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ABOG Complex Family Planning study materials
ABOG Complex Family Planning study resources

ABOG Complex Family Planning practice questions

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Question 1Contraception

Which is the principal contraceptive mechanism of combined oral contraceptive pills?

  1. Thickening of cervical mucus without any ovarian effect
  2. A direct spermicidal effect of ethinyl estradiol in the vagina
  3. Suppression of the midcycle gonadotropin surge that prevents ovulation Correct answer.
  4. Immediate endometrial decidualization that blocks all implantation

Explanation

Combined pills act mainly by suppressing the midcycle surge of LH and FSH, so no dominant follicle ruptures. The progestin component also thickens cervical mucus and thins the endometrium, but these are secondary effects. Ovulation inhibition is the dominant mechanism and explains the low typical-use failure rate.

Question 2Contraception

Which effect accounts for most of the contraceptive action of the copper intrauterine device?

  1. Copper ions that impair sperm motility and fertilizing capacity Correct answer.
  2. Decidualization of the endometrium that prevents blastocyst attachment
  3. Thickening of cervical mucus that blocks sperm entry
  4. Suppression of ovulation through a systemic progestin effect

Explanation

Copper released from the device creates a spermicidal environment in the uterine cavity and fallopian tubes, immobilizing sperm before they can reach the oocyte. The device is not hormonal, so ovulation continues normally. The endometrium shows an inflammatory response rather than the decidual change of pregnancy.

Question 3Contraception

Levonorgestrel 1.5 mg for emergency contraception is labeled for use within how long after unprotected intercourse?

  1. 24 hours
  2. 72 hours Correct answer.
  3. 120 hours
  4. 48 hours

Explanation

Levonorgestrel emergency contraception is approved for use within 72 hours of unprotected intercourse, although some benefit persists up to 120 hours. Efficacy declines as the interval lengthens. Ulipristal acetate and the copper IUD retain labeled or documented efficacy through 120 hours.

Question 4Contraception

A patient starts combined oral contraceptives on day 5 of her menstrual cycle. For how long should she use a backup method?

  1. No backup is needed if started within the first 7 days
  2. 7 days Correct answer.
  3. Until the next menses
  4. 2 days

Explanation

A pill started after the first 5 days of menses requires 7 days of backup because ovulation suppression is not yet established. If the pill is started within the first 5 days of menses, backup is not required. The same 7-day rule applies to the patch and vaginal ring.

Question 5Contraception

Which statement about vasectomy is accurate?

  1. The procedure requires general anesthesia in most cases
  2. Contraception can be stopped as soon as the procedure is finished
  3. Sterility is not immediate; a follow-up semen analysis is required Correct answer.
  4. Failure rates rise steadily with each year after the procedure

Explanation

Sperm remain in the distal ducts after vasectomy, so another method must be used until a postprocedure semen analysis confirms azoospermia or very low sperm counts. Local anesthesia with or without sedation is typical. Late failure is uncommon and does not increase steadily year after year.

Question 6Contraception

Which statement best describes return of fertility after the last depot medroxyprogesterone acetate injection?

  1. Users usually remain permanently infertile after 2 years of use
  2. Return to fertility is substantially faster than with combined oral contraceptives
  3. Conception is typically delayed by several months after the last dose Correct answer.
  4. Fertility returns within 4 weeks of the final injection

Explanation

Because depot medroxyprogesterone acetate is stored in fat and clears slowly, ovulation may not resume for months; median time to conception is roughly 10 months after the last injection. Return is slower than with pills, patches, rings, or implants. It is not permanent, and most users conceive within 18 to 24 months.

Question 7Contraception

Which lubricant should be avoided with latex male condoms?

  1. Saliva
  2. Silicone-based lubricant
  3. Oil-based lubricant Correct answer.
  4. Water-based lubricant

Explanation

Oil-based products such as petroleum jelly, mineral oil, and cooking oils degrade latex, causing microscopic breaks that permit sperm and pathogens to pass. Water-based and silicone-based lubricants are compatible with latex. Saliva does not dissolve latex but is a poor lubricant and carries a risk of bacterial transfer.

