MCCQE OBGYN High Yield: The Definitive Cheat Sheet

Obstetrics and Gynecology is a core specialty tested on the Medical Council of Canada Qualifying Examination (MCCQE) Part 1. The questions are based on the guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC). This cheat sheet outlines the key concepts you must master, focusing on hypertensive disorders of pregnancy, postpartum hemorrhage, and normal labor.

Key Takeaways

• The Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines define all OBGYN clinical standards on the exam (SOGC, 2026).
• Postpartum hemorrhage is a major cause of obstetric morbidity, and uterine atony is the cause in approximately 80% of cases.
• Hypertensive disorders of pregnancy must be classified correctly based on whether they present before or after 20 weeks of gestation.

Identifying and Managing Hypertensive Disorders of Pregnancy (HDP)

In 2026, SOGC guidelines classify hypertensive disorders of pregnancy into four main categories based on whether they present before or after 20 weeks of gestation (SOGC, 2026). You must distinguish these presentations to select the correct management:

1. Pre-existing (Chronic) Hypertension

• Definition: Hypertension (BP ≥ 140/90 mmHg) documented before pregnancy or presenting before 20 weeks of gestation. It persists postpartum.

2. Gestational Hypertension

• Definition: New-onset hypertension (BP ≥ 140/90 mmHg) presenting after 20 weeks of gestation, with no proteinuria or other signs of end-organ dysfunction. It resolves postpartum.

3. Preeclampsia

• Definition: New-onset hypertension (BP ≥ 140/90 mmHg) after 20 weeks of gestation, accompanied by proteinuria (protein-creatinine ratio ≥ 0.3 or 24-hour urine protein ≥ 300 mg) OR one or more adverse conditions/end-organ dysfunction (thrombocytopenia < 100 x 10^9/L, elevated liver enzymes, severe headache, visual disturbances, or pulmonary edema).
• Prevention: For patients with risk factors, start low-dose aspirin (150 mg daily) before 16 weeks of gestation and continue until 36 weeks.
• Definitive Treatment: The only cure for preeclampsia is delivery. If the patient is at 37 weeks or has signs of maternal or fetal compromise, delivery is indicated.

4. HELLP Syndrome and Eclampsia

• HELLP Syndrome: A severe variant of preeclampsia characterized by Hemolysis (schistocytes on blood smear, elevated LDH), Elevated Liver enzymes (AST or ALT elevated), and Low Platelets (< 100 x 10^9/L).
• Eclampsia: New-onset generalized tonic-clonic seizures in a patient with preeclampsia.

Magnesium Sulfate (MgSO4) Seizure Prophylaxis Protocol

You must memorize the administration and monitoring rules for magnesium sulfate:

• Indication: Seizure prophylaxis and treatment in severe preeclampsia or eclampsia.
• Dose: Loading dose of 4g IV over 20 minutes, followed by a continuous maintenance infusion of 1 to 2g/h.
• Clinical Monitoring (Critical):
  • Deep Tendon Reflexes (DTRs): Assess patellar reflexes. Loss of reflexes is the first clinical sign of magnesium toxicity.
  • Respiratory Rate: Monitor respiratory rate. Hold MgSO4 if rate is under 12 breaths/min.
  • Urine Output: Monitor output. Hold MgSO4 if output is under 30 mL/h (since magnesium is cleared renally).
• Antidote: If toxicity presents (loss of reflexes, respiratory depression, or cardiac arrest), stop the infusion immediately and administer Calcium Gluconate (10 mL of 10% solution IV over 3 to 5 minutes).

Many candidates think the primary goal of antihypertensive therapy in preeclampsia is to prevent seizures. In reality, antihypertensives (such as oral labetalol, nifedipine, or methyldopa) are used to prevent maternal stroke, while magnesium sulfate is the agent that prevents seizures.

master all high-yield subjects

Uterotonics and the Four Ts of Postpartum Hemorrhage (PPH)

Postpartum hemorrhage remains a major focus of acute care on the exam, with uterine atony causing approximately 80% of primary PPH cases (SOGC, 2026). Primary PPH is defined as blood loss of 500 mL or more after a vaginal delivery, or 1000 mL or more after a cesarean section.

Uterotonic Medication Sequence and Contraindications

Active management of the third stage of labor includes administering IM oxytocin (10 IU) immediately with delivery of the anterior shoulder to prevent PPH. If PPH occurs due to uterine atony, you must know the sequence of uterotonic agents and their contraindications:

1. Oxytocin: First-line agent. Given as an IV infusion or IM.
2. Carbetocin: Long-acting oxytocin agonist. Used primarily for prevention in cesarean sections.
3. Ergonovine: 0.25 mg IM or IV.
   • Contraindication: Hypertension or Preeclampsia. Ergonovine causes significant vasoconstriction and can precipitate severe acute hypertension or maternal stroke.
4. Carboprost (Hemabate): Prostaglandin F2-alpha, 0.25 mg IM.
   • Contraindication: Asthma. Carboprost causes smooth muscle contraction, which can lead to severe bronchoconstriction.
5. Misoprostol: Prostaglandin E1, 800 to 1000 mcg sublingually or rectally.

I once managed a postpartum hemorrhage case during my clerkship where the cause was a cervical laceration. The uterus was firm (normal tone), which immediately pointed us toward trauma. Remembering this distinction helped me select the correct option (surgical inspection) on a similar exam scenario.

To study the scheduling of prenatal visits, refer to:

• routine prenatal care milestones

Screening and Preventive Care Guidelines

In 2026, preventive gynecological screening is based on guidelines from the Canadian Task Force on Preventive Health Care (CTFPHC, 2026). You must know the age criteria and intervals for screening tests.

Cervical cancer screening with a Pap test starts at age 25 in most provinces, and is repeated every 3 years if results are normal. This is a common point of difference from US guidelines, which often recommend starting at age 21.

Other key screening topics include chlamydia and gonorrhea screening for sexually active individuals under 25, and gestational diabetes screening using the 50g oral glucose challenge test at 24 to 28 weeks of gestation.

To study the screening details, consult:

• Canadian screening guidelines cheat sheet

For public health immunization and reporting requirements, refer to:

• public health cheat sheet

Frequently Asked Questions

When do you start aspirin to prevent preeclampsia?

You start low-dose aspirin (150 mg daily) before 16 weeks of gestation in patients with high-risk factors, such as pre-existing hypertension or prior preeclampsia (SOGC, 2026).

What is the first-line medication for uterine atony?

Oxytocin is the first-line pharmacological treatment for uterine atony. It is administered immediately after delivery as part of the active management of the third stage of labor (SOGC, 2026).

At what age does cervical cancer screening begin in Canada?

Cervical cancer screening with a Pap test begins at age 25 in most Canadian provinces, and is performed every 3 years if results remain normal (CTFPHC, 2026).

Conclusion

Understanding OBGYN clinical guidelines is essential for the MCCQE Part 1. Focus your study on preeclampsia classification, the management steps for postpartum hemorrhage, and Canadian-specific screening ages.

• Use the 4 Ts to systematically diagnose the cause of postpartum hemorrhage.
• Remember that cervical cancer screening starts at age 25 in Canada.
• Know the first-line anti-hypertensive drugs used in pregnancy.

To practice these clinical OBGYN scenarios with mock questions, sign up for a Canadian-focused question bank.