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MRCOG Part 1 - Complete Syllabus

Exam Format

• 2 papers, each with 100 Single Best Answer (SBA) questions = 200 questions total
• 2.5 hours per paper (5 hours total), with a 1-hour break between papers
• Scores from both papers are combined - you do NOT need to pass each paper separately
• Maximum 6 attempts allowed
• Taken at Pearson VUE test centres worldwide

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Structure: 4 Domains, 15 Knowledge Areas

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DOMAIN 1: Understanding Cell Function

1. Physiology

• Maternal physiological adaptations in pregnancy
  • Cardiovascular: increased cardiac output, decreased SVR, blood pressure changes
  • Respiratory: increased tidal volume, decreased FRC, physiological hyperventilation
  • Renal: increased GFR, renal plasma flow, glycosuria
  • Haematological: physiological anaemia, hypercoagulable state
  • Gastrointestinal: delayed gastric emptying, reduced lower oesophageal tone
• Fetal circulation and fetal-placental physiology
  • Ductus arteriosus, ductus venosus, foramen ovale
  • Fetal haemoglobin and oxygen dissociation curve
• Mechanism and physiology of labour
  • Myometrial contractility, role of prostaglandins, oxytocin
  • Biochemical basis of acid-base balance in labour
  • Fetal physiological changes during labour
• Menstrual cycle physiology
  • Follicular phase, ovulation, luteal phase
  • Hormonal regulation: FSH, LH, oestrogen, progesterone
• Puberty and menopause physiology
• Placental physiology: gas exchange, nutrient transfer, endocrine functions

2. Endocrinology

• Hypothalamic-pituitary-ovarian axis
  • GnRH pulsatility, FSH, LH regulation
  • Feedback mechanisms (positive and negative)
• Pituitary gland: anatomy, histology, hormones (GH, prolactin, TSH, ACTH, ADH, oxytocin)
• Thyroid, adrenal, and pancreatic physiology relevant to O&G
• Hormonal changes in pregnancy
  • hCG, progesterone, oestrogen (oestriol), HPL
  • Maturation of fetal endocrine system
• Physiology and endocrinology of parturition (myometrial signalling pathways)
• Endocrinology of contraception
• Reproductive endocrinology: ovulation, corpus luteum, PCOS

3. Biochemistry

• Metabolic pathways relevant to O&G
  • Carbohydrate metabolism; glucose homeostasis in pregnancy
  • Lipid and protein metabolism
  • Nutritional requirements in pregnancy
• Biochemical changes in pregnancy
• Biochemical basis of acid-base balance (arterial blood gas interpretation, fetal cord blood)
• Placental biochemistry
• Biochemistry of myometrial contractility
• Cell signalling pathways relevant to reproductive biology
• Biochemistry of steroid hormone synthesis

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DOMAIN 2: Understanding Human Structure

4. Anatomy

• Surgical anatomy of the pelvis and abdomen (high-yield area)
  • Bony pelvis: types, measurements, obstetric significance
  • Pelvic floor: muscles, fascia, perineal body
  • Uterus: relations, ligaments, blood supply, lymphatics, nerve supply, histology
  • Ovaries and fallopian tubes: relations, blood supply, histology
  • Vagina and cervix: structure, supports, relations
  • Bladder, ureter, and urethra - relations to reproductive organs (surgical importance)
  • Rectum and anal canal: relations
  • Pelvic blood vessels: internal iliac artery branches, venous plexuses
  • Pelvic nerves: lumbosacral plexus, pudendal nerve, autonomic supply
  • Lymphatic drainage of pelvic organs
• Abdominal wall
  • Layers, inguinal canal, hernial orifices
  • Anterior abdominal incisions (Pfannenstiel, midline)
• Breast anatomy: structure, lymphatic drainage (axillary nodes)
• Endocrine gland anatomy: thyroid, adrenal, pituitary (sella turcica)
• Female perineum: anatomy and principles of perineal repair
• Cell and tissue organisation
  • Cell organelles and their functions
  • Classification systems for gynaecological and obstetric conditions (FIGO, etc.)