Question 8Contraception

Which set of conditions defines the lactational amenorrhea method?

  1. Any breastfeeding with amenorrhea for the first 12 months
  2. Exclusive breastfeeding at any duration with no supplemental feeds
  3. Full breastfeeding, amenorrhea, and less than 6 months postpartum Correct answer.
  4. Full breastfeeding with return of menses but no supplementation

Explanation

The method requires all three criteria: the infant is fully or nearly fully breastfed, the mother is amenorrheic, and the infant is under 6 months old. When any criterion is no longer met, another method should be started. Typical-use failure rates are low when the criteria are strictly applied.

Question 9Contraception

A 29-year-old woman has migraine with aura and no other medical problems. Which method is contraindicated?

  1. Copper intrauterine device
  2. Depot medroxyprogesterone acetate
  3. Combined oral contraceptive pills Correct answer.
  4. Etonogestrel implant

Explanation

Migraine with aura is a category 4 condition for all estrogen-containing methods at any age because of increased ischemic stroke risk. Progestin-only methods and the copper IUD remain acceptable. The contraindication applies to pills, patches, and rings alike.

Question 10Contraception

A 37-year-old woman smokes 20 cigarettes daily and requests combined oral contraceptives. What is the correct assessment?

  1. The method is acceptable if she has used it without problems for years
  2. The method is contraindicated because of age and heavy smoking Correct answer.
  3. The method is safe if she uses a 20-microgram estrogen formulation
  4. The method is safe if her blood pressure is below 140/90 mm Hg

Explanation

Smoking 15 or more cigarettes daily at age 35 or older is a category 4 condition for combined hormonal contraception because of cardiovascular and thromboembolic risk. Lowering the estrogen dose does not remove the restriction. Progestin-only or nonhormonal methods should be offered instead.

Question 11Contraception

A 22-year-old requests to start combined oral contraceptives on day 14 of her cycle, and a urine pregnancy test is negative. What is the appropriate next step?

  1. Ask her to return on day 1 of the next cycle to begin pills
  2. Start the pill now and use a barrier method for the first 7 days Correct answer.
  3. Start the pill now with no backup method needed at any time
  4. Give emergency contraception and start pills at the next menses

Explanation

A Quick Start approach begins the pill immediately after a negative pregnancy test, regardless of cycle day, with backup for 7 days. This reduces the interval before protection and avoids unintended pregnancy during the waiting period. Emergency contraception is added only when unprotected intercourse occurred within the preceding 5 days.

Question 12Contraception

A woman taking rifampin for tuberculosis needs contraception. Which approach is most appropriate?

  1. Increase the combined pill to two tablets daily
  2. Use a combined vaginal ring weekly
  3. Use the transdermal patch instead of pills
  4. Use a copper IUD or depot medroxyprogesterone Correct answer.

Explanation

Rifampin is a potent enzyme inducer that accelerates metabolism of steroid hormones, reducing the reliability of combined pills, patches, and rings. Depot medroxyprogesterone acetate and the copper IUD are classified as category 1 with rifampin and are preferred. Doubling oral doses is not a validated strategy.

Question 13Contraception

A woman with epilepsy stabilized on lamotrigine starts a combined oral contraceptive. What is the main concern?

  1. The contraceptive becomes ineffective
  2. Ethinyl estradiol levels fall, causing heavy breakthrough bleeding
  3. Lamotrigine levels rise, causing toxicity
  4. Lamotrigine levels fall, increasing seizure risk Correct answer.

Explanation

Ethinyl estradiol induces glucuronidation of lamotrigine, lowering serum concentrations by up to half and risking breakthrough seizures. Levels rise again during the hormone-free week, so patients may experience seizure clustering then. Monitoring and dose adjustment are often needed.

Question 14Contraception

After a woman takes ulipristal acetate for emergency contraception, when should hormonal contraception be started?

