Regarding failure rates of contraceptive methods:

• a)
  

  The true method failure rate for cervical caps is dependent on parity

  
  
• b)
  

  In the UK the cumulative life table pregnancy rate for the contraceptive sponge is 24.5/100 WY

  
  
• c)
  

  The failure rate of vasectomy is quoted as 1:2000

  
  
• d)
  

  The no scalpel method of performing vasectomy is more effective in preventing a pregnancy than the scalpel method

  
  
• e)
  

  Female sterilisation is quoted as 1:200

Regarding efficacy of contraceptive methods:

• a)
  

  Progestogen only injectable contraceptives have a failure of 0.3 − 3/100 WY

  
  
• b)
  

  The efficacy of POPs is reduced by the use of liver enzyme inducing drugs

  
  
• c)
  

  Non-latex condoms have higher pregnancy rates compared to latex condoms.

  
  
• d)
  

  Breakage and slippage rates during condom use can be poor indicators of failure leading to pregnancy.

  
  
• e)
  

  Liver enzyme inducing drugs reduce the contraceptive efficacy of the COCP

Regarding reliability of contraception

• a)
  

  Efficacy refers to how well an intervention works in the situation of a clinical trial

  
  
• b)
  

  Typical use failure rates are derived from survey data and reflect actual use

  
  
• c)
  

  High intrinsic efficacy of a method consistently leads to low failure rates

  
  
• d)
  

  Failure rates of many methods increase after the first 12 months of use

  
  
• e)
  

  Discontinuation rates are higher for hormonal methods compared to withdrawal

Regarding the factors that affect risk of contraceptive failure

• a)
  

  Young age is less important than racial differences

  
  
• b)
  

  As coital frequency increases the risk of pregnancy rises

  
  
• c)
  

  Poverty impacts on the risk of contraceptive failure for all methods

  
  
• d)
  

  Discontinuation of the COC can be reduced by the quick start method

  
  
• e)
  

  Life table analysis controls for the effect of duration of use on efficacy rates

Regarding the legality of abortion worldwide:

• a)
  

  In all EU countries, abortion is available without restriction

  
  
• b)
  

  There are continental consistencies in the legality of abortion

  
  
• c)
  

  The proportion of women of reproductive age living in countries with highly restrictive abortions laws is greater than the proportion living in countries with more liberal laws

  
  
• d)
  

  In countries which permit legal abortion, the abortion rate is much higher than in those countries with restrictions

  
  
• e)
  

  Changes in abortion laws take many years to be translated into changes in practice

Trends in legal abortion worldwide:

• a)
  

  The largest decline in legal abortions over the last decade was reported in Eastern Europe

  
  
• b)
  

  Abortion rates vary not only by country but by population within countries

  
  
• c)
  

  Under-reporting of legal abortions is not significant in most countries

  
  
• d)
  

  Variations in the provision and legality of abortions worldwide does not influence the number of women choosing to end unplanned pregnancies

  
  
• e)
  

  Abortion rates and contraceptive prevalence are closely related

Until 2003 the World Health Organization (WHO) estimated that the highest rate of unsafe abortion per 1000 women in fertile age was found in:

• a)
  

  Central America and the Caribbean

  
  
• b)
  

  Eastern Central Europe

  
  
• c)
  

  Eastern Africa

  
  
• d)
  

  South America

  
  
• e)
  

  South Eastern Asia

The main interventions that have been successful in reducing the induced abortion rates are:

• a)
  

  Expanding information and access to contraceptive methods

  
  
• b)
  

  Offering family planning counselling and services immediately after abortion

  
  
• c)
  

  Introducing legislations that establishes severe penalties for women who had voluntarily induced abortion

  
  
• d)
  

  Introducing legislations that establishes severe penalties for practitioners who perform abortions

  
  
• e)
  

  Expanding programs of comprehensive and unbiased sex education in the school system

The contraceptive methods that are more effective at preventing unplanned/unwanted pregnancies and abortions are

• a)
  

  The combined contraceptive pill

  
  
• b)
  

  The copper T intrauterine device with 340 mm of copper surface (TCu 340 IUD)

  
  
• c)
  

  Hormone releasing Implants such as Implanon

  
  
• d)
  

  The combination of Periodic abstinence with the use of condoms

  
  
• e)
  

  Long acting injectables

The following statement(s) about presentation for termination of pregnancy at 13+ weeks is/are true:

• a)
  

  An increasing proportion of abortions were performed at 13+ weeks in the UK in 2007 compared to 2003

  
  
• b)
  

  The overall proportion of abortions carried out under 10 weeks has reduced between 1995 and 2005

  
  
• c)
  

  Lack of early awareness of pregnancy is an important reason why British women present for second trimester abortion

  
  
• d)
  

  There is evidence that women who have abortions late in the second trimester experience delays in referral for services

  
  
• e)
  

  The availability of state-funded abortion services does not impact on the distribution of abortion by trimester

Recognised risk factors for developing psychiatric illness post abortion include

• a)
  

  Previous psychiatric history

  
  