5. Embryology

• Gametogenesis: spermatogenesis and oogenesis
• Fertilisation and implantation
• Early embryonic development (cleavage, morula, blastocyst)
• Gastrulation and germ layer derivatives
• Development of the reproductive system
  • Undifferentiated gonad, Müllerian (paramesonephric) and Wolffian (mesonephric) duct development
  • Sexual differentiation: role of SRY gene, androgens, anti-Müllerian hormone
  • Congenital anomalies: Müllerian anomalies (ASRM classification), cryptorchidism
• Development of the placenta and membranes
  • Trophoblast differentiation, villous development
  • Amniotic fluid dynamics
• Fetal organ development (cardiovascular, renal, CNS)
• Structural changes in the newborn at birth (closure of fetal shunts)
• Teratology: critical periods, mechanisms of teratogens

6. Genetics

• Chromosomal structure and cell division (mitosis and meiosis)
• Chromosomal abnormalities
  • Numerical: trisomies (Down's, Edwards', Patau's), Turner's (45X), Klinefelter's (47XXY)
  • Structural: deletions, inversions, translocations, isochromosomes
  • Confined placental mosaicism
• Mendelian inheritance patterns
  • Autosomal dominant, autosomal recessive, X-linked dominant, X-linked recessive
  • Examples relevant to O&G (CF, sickle cell, thalassaemia, fragile X, achondroplasia)
• Non-Mendelian inheritance
  • Mitochondrial inheritance, imprinting, uniparental disomy
• Molecular genetics
  • DNA replication, transcription, translation
  • Oncogenes and tumour suppressor genes; cellular biology of cancer
• Prenatal diagnosis and screening
  • First trimester combined screening (NT, PAPP-A, free beta-hCG)
  • Quadruple test (second trimester)
  • Cell-free fetal DNA (cfDNA/NIPT)
  • Invasive testing: amniocentesis, CVS - techniques, risks, interpretation
  • Karyotyping, FISH, chromosomal microarray
• Pharmacogenomics (basic concepts)
• Genetic basis of congenital disorders and gynaecological malignancies

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DOMAIN 3: Understanding Measurement and Manipulation

7. Biophysics

• Physics of ultrasound
  • Piezoelectric effect, transducers, frequency vs. resolution vs. penetration
  • Doppler principles: continuous wave, pulsed wave, colour Doppler
  • Artefacts in ultrasound
• Radiation physics and safety
  • Ionising radiation: X-rays, CT scans, radiation dose in pregnancy
  • MRI physics: basic principles, safety in pregnancy
• Fetal monitoring: CTG interpretation principles (physics of electronic fetal monitoring)
• Laser physics (colposcopy and surgical applications)

8. Epidemiology

• Study designs: cohort, case-control, RCT, cross-sectional, case series
• Measures of disease frequency: incidence, prevalence
• Measures of association: relative risk, odds ratio, attributable risk, NNT
• Bias, confounding, and effect modification
• Screening principles
  • Wilson and Jungner criteria
  • Sensitivity, specificity, PPV, NPV
  • ROC curves
• Epidemiology of conditions relevant to O&G
  • Subfertility, maternal mortality, perinatal mortality
  • Gestational diabetes, pre-eclampsia, ectopic pregnancy
  • Gynaecological malignancies (cervical, endometrial, ovarian cancer)
  • Sexually transmitted infections
  • TORCH infections (Toxoplasma, Rubella, CMV, HSV, parvovirus B19, Zika)

9. Statistics

• Descriptive statistics: mean, median, mode, SD, IQR
• Types of data: nominal, ordinal, interval, ratio
• Normal distribution and standard deviation
• Hypothesis testing
  • Null hypothesis, p-value, type I and II errors
  • Statistical power and sample size calculations
• Parametric tests: t-test (paired and unpaired), ANOVA, Pearson correlation
• Non-parametric tests: Mann-Whitney U, Wilcoxon, Spearman correlation, chi-squared
• Confidence intervals
• Systematic review and meta-analysis: forest plots, funnel plots, heterogeneity (I2)
• Kaplan-Meier survival curves, log-rank test
• Number needed to treat (NNT) and number needed to harm (NNH)