  1. Only at the start of the next menstrual cycle
  2. Immediately on the same day, with backup for 7 days
  3. After 5 days, with backup for the next 7 days Correct answer.
  4. After 14 days, once pregnancy has been excluded

Explanation

Because ulipristal acetate is a progesterone receptor modulator, starting a hormonal method immediately can reduce its emergency efficacy, and the emergency agent can blunt the hormonal method. Current guidance is to wait 5 days, then begin hormonal contraception with 7 days of backup. Levonorgestrel emergency contraception, by contrast, allows immediate start with 7 days of backup.

Question 15Contraception

A 26-year-old has unprotected intercourse 3 days ago and wants emergency contraception. Her BMI is 32. Which option is most effective?

  1. Ulipristal acetate 30 mg orally
  2. Levonorgestrel 1.5 mg orally
  3. Copper intrauterine device placement Correct answer.
  4. Combined oral contraceptive pills taken twice daily for 3 days

Explanation

The copper IUD is the most effective emergency method, preventing pregnancy in over 99 percent of cases when placed within 5 days, and its efficacy is not reduced by higher body weight. Oral emergency pills lose effectiveness as BMI rises. Regimens of combined pills are obsolete and less effective.

Question 16Contraception

What is a recognized disadvantage of inserting a levonorgestrel IUD immediately after delivery of the placenta?

  1. It requires general anesthesia for placement
  2. It permanently impairs lactation
  3. It cannot be placed until at least 6 weeks after delivery
  4. Expulsion rates are higher than with interval insertion Correct answer.

Explanation

Immediate postpartum placement is safe and convenient but carries a higher expulsion rate than interval placement, so string checks and follow-up are important. It does not interfere with breastfeeding and can be done without anesthesia. Placement is feasible within minutes of placental delivery.

Question 17Contraception

According to medical eligibility criteria, combined hormonal contraception in a woman who is breastfeeding an infant younger than 21 days is classified as:

  1. Category 4, unacceptable health risk Correct answer.
  2. Category 2, benefits generally outweigh risks
  3. Category 1, no restriction on use
  4. Category 3, risks generally outweigh benefits

Explanation

Before 21 days postpartum, combined hormonal contraception is category 4 because of elevated venous thromboembolism risk and theoretical concerns about milk supply in the exclusively breastfeeding woman. From 21 to 42 days the category drops to 3, and after 42 days it becomes 2. Progestin-only methods are preferred in the early postpartum period.

Question 18Contraception

A woman with a BMI of 36 wants the transdermal contraceptive patch. What should she be counseled?

  1. Efficacy is reduced, but doubling the patches restores it
  2. Efficacy is unchanged, so the patch is an ideal choice
  3. The patch is contraindicated at any BMI above 30
  4. Efficacy is lower in obesity; a long-acting method is preferred Correct answer.

Explanation

Pharmacokinetic data and labeling indicate that the patch is less effective in women weighing 90 kg or more, likely because of altered absorption and distribution. Long-acting reversible methods such as the IUD or implant are recommended when efficacy is a priority. Obesity is not an absolute contraindication to the patch.

Question 19Contraception

A woman using a norethindrone progestin-only pill realizes she is 5 hours late taking a pill. What should she do?

  1. Take the late pill now and use backup for 2 days Correct answer.
  2. Take the late pill and use no backup contraception
  3. Skip the late pill and resume at the usual time tomorrow
  4. Take two pills and use backup for 14 days

Explanation

The traditional norethindrone progestin-only pill has a 3-hour window; a dose more than 3 hours late requires taking the missed pill as soon as possible and using backup for 2 days. Ovulation may resume quickly once the progestin effect lapses. Doubling doses and prolonged backup are not recommended.

Question 20Contraception

Which statement about pelvic inflammatory disease after IUD insertion is correct?