• b)
  

  Strong social supports

  
  
• c)
  

  Late abortion

  
  
• d)
  

  Having no previous children

  
  
• e)
  

  Where coercion to have an abortion is present

Abortion is associated with

• a)
  

  Increased rates of mental illness in some women

  
  
• b)
  

  Decreased rates of mental illness in some women

  
  
• c)
  

  Improvement in partner relationships overall

  
  
• d)
  

  Improvement in educational prospects in some women

  
  
• e)
  

  Negative sexual effects in up to 20% of women post abortion

Abortion is associated with

• a)
  

  A specific psychiatric disorders known as post abortion syndrome

  
  
• b)
  

  A high prevalence of psychotic illness

  
  
• c)
  

  An increased risk of substance abuse

  
  
• d)
  

  An increased risk of suicide

  
  
• e)
  

  A causal link to suicide

When counselling women undergoing termination of pregnancy:

• a)
  

  Rhesus negative women undergoing abortion in the first trimester require Rhesus prophylaxis.

  
  
• b)
  

  Surgical termination of pregnancy under local anaesthesia is likely to be associated with less surgical complications compared to cases having general anaesthesia.

  
  
• c)
  

  Manual vacuum aspiration is less effective than electric vacuum aspiration.

  
  
• d)
  

  Medical abortion using misoprostol only regimens is as effective as combined regimens of mifepristone and misoprostol.

  
  
• e)
  

  Mifepristone has a higher teratogenic potential compared to misoprostol

In the context of medical termination of pregnancy in the first trimester:

• a)
  

  The regimen is not licensed for use in women at 9–13 weeks of gestation and should, therefore, not be offered as an option in such cases.

  
  
• b)
  

  Misoprostol is as effective as gemeprost in this context and would be an acceptable alternative to gemeprost.

  
  
• c)
  

  When using misoprostol, oral administration has been shown to be more effective than vaginal administration.

  
  
• d)
  

  The majority of women undergoing medical abortion will require intramuscular opiates.

  
  
• e)
  

  Vaginal administration of misoprostol is likely to have a more rapid onset of action when compared to oral or sublingual administration.

The following statements are true about cervical priming with surgical termination of pregnancy:

• a)
  

  Women at higher gestations are less likely to have complications with surgery and, therefore, less likely to benefit from having cervical priming prior to abortion.

  
  
• b)
  

  Gemeprost is not a suitable option for use in this context.

  
  
• c)
  

  Vaginal administration of misoprostol is more effective than oral administration.

  
  
• d)
  

  The optimal priming to abortion interval with misoprostol is eight hours.

  
  
• e)
  

  The optimal dose of vaginal misoprostol in the context of cervical priming is 400 μgm.

The epidemiology of induced abortions suggests that:

• a)
  

  1 in 8 women have an abortion worldwide.

  
  
• b)
  

  The abortion rate is lower in Northern America compared to Europe in 2003.

  
  
• c)
  

  The abortion rate is rising in the United Kingdom.

  
  
• d)
  

  Most abortions are carried out medically in the United Kingdom.

  
  
• e)
  

  About one million women worldwide are hospitalised each year with abortion related complications

The following is/are true regarding the risk of complications of induced abortion worldwide:

• a)
  

  Approximately 1 in 4 of all induced abortions were estimated to be unsafe in 2003.

  
  
• b)
  

  Unsafe abortions account for 13% of maternal deaths

  
  
• c)
  

  Infective complications occur in ∼1% of women following induced abortion worldwide.

  
  
• d)
  

  Infective complications risks are much higher in medical abortion as compared to the surgical group.

  
  
• e)
  

  Overall complications rate secondary to induced abortion can be reduced by the use of Long Acting Reversible Contraception (LARCS)

Cost-effectiveness of prophylactic antibiotics:

• a)
  

  Universal prophylaxis has been shown to reduce infection rates by up to 50% and has been found to be cost-effective.

  
  
• b)
  

  Screen and treat is more effective than universal prophylaxis policy for reducing short term sequelae.

  
  
• c)
  

  Screening for Gonorrhoea is cost-effective in the United Kingdom

  
  
• d)
  

  The prevalence of Chlamydia trachomatis is declining in the western world

  
  
• e)
  

  For the treatment of confirmed Chlamydial infection, Doxycycline and Azithromycin are equally cost-effective

The following statement(s) is/are true about medical termination of pregnancy:

• a)
  

  Misoprostol oral route dosage is higher than the vaginal route

  
  
• b)
  

  Misoprostol is more effective than Gemeprost

  
  
• c)
  

  Misoprostol plus Mifepristone is the most cost-effective association

  
  
• d)
  

  Medical termination should be avoided in favor of the surgical one for late termination

  
  
• e)
  

  Interval between administration of Mifepristone plus Misoporstol is less than 12 h

The following statement(s) is/are true about surgical termination of pregnancy:

• a)
  

  D&E is not the treatment of choice before 15 weeks of gestation

  
  
• b)
  

  D&E is the treatment of choice after 15 weeks of gestation when undertaken by specialist trained practitioners