10. Data Interpretation

• Interpretation of haematological investigations
  • FBC, coagulation screen, blood film
• Interpretation of biochemical investigations
  • Renal and liver function, thyroid function, tumour markers (CA-125, AFP, hCG)
• Interpretation of endocrine investigations
  • Hormone profiles (FSH, LH, oestradiol, testosterone, prolactin, AMH)
• Interpretation of imaging
  • Ultrasound (transvaginal, transabdominal)
  • CTG traces in labour
  • CTG features: baseline, variability, accelerations, decelerations (type classification)
• Fetal blood gas and cord blood gas interpretation
• Prenatal screening results interpretation
• Microbiology results interpretation

11. Pharmacology

• Pharmacokinetics: absorption, distribution, metabolism, excretion; placental transfer
• Pharmacodynamics: receptor theory, dose-response curves, agonists/antagonists
• Drug teratogenicity
  • FDA/ADEC categories, mechanisms of teratogenesis
  • High-risk drugs: thalidomide, valproate, warfarin, ACE inhibitors, isotretinoin, cytotoxics
• Obstetric pharmacology
  • Uterotonic agents: oxytocin, ergometrine, misoprostol, carboprost (mechanisms, doses, side effects)
  • Tocolytics: nifedipine, atosiban, betamimetics
  • Magnesium sulfate (eclampsia, neuroprotection)
  • Antenatal corticosteroids (betamethasone, dexamethasone)
  • Antihypertensives in pregnancy (labetalol, methyldopa, nifedipine, hydralazine)
  • Anticoagulation in pregnancy (heparin vs. warfarin, LMWH)
  • Antibiotics: beta-lactams, macrolides, aminoglycosides - safety in pregnancy
• Gynaecological pharmacology
  • Hormonal contraception: combined OCP, progestogen-only pill, DMPA, implants, IUS/IUD
  • Fertility drugs: clomifene, gonadotrophins, GnRH analogues, letrozole
  • Drugs used in early pregnancy: mifepristone, misoprostol, methotrexate
  • Drugs for menstrual disorders: tranexamic acid, mefenamic acid, norethisterone
  • HRT preparations
  • Endometriosis drugs: GnRH agonists, danazol, progestogens
  • Cervical ripening: prostaglandins

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DOMAIN 4: Understanding Illness

12. Immunology

• Basic immunology
  • Innate vs. adaptive immunity
  • Cellular immunity (T lymphocytes: CD4, CD8) and humoral immunity (B cells, antibodies)
  • Complement system (classical, alternative, lectin pathways)
  • MHC class I and II, HLA system
• Maternal immune adaptations in pregnancy
  • Immune tolerance mechanisms (Th1/Th2 shift, regulatory T cells, trophoblast immune evasion)
  • Placental immunology: uterine NK cells, decidual immunology
• Immunology of reproductive failure
  • Antiphospholipid syndrome: antibodies, thrombotic and pregnancy morbidity criteria
  • Alloimmune causes of miscarriage
  • Red cell alloimmunisation: anti-D, Kleihauer test, anti-D prophylaxis
  • Neonatal alloimmune thrombocytopenia (NAIT)
• Autoimmune conditions in pregnancy
  • Systemic lupus erythematosus (SLE)
  • Thyroid autoimmunity
  • Inflammatory bowel disease
• Hypersensitivity reactions (Type I-IV: mechanisms)
• Immunology of infection: maternal immune response to organisms

13. Microbiology

• Bacteria relevant to O&G
  • Group B Streptococcus (GBS): carriage, neonatal infection, IAP
  • Group A Streptococcus: puerperal sepsis
  • Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum (syphilis)
  • Bacterial vaginosis: organisms, Amsel criteria, treatment
  • Listeria monocytogenes: food safety in pregnancy
  • Escherichia coli, Staphylococcus aureus (including MRSA), Clostridium species
• Viruses relevant to O&G
  • HIV: transmission (vertical), management in pregnancy, drug classes
  • Herpes simplex virus (HSV): primary vs. recurrent, neonatal herpes, aciclovir
  • Cytomegalovirus (CMV): congenital infection, manifestations
  • Rubella: congenital rubella syndrome, vaccine
  • Parvovirus B19: hydrops fetalis, slapped cheek disease
  • Varicella zoster virus (VZV): chickenpox in pregnancy, neonatal varicella
  • Hepatitis B and C: vertical transmission, vaccination
  • Human papillomavirus (HPV): types, cervical cancer link, vaccines
  • Zika virus: microcephaly, travel advice
  • SARS-CoV-2: effects in pregnancy (for completeness)
• Protozoa and parasites
  • Toxoplasma gondii: transmission, congenital toxoplasmosis, treatment (spiramycin/pyrimethamine)
  • Trichomonas vaginalis: diagnosis, treatment
  • Malaria: P. falciparum in pregnancy, management
• Antifungals relevant to O&G (Candida - azoles, nystatin)
• Antimicrobial drug classes and mechanisms (beta-lactams, macrolides, tetracyclines, aminoglycosides, fluoroquinolones, metronidazole, antivirals)
• Antimicrobial resistance mechanisms