  1. Universal antibiotic prophylaxis before insertion is recommended
  2. Screening for gonorrhea and chlamydia is required before every insertion
  3. Elevated risk is largely limited to the first 20 days Correct answer.
  4. The risk remains elevated for at least 12 months after insertion

Explanation

Contamination at the time of insertion transiently raises the risk of pelvic infection, and the excess risk is concentrated in the first 20 days. After that period, risk reflects the patient's own risk of sexually transmitted infection rather than the device. Routine antibiotic prophylaxis is not recommended, and screening should follow population risk rather than being mandatory for all.

Question 21Contraception

Which pattern best describes venous thromboembolism risk among combined oral contraceptive users?

  1. Risk falls sharply after the first 3 months and then remains at baseline
  2. Risk is highest during the first 3 months of use and after restarting Correct answer.
  3. Risk is highest after 5 years of continuous use because of cumulative exposure
  4. Risk is constant from the first cycle through the tenth year of use

Explanation

The absolute risk of venous thromboembolism is greatest in the first 3 months of combined hormonal contraceptive use and again after a break in use, reflecting a transient prothrombotic state. Risk then declines but remains above baseline for as long as the method is used. Risk does not accumulate with duration.

Question 22Contraception

A 38-year-old woman treated for estrogen receptor-positive breast cancer 2 years ago requests contraception. Which method is most appropriate?

  1. Copper intrauterine device Correct answer.
  2. Etonogestrel implant
  3. Transdermal contraceptive patch
  4. Combined oral contraceptive pills

Explanation

The copper IUD is category 1 for women with past or current breast cancer because it is nonhormonal. Hormonal methods are category 3 in this setting, with risks generally outweighing benefits in a hormone-sensitive tumor. The copper IUD also provides highly effective long-term contraception.

Question 23Contraception

A 30-year-old with systemic lupus erythematosus has positive antiphospholipid antibodies. Which method is contraindicated?

  1. Levonorgestrel intrauterine device
  2. Etonogestrel implant
  3. Combined oral contraceptive pills Correct answer.
  4. Copper intrauterine device

Explanation

Positive antiphospholipid antibodies with systemic lupus erythematosus confer a high risk of arterial and venous thrombosis, making combined hormonal contraception category 4. Estrogen-containing pills, patches, and rings are therefore avoided. Progestin-only and nonhormonal methods are acceptable alternatives.

Question 24Contraception

Which contraceptive concern is specific to a woman who has undergone a malabsorptive bariatric procedure such as Roux-en-Y gastric bypass?

  1. Oral contraceptive absorption may be reduced Correct answer.
  2. Intrauterine devices are less effective after surgery
  3. Depot medroxyprogesterone acetate is contraindicated after surgery
  4. Implants must be removed before surgery and never replaced

Explanation

Malabsorptive procedures decrease absorption of orally administered drugs, so the reliability of oral contraceptives becomes uncertain. Nonoral methods such as the IUD, implant, and injectable are preferred. Restrictive procedures without malabsorption are less of a concern, although vomiting and nutrient deficiencies still warrant counseling.

Question 25Contraception

A healthy 52-year-old woman with regular cycles asks how long she needs contraception. What is the best advice?

  1. Continue 12 months after the final natural menses
  2. Stop once a follicle-stimulating hormone level exceeds 30 IU/L
  3. Stop now, because fertility is negligible after age 50
  4. Continue until age 55 because spontaneous pregnancy is still possible Correct answer.

Explanation

A widely used guideline is to continue contraception until age 55, when spontaneous pregnancy is extremely unlikely, because ovulation can occur intermittently through perimenopause. For women over 50 who prefer a menses-based rule, contraception can stop after 12 months of amenorrhea if cycles were previously regular, or 24 months if they were irregular. A single hormone level does not confirm infertility.

Question 26Contraception

Which mechanism best explains the contraceptive action of a copper-bearing intrauterine device?

  1. Spermicidal effect and endometrial inflammation Correct answer.
  2. Suppression of the midcycle luteinizing hormone surge
  3. Persistent anovulation maintained by low progesterone
  4. Thickening of cervical mucus that blocks sperm entry

Explanation

Copper ions are directly toxic to sperm, and the device provokes a sterile inflammatory reaction in the endometrium that is spermicidal and hostile to implantation. The copper device does not reliably suppress ovulation and changes cervical mucus only minimally. Fertility returns promptly once the device is removed.

