with hypopituitarism.
SHBG is reduced in insulin resistance and actually a very good marker for insulin resistance. Many women with polycystic ovarian syndrome have a high-normal or even a normal total testosterone but have a low SHBG because they have insulin resistance. Therefore, their bioavailable testosterone is often on the high side.
46. After 72 hours of unprotected coitus, the emergency contraception of choice is
A. Levonorgestrel
B. Premarin
C. Yuzpe method
D. Copper T
Ans d
Copper upto 5 days
47. The lifespan of Copper T — 380 A is
A. 3 years
B. 5 years
C. 7 years
D. 10 years
Ans D
• Copper T380A has a loading capsule and insertion tube with graduated scale card included. It loads in seconds and can be used as emergency contraception for up to 5 days after unprotected sex.
• Copper T380A has a shelf life of 7 years and has an intra-uterine life span of 10 years giving your patient a decade of confidence.
48. Hormone releasing intrauterine device Mirena releases how many microgram of levonorgestrel per day ?
A. 10
B. 20
C. 30
D. 40
Ans B
Mirena is intended to provide an initial release rate of 20 μg/day of levonorgestrel.
49. Which one of the following regarding "Progestin-only" contraceptive pills is NOT correct ?
A. Mainly cause anovulation
B. Can be used in diabetes mellitus
C. No adverse effect on lactation
D. Break through bleeding is common
Ans a
Breakthrough bleeding or spotting can occur with progestin-only pills
Lacking the estrogen of combined pills, they are not associated with increased risks of DVT or heart disease. With the decreased clotting risk, they are not contraindicated in the setting of sickle-cell disease. The progestin-only pill is recommended over regular birth control pills for women who are breastfeeding because the mini-pill does not affect milk production (estrogen reduces the amount of breast milk). Like combined pills, the minipill decreases the likelihood of pelvic inflammatory disease.
It is unclear whether POPs provide protection against ovarian cancer to the extent that COCP do.
There are fewer serious complications than on COCP
The mechanism of action of progestogen-only contraceptives depends on the progestogen activity and dose.
• Very-low-dose progestogen-only contraceptives, such as traditional progestogen-only pills (and subdermal implants Norplant and Jadelle and intrauterine systems Progestasert and Mirena), inconsistently inhibit ovulation in ~50% of cycles and rely mainly on their progestogenic effect of thickening the cervical mucus, thereby reducing sperm viability and penetration.
• Intermediate-dose progestogen-only contraceptives, such as the progestogen-only pill Cerazette (or the subdermal implant Nexplanon), allow some follicular development (part of the steps of ovulation) but much more consistently inhibit ovulation in 97–99% of cycles. The same cervical mucus changes occur as with very-low-dose progestogens.
• High-dose progestogen-only contraceptives, such as the injectables Depo-Provera and Noristerat, completely inhibit follicular development (see above) and ovulation. The same cervical mucus changes occur as with very-low-dose and intermediate-dose progestogens.
50. Which one is NOT TRUE about Nonoxyno1-9 as a contraceptive ?
A. Immobilizes sperms
B. Should not be removed for 6 hours after intercourse
C. Failure rate is about 10/HWY
D. Increased risk of toxic shock syndrome
Ans C
Failure rate 23 /HWY
Some people are allergic to the spermicide used in the sponge. Women who use contraceptive sponges have an increased risk of yeast infection and urinary tract infection. Improper use, such as leaving the sponge in too long, can result in toxic shock syndrome.
The sponge can be inserted up to 24 hours before intercourse. It must be left in place for at least six hours after intercourse. It should not be worn for more than 30 hours in a row
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