14. Pathology

• General pathology
  • Cell injury, adaptation, and death: apoptosis vs. necrosis
  • Inflammation: acute and chronic
  • Wound healing
  • Neoplasia: benign vs. malignant, grading vs. staging
  • Tumour spread: local invasion, lymphatic, haematogenous, transcoelomic
• Obstetric pathology
  • Pre-eclampsia: pathophysiology (spiral artery remodelling failure, sFlt-1/PlGF imbalance, endothelial dysfunction)
  • Placenta praevia, placental abruption: pathology
  • Placenta accreta spectrum: pathology
  • Gestational trophoblastic disease: complete vs. partial mole, choriocarcinoma
  • Miscarriage pathology: types, chromosomal causes
  • Ectopic pregnancy: sites, pathology
• Gynaecological pathology
  • Endometriosis: pathogenesis theories, staging (rASRM), histology (chocolate cysts)
  • Leiomyomata (fibroids): types, histology, degeneration types
  • Endometrial polyps vs. hyperplasia vs. carcinoma (WHO classification)
  • Ovarian tumours: surface epithelial, germ cell, sex cord-stromal - WHO classification, histology
  • Cervical cancer: CIN grading, squamocolumnar junction, adenocarcinoma vs. squamous
  • Vulval pathology: lichen sclerosus, VIN, Paget's disease
• Histopathology of the normal reproductive tract

15. Clinical Management

• Principles of clinical management in O&G
  • History and examination; use of investigations
  • Evidence-based medicine: levels of evidence, GRADE system
  • Risk assessment and clinical governance
• Antenatal care
  • Booking investigations and their rationale
  • Fetal growth monitoring and surveillance
  • Antenatal screening programmes (Down's syndrome, structural anomalies)
• Intrapartum care
  • Mechanisms of normal labour
  • Fetal assessment in labour (CTG, fetal blood sampling)
  • Operative delivery: indications, contraindications, risks
  • Third stage management (active vs. physiological)
  • Perineal repair principles
• Postnatal care
  • Normal puerperium
  • Postnatal mental health
• Early pregnancy
  • Miscarriage management (expectant, medical, surgical)
  • Ectopic pregnancy: diagnosis and management (salpingotomy vs. salpingectomy, methotrexate criteria)
  • Gestational trophoblastic disease: follow-up principles
• Gynaecological conditions
  • Menstrual disorders: investigation and management principles
  • Pelvic inflammatory disease: diagnosis criteria, microbiology, treatment
  • Subfertility: initial investigation pathway, causes
  • Contraception: methods, mechanisms, contraindications (UKMEC categories)
  • Menopause and HRT: types, indications, contraindications
  • Gynaecological oncology: surgical staging, principles of management
• Public health
  • Cervical screening: colposcopy referral criteria, HPV primary screening
  • National screening programmes (antenatal, postnatal)
  • Maternal mortality statistics and classification (MBRRACE-UK)

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Exam Blueprint: Paper Distribution

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Official RCOG Curriculum: 14 Knowledge Areas Mapped to O&G Clinical Modules

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Recommended Resources

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High-Yield Tips

• Anatomy is consistently the most heavily tested area in Paper 1 - master pelvic surgical anatomy
• Physiology questions frequently link to clinical scenarios (e.g., pre-eclampsia pathophysiology, CTG changes)
• Pharmacology in Paper 2 tests drug mechanisms and teratogenicity rather than prescribing doses
• Statistics questions are very formulaic - learn the test selection algorithm (parametric vs. non-parametric)
• Genetics - prenatal diagnosis techniques and chromosomal abnormality patterns are high yield
• Immunology - antiphospholipid syndrome and Rh alloimmunisation feature repeatedly
• All questions are SBA format (no negative marking) - eliminate wrong answers systematically