Question 27Contraception

Long-term use of combined hormonal contraception is associated with a reduced risk of which malignancy?

  1. Invasive cervical cancer
  2. Hepatocellular carcinoma
  3. Epithelial ovarian cancer Correct answer.
  4. Breast cancer

Explanation

Suppression of recurrent ovulatory follicular rupture and lower gonadotropin drive are thought to explain the durable reduction in epithelial ovarian cancer risk seen with combined hormonal contraceptives. The protection increases with duration of use and persists for decades after discontinuation. Endometrial cancer risk is also reduced.

Question 28Contraception

Which schedule describes standard use of the transdermal combined contraceptive patch?

  1. One patch weekly for 3 weeks, then 1 week without a patch Correct answer.
  2. A new patch every day for 21 days, then 7 days without a patch
  3. A single patch left in place for 21 days, then removed for 7 days
  4. A new patch every 72 hours for 21 days, then 7 days without a patch

Explanation

Each patch is designed to deliver hormone across the skin for 7 days, so standard cyclic use is one patch weekly for three consecutive weeks followed by a 7-day patch-free interval. Extended or continuous schedules exist but are not the standard regimen. Efficacy may be lower in women weighing 90 kg or more.

Question 29Contraception

A 24-year-old woman asks which contraceptive method will also lower her risk of acquiring gonorrhea and chlamydia.

  1. Etonogestrel subdermal implant
  2. External condom used consistently Correct answer.
  3. Copper intrauterine device
  4. Combined oral contraceptive pill

Explanation

Only barrier methods physically reduce transmission of bacterial sexually transmitted infections, and the latex external condom has the best supporting evidence when used consistently and correctly. Hormonal and intrauterine methods prevent pregnancy but provide no meaningful protection against gonorrhea or chlamydia. Dual protection should be discussed with all method choices.

Question 30Contraception

A woman using a 30-microgram ethinyl estradiol combined pill misses three consecutive active pills in the first week of a new pack and reports unprotected intercourse 2 days ago. What is the most appropriate advice?

  1. Take one pill each day and rely on the pill alone for the remaining week
  2. Take all three missed pills together and continue the pack as scheduled
  3. Stop the current pack now and restart a fresh pack seven days later
  4. Take one missed pill, finish the pack, and add 7 days of backup Correct answer.

Explanation

Missing two or more pills in the first week extends the hormone-free interval enough to permit escape ovulation, so contraception is no longer assured. She should take the most recent missed pill, continue the pack, use backup for 7 days, and be offered emergency contraception because unprotected intercourse occurred within the preceding 5 days. Taking extra pills to catch up does not restore protection.

Question 31Contraception

A woman using a combined vaginal ring finds that it has been out of the vagina for 6 hours during the second week of use. What should she do?

  1. Discard the ring and insert a new one after a 7-day interval
  2. Reinsert the same ring and continue without backup
  3. Reinsert the same ring and use backup for 7 days Correct answer.
  4. Switch to a progestin-only pill for the rest of the cycle

Explanation

The ring is only contraceptive while it is in place; an expulsion longer than 3 hours during weeks 1 or 2 requires prompt reinsertion plus 7 consecutive days of backup contraception. If the same thing happens during week 3, the ring-free week should be skipped and a new ring started. Expulsions shorter than 3 hours need no backup.

Question 32Contraception

A 44-year-old woman has repeated blood pressure readings averaging 164/104 mmHg, no other cardiovascular risk factors, and requests combined oral contraceptives. What is the best response?

  1. They are acceptable with a 20-microgram estrogen formulation
  2. They are contraindicated; offer a progestin-only method Correct answer.
  3. They are acceptable because she has no other cardiac risk factors
  4. They are acceptable once home readings confirm normal pressure

Explanation

Systolic pressure of 160 mmHg or higher, or diastolic pressure of 100 mmHg or higher, places combined hormonal contraception in category 4, meaning the method should not be used because of elevated stroke and myocardial infarction risk. Readings of 140-159/90-99 are category 3, and lower levels are generally category 2 or 1. Progestin-only and non-hormonal methods remain suitable.

Question 33Contraception

A woman with a previous ectopic pregnancy asks whether an intrauterine device remains an option for her. What is the correct advice?

  1. An IUD is contraindicated after any ectopic pregnancy
  2. An IUD is acceptable; her overall ectopic risk will be lower Correct answer.
  3. An IUD is acceptable only if the ectopic was treated with methotrexate
  4. An IUD is acceptable if she also uses condoms for 12 months

Explanation

Past ectopic pregnancy is not a contraindication to intrauterine contraception and does not restrict the choice of device. Because the absolute pregnancy rate with an IUD is very low, the overall chance of ectopic pregnancy falls even though any pregnancy that does occur with a device in place is more likely to be ectopic. She should be counseled to seek evaluation promptly if she misses a period or develops pain.

Question 34Contraception

A woman on a continuous combined oral contraceptive regimen with no hormone-free week reports 2 weeks of light unscheduled bleeding during her second month. What is the most appropriate management?

  1. Switch to a 21/7 schedule for the next few cycles
  2. Stop the pills and arrange endometrial biopsy within a week
  3. Add 10 days of oral estrogen to the current regimen
  4. Continue; unscheduled bleeding often settles within months Correct answer.

Explanation

Irregular bleeding is common in the first 3 to 6 months of extended or continuous combined regimens as the endometrium adjusts, and reassurance with continued use is usually appropriate. Adherence, smoking, and interacting drugs should be reviewed, and persistent bleeding beyond about 6 months warrants evaluation. Immediate biopsy is reserved for bleeding that persists or occurs in women at elevated risk of endometrial pathology.

Question 35Contraception

A couple is deciding between vasectomy and laparoscopic tubal sterilization. Which counseling point is most accurate?

  1. Vasectomy is safer and slightly more effective Correct answer.
  2. Vasectomy is less effective than laparoscopic tubal ligation
  3. Both procedures are designed to be easily reversed
  4. Vasectomy requires general anesthesia and an overnight stay

Explanation

Vasectomy is performed under local anesthesia in an office setting, has a failure rate of roughly 1 per 1000 procedures, and carries fewer major complications than tubal sterilization, whose failure rate is around 1 per 200. Neither procedure works immediately: vasectomy requires a negative semen analysis after about 8 to 12 weeks. Both should be presented as permanent.

Question 36Contraception

Which counseling point about nonoxynol-9 spermicide is correct?

  1. Frequent use may cause genital irritation and increase HIV risk Correct answer.
  2. It provides reliable protection against bacterial vaginosis and candidiasis
  3. It is recommended as a lubricant for both vaginal and anal intercourse
  4. It reliably inactivates HIV and substantially reduces sexual transmission

Explanation

Nonoxynol-9 damages vaginal and rectal epithelium with frequent use, and trials showed higher HIV acquisition among heavy users rather than protection. It should not be marketed or used for infection prevention. Spermicides also provide only modest contraceptive efficacy when used alone.

Question 37Contraception

A 30-year-old woman has a 52-mg levonorgestrel-releasing intrauterine device placed today. What bleeding pattern should she expect during the first few months?

  1. Heavy menses that increase over the first year
  2. Regular cycles identical to her baseline pattern
  3. Immediate amenorrhea in nearly all users
  4. Irregular spotting early, then lighter periods Correct answer.

Explanation

Early after insertion, unscheduled light bleeding and spotting are common as the endometrium responds to local levonorgestrel. Over subsequent months, bleeding usually becomes progressively lighter, and a substantial proportion of users develop amenorrhea by the end of the first year. This expected pattern should be explained in advance to improve satisfaction and continuation.

Question 38Contraception

A 36-year-old woman with decompensated cirrhosis and portal hypertension requests contraception. Which method is most appropriate?

