Fellowship in Maternal Fetal Medicine

Program Description

Clinical ProgramResearch TrainingDidactic

Clinical Program

 

This fellowship program provides