Overview of the Maternal Fetal Medicine Fellowship
The program is divided equally between pure research and pure clinical endeavors. A very strong basic science group is well-funded with primary areas of interest that include hypertensive diseases, prematurity, maternal/fetal physiology, and developmental programming. The basic science component includes a strong presence in perinatal epidemiology. A large clinical division with extensive expertise among its members that spans the full gamut of MFM further supports the fellowship. The clinical component includes an outstanding infrastructure with excellent administrative and research support services, a Perinatal Research Division, consisting of a team of seasoned research nurses and technicians, and an office of grants and publications. The Division is actively involved in several NIH Networks, including the Stillbirth Collaborative Research Network, the Obstetric and Fetal Pharmacology Network, the Genomic and Proteomic Network for Preterm Birth, and the Maternal Fetal Medicine Units Network. A substantial clinical base has been secured by an intensive satellite clinic system spanning 500 geographic miles of the Gulf Coast, and encompassing 30 outlying clinics. Annually, UTMB manages 6878 deliveries, 173,600 OB visits, 83,600 high risk and 11,800 Level II ultrasounds. Additional collaboration from Anesthesia, Neonatalogy & Pathology produce an outstanding educational opportunity.
Labor and Delivery and Antepartum Service (11 months)
During FY2006, 6878 total deliveries were performed by residents, Certified Nurse Midwives and private physicians. Total of 2365 cesarean section deliveries, 658 postpartum bilateral tubal ligations and 15 cesarean hysterectomies were performed. Intrauterine transfusions for Rh-isoimmunization and fetal parvovirus infection with hydrops. Multiple amnioreductions were performed for complications of twin-twin transfusions. The fellows will play the role of high risk consultants for the resident obstetrical service. Fellows will assist in the OR and labor room with deliveries and manage gravidium with medical complications such sickle cell crisis, lupus flare, thyroid storm, diabetic ketoacidosis and postpartum hemorrhage. They will also round and help residents with management of the antepartum service.
Ultrasound/ Genetics (4.5 months / 2 weeks)
The MFM fellow will attend the Genetic clinic and rounds with the genetic service with Dr. Lockhart. The fellows will learn the principles in the following: Patterns of inheritance- Hardy-Weinberg Law and its applications; Cytogenetics; Chromosomal Abnormalities- interpret chromosome pathology; Prenatal Diagnosis- be able to discuss amniocentesis and chorionic villous sampling and use of molecular genetic analysis; and Genetic screening. The fellow should be able to describe normal embryology and outline the general principles of teratology.
Level II ultrasounds are performed by Maternal Fetal Medicine faculties at Galveston clinic and Pasadena clinics. During FY2006, 11874 level II, Doppler studies and follow-up sonograms and 157 genetic or Rh-isoimmunization amniocentesis procedures were performed. MFM fellows spent 5 months on the ultrasound rotations with hands-on experience in sonogram scans, genetic amniocentesis, cystocentesis, amnioreduction and cordocentesis procedures. During the ultrasound rotation, the fellows will be assigned 4-5 patients for complete anatomical survey. They will also review with MFM faculty any ultrasound cases of congenital anomalies, chromosomal abnormalities, metabolic disorders and placental pathology. During L&D rotation and the night/weekend calls, the fellows will also perform level II sonogram evaluation of high risk pregnancies admitted to L&D or antepartum services on Philips En Visor ultrasound.
Neonatal Intensive Care Unit (1 month)
The fellow will rotate with the neonatology service and manage newborns and premies with prematurity complications. The fellow should be able to institute immediate care of the baby in the delivery room and understand neonatal adaptation. The fellow should be able to describe and perform resuscitation of the newborn, including: intubation and ventilation; drug use; cardiac massage; umbilical catheterization; volume replacement; temperature control; interpretation and management of acid-base and blood gas status. The fellow should be able to describe the etiology, management, sequelae, and, when appropriate, prevention of: respiratory disease, including meconium aspiration and persistent fetal circulation; hyperbilirubinemia; infection in the newborn; newborn seizures; metabolic abnormalities of the newborn including hypoglycemia, hypocalcemia; hemorrhagic disorders; intracranial hemorrhage; necrotizing enterocolitis; significant anomalies; alloimmune thrombocytopenia; and hydrops.
Obstetrics Anesthesia (1 month)
To provide an introduction to obstetric anesthesia. You will gain a better understanding and get a broader perspective in taking care of the obstetric patient. You will learn the basic concepts in the management of labor analgesia, anesthesia for cesarean section, tubal ligation and other operative obstetric procedures, including general anesthesia. You should be able to perform procedures including spinals and epidurals. You will be able to recognize and manage OB anesthesia related complications.
Maternal Fetal Medicine Fellow Clinic (Pasadena clinic / Pearland clinic- 3 per week)
The University of Texas Medical Branch at Galveston, Department of Obstetrics and Gynecology operates 19 Regional Maternal & Child Health Program clinics in Southeast Texas. During the FY2006, these clinics managed 123,600 Obstetrical visits and 83,600 high risk obstetrical visits. MFM fellows participate in the care of high risk obstetrical patients at the Pasadena RMCHP clinic along with a team of High Risk Nurse Practitioners. Every week, the high risk obstetrical patients are being managed in four Maternal Fetal Medicine Fellow clinics and twelve High risk Nurse Practitioners clinics. During FY2006, they managed 4796 high risk obstetrical visits at the Pasadena clinic by patients with multiple medical and obstetrical complications such as cardiomyopathy, pulmonary hypertension, breast cancer, Class B-R diabetes mellitus, connective tissue disorders, placenta accreta, incompetent cervix, multigestations, twin-twin transfusion and hypertensive disorders. The fellows are responsible for presenting high risk antepartum patients at the MFM conference for consensus in the plan of management.
Maternal Fetal Medicine / Perinatal Conference
Obstetrics and Gynecology Didactic lecture is held on Wednesdays. Residentsí Morbidity & Mortality conference starts at 7 am and followed by Grand Rounds and Residentsí Lecture. On Wednesdays, the fellows have an MFM Conference with focus on high risk obstetrics, prenatal diagnosis, medical complications of pregnancy, infectious complications of pregnancy, research topics and Journal Club. The perinatal conference is a joint conference with neonatologist, pediatric geneticists, obstetrical/neonatal pathologist. Neonatal cases, congenital anomalies cases, genetic/metabolic disorders and abnormal fetal/placental pathology cases are presented. During this conference, delivery plan for fetus with congenital defect are also made. The fellows are exposed to wealth of prenatal and neonatal medical knowledge.
Surgical Intensive Care Unit (optional - 1 month)
The fellow will participate in the initial evaluation, stabilization, and continuing management of patients admitted to the surgical intensive critical care including ventilator support, transfusion therapy and management of cardiac arrhythmias and heart failure. They will co-manage these critical patients along with MFM faculties and the SICU team. The fellow will participate in the placement and management of invasive monitors. The fellows also have an option of a one-month elective with SICU service.
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Last modified : 11/12/2007