  1. Transdermal contraceptive patch
  2. Combined oral contraceptive pill
  3. Monthly combined injectable
  4. Copper intrauterine device Correct answer.

Explanation

Combined hormonal methods are category 4 in decompensated cirrhosis because hepatic impairment alters estrogen metabolism and increases thrombotic and hepatic risk. The copper intrauterine device is highly effective, avoids hepatic metabolism, and is category 1 in this setting. Progestin-only methods and barrier methods are also reasonable alternatives.

Question 39Contraception

A woman with HIV who takes efavirenz-based antiretroviral therapy requests an etonogestrel implant. What is the correct guidance?

  1. The implant should be replaced every 2 years while on efavirenz
  2. The implant works only with a higher-dose efavirenz regimen
  3. The implant can be used despite a theoretical interaction Correct answer.
  4. The implant is contraindicated because efavirenz causes failure

Explanation

Efavirenz induces hepatic enzymes and may modestly lower etonogestrel concentrations, but pharmacodynamic and clinical data do not show a meaningful loss of contraceptive effectiveness, so the implant is classified as category 2. The method can be offered with counseling and does not require earlier replacement. If efficacy is a concern, a copper or levonorgestrel IUD is a highly effective alternative unaffected by enzyme induction.

Question 40Contraception

A woman who delivered by cesarean 4 weeks ago has a BMI of 34 and smokes 10 cigarettes daily. She is not breastfeeding and requests combined oral contraceptives. What is the best assessment?

  1. Combined pills are safe with a low-estrogen formulation
  2. They should be avoided because she has extra VTE risk factors Correct answer.
  3. Combined pills are safe if she stops smoking before starting
  4. Combined pills are safe at 4 weeks postpartum if she is not breastfeeding

Explanation

Between 21 and 42 days postpartum, combined hormonal contraception is category 3 when additional venous thromboembolism risk factors such as obesity, smoking, cesarean delivery, or immobility are present, so the risks generally outweigh the benefits. Without such factors the same interval is category 2. Progestin-only methods, the levonorgestrel or copper IUD, and barrier methods are appropriate alternatives.

Question 41Abortion Care

Which regimen is the most effective medication abortion regimen for a patient at 8 weeks of gestation?

  1. Mifepristone 200 mg orally, then misoprostol 800 mcg buccally 24–48 hours later Correct answer.
  2. Methotrexate 50 mg/m² intramuscularly, followed by misoprostol 800 mcg vaginally the next day
  3. Misoprostol 800 mcg vaginally, repeated every 3 hours for three total doses
  4. Mifepristone 600 mg orally, then misoprostol 400 mcg orally 48 hours later

Explanation

Combined mifepristone plus misoprostol is the most effective medical regimen, with 200 mg of mifepristone and 800 mcg of misoprostol given 24 to 48 hours apart. Misoprostol-only regimens are less effective and cause more gastrointestinal side effects. Older high-dose mifepristone and oral misoprostol regimens are no longer preferred.

Question 42Abortion Care

At what gestational age does standard Rh(D) immune globulin prophylaxis for an unsensitized Rh-negative patient change from 50 mcg to 300 mcg?

  1. 28 weeks
  2. 12 weeks Correct answer.
  3. 20 weeks
  4. 8 weeks

Explanation

A 50 mcg (250 IU) dose is sufficient through 12 weeks of gestation. After 12 weeks, a 300 mcg (1500 IU) dose is used because the volume of fetomaternal hemorrhage that must be covered is larger.

Question 43Abortion Care

A patient requests a copper intrauterine device after an uncomplicated first-trimester aspiration abortion. When is placement appropriate?

  1. Only after a negative urine pregnancy test in 4 weeks
  2. Immediately after the aspiration Correct answer.
  3. After the next menstrual period
  4. At least 6 weeks after the procedure

Explanation

Immediate postabortion IUD placement is safe, effective, and associated with higher uptake than delayed insertion. There is no need to wait for menses or a follow-up pregnancy test after an uncomplicated first-trimester aspiration.