  
  
• c)
  

  Cervical osmotic dilators are not known to be safe and effective for cervical preparation prior to surgical termination of pregnancy

  
  
• d)
  

  Medical regimens for cervical preparation should be avoided

  
  
• e)
  

  Uterine rupture prevalence is between 1 and 10%

The following statement(s) is/are true about late selective fetal reduction:

• a)
  

  The associated risk of miscarriage is 20%

  
  
• b)
  

  Congenital heart defects are the least common abnormalities detected

  
  
• c)
  

  Laser coagulation has been demonstrated to be more effective than bipolar coagulation

  
  
• d)
  

  Any obstetrician is allowed to perform a feticide

  
  
• e)
  

  Most of the data on selective reduction was obtained from studies on TTTS, TRAP and selective IUGR pregnancies

The following statements are true regarding surgical abortion in the second trimester:

• a)
  

  D&E comprises the majority of second trimester abortions in the USA

  
  
• b)
  

  D&X is better than D&E

  
  
• c)
  

  D&E does not require any cervical dilatation preoperatively

  
  
• d)
  

  Bleeding happens mostly at lower gestational age

  
  
• e)
  

  The use of uterotonics, such as oxytocin, has been shown to be effective at reducing the amount of blood loss in surgical abortion in prospective trials

The following statements are true regarding medical abortion in second trimester

• a)
  

  Misoprostol is cheap and stable at room temperature while gemeprost must be stored below −10 °C.

  
  
• b)
  

  Gemeprost is more effective than misoprostol in second trimester abortion.

  
  
• c)
  

  The regimen of vaginal misoprostol 400 μg every 6 h is less effective than vaginal misoprostol every 3 h as proven by 2 randomised trials.

  
  
• d)
  

  Misoprostol together with mifepristone is proven to be a better option than D&E in second trimester abortion.

  
  
• e)
  

  Vaginal route of administration is more effective than oral or sublingual route of misoprostol in second trimester abortion.

Further regarding second trimester abortion:

• a)
  

  Second trimester abortions account for approximately 10% of all abortions in the UK

  
  
• b)
  

  Rates of second trimester abortion in the USA are in excess of 10%

  
  
• c)
  

  Approximately half of all major complications are attributable to those performed in the second trimester

  
  
• d)
  

  Uterine perforation has been shown to be reduced by routine intra-operative ultrasound guidance during D&E

  
  
• e)
  

  Facilitating access to first trimester abortion is likely to reduce the rate of complications

The following is/are true regarding second trimester abortion related bleeding:

• a)
  

  Bleeding is the most common complication of surgical abortion in the second trimester

  
  
• b)
  

  The use of uterotonics, such as oxytocin has been shown to reduce bleeding in prospective trials

  
  
• c)
  

  Uterine artery embolization has been shown to be effective in haemorrhage control in prospective studies

  
  
• d)
  

  Adequate cervical dilatation before D&E can help to reduce the risk of complications

  
  
• e)
  

  Laminaria tents have been shown to reduce the rate of bleeding

Regarding mechanical dilating agents:

• a)
  

  Laminaria is a genus of blue-green algae

  
  
• b)
  

  Laminaria is dehydrated before clinical use

  
  
• c)
  

  Prolonged intra-cervical placement is required with Laminaria

  
  
• d)
  

  Lamicel, a synthetic osmotic dilator, is a sterile tent of dehydrated polyvinyl alcohol

  
  
• e)
  

  Dilapan and Lamicel have been compared in controlled trials

Regarding second trimester abortion in women with previous Caesarean Section:

• a)
  

  The incidence of abortion in women with previous Caesarean Section is rising

  
  
• b)
  

  Both medical and surgical methods are considered safe in the literature

  
  
• c)
  

  Both gemeprost and misprostol are considered safe

  
  
• d)
  

  Systematic review has shown a uterine rupture rate of over 1% for women with one previous lower segment Caesarean

  
  
• e)
  

  Limited data support the higher rate of uterine rupture in women with previous classical Caesarean section

Regarding worldwide abortion

• a)
  

  An unsafe abortion is defined as a termination by persons lacking the necessary skills or in an environment lacking the minimal medical standards

  
  
• b)
  

  A safe abortion is one where there is considered no risk to the mother

  
  
• c)
  

  Unsafe abortions only occur in countries where it is illegal

  
  
• d)
  

  Safe abortions do not occur in countries where abortion is illegal

  
  
• e)
  

  The terms unsafe and illegal are essentially interchangeable terms

Regarding unintended pregnancies:

• a)
  

  Women’s perception of whether the pregnancy was planned or wanted can change over the time course of the pregnancy

  
  
• b)
  

  Women’s desire for fertility has been shown to be stable over time

  
  
• c)
  

  Changes in personal circumstances influence childbearing intentions

  
  
• d)
  

  Non-use of contraception appears to be most associated with ambivalence about falling pregnant

  
  
• e)
  

  Pregnancy ambivalence is associated with the use of less effective contraceptives