Question 44Abortion Care

Which prophylactic antibiotic regimen is recommended before surgical abortion?

  1. Ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally
  2. Doxycycline 200 mg orally 1 hour before the procedure Correct answer.
  3. Azithromycin 1 g orally on the day of the procedure
  4. Metronidazole 500 mg orally twice daily for 5 days

Explanation

A single 200 mg oral dose of doxycycline before surgical abortion reduces the risk of postoperative endometritis. An alternative is 100 mg twice daily around the procedure. Broad regimens such as ceftriaxone plus azithromycin are not indicated for routine prophylaxis.

Question 45Abortion Care

Under current FDA labeling, mifepristone for medication abortion is approved through which gestational age?

  1. 49 days
  2. 63 days
  3. 77 days
  4. 70 days Correct answer.

Explanation

FDA labeling approves mifepristone for medication abortion through 70 days (10 weeks) of gestation. Evidence supports use through 77 days, but that is beyond the current label. The 49-day and 63-day limits reflect older or alternative protocols.

Question 46Abortion Care

Before initiating medication abortion, which finding requires further evaluation for possible ectopic pregnancy?

  1. An adnexal mass with free fluid on ultrasound Correct answer.
  2. Mild nausea and breast tenderness
  3. A gestational sac with a yolk sac inside the uterus
  4. A history of one prior vaginal delivery

Explanation

Ectopic pregnancy must be excluded before medication abortion. An adnexal mass with free fluid is concerning for ectopic pregnancy or another adnexal emergency. An intrauterine gestational sac with a yolk sac makes ectopic pregnancy unlikely, though heterotopic pregnancy is rare.

Question 47Abortion Care

Which of the following is a labeled contraindication to mifepristone for medication abortion?

  1. Controlled chronic hypertension
  2. Mild intermittent asthma
  3. Chronic adrenal failure Correct answer.
  4. A history of one cesarean delivery

Explanation

Chronic adrenal failure is a labeled contraindication because mifepristone has antiglucocorticoid activity. Other labeled contraindications include inherited porphyria and long-term anticoagulant therapy. Prior cesarean, mild asthma, and controlled hypertension are not contraindications.

Question 48Abortion Care

In a state with a parental involvement law, which mechanism allows a minor to obtain an abortion without notifying or obtaining consent from a parent?

  1. A referral from a family planning clinic
  2. A statement from the patient’s primary care physician
  3. A judicial bypass order Correct answer.
  4. A letter from a school counselor

Explanation

Parental involvement laws generally require consent or notification, but most provide a judicial bypass process. A judge can waive the requirement if the minor is mature enough or if the abortion is in her best interest. Other professionals cannot override the statutory requirement.

Question 49Abortion Care

A hemodynamically stable patient has an incomplete abortion at 10 weeks and prefers to avoid surgery. Which medical regimen is appropriate?

  1. Methotrexate 50 mg/m² intramuscularly
  2. Mifepristone 200 mg orally followed by expectant management
  3. Misoprostol 600 mcg orally as a single dose Correct answer.
  4. Oxytocin 20 units intramuscularly

Explanation

For incomplete abortion, misoprostol 600 mcg orally is an accepted medical treatment; vaginal or sublingual routes are also used. Methotrexate is for ectopic pregnancy, and oxytocin is not an outpatient treatment for incomplete abortion. Expectant management is an option, but mifepristone alone is not standard for incomplete abortion.

Question 50Abortion Care

Which cervical preparation is most appropriate before a dilation and evacuation at 16 weeks?

  1. No preparation because the cervix is already dilated by gestational age
  2. A single 200 mcg dose of misoprostol 1 hour before the procedure
  3. Balloon dilation of the cervix immediately before the procedure
  4. Osmotic dilators the day before, with or without misoprostol Correct answer.

Explanation

At 16 weeks, adequate cervical preparation is needed to reduce the risk of cervical injury and uterine perforation. Osmotic dilators placed the day before, often with adjunctive misoprostol, are standard. A single misoprostol dose 1 hour before is inadequate for second-trimester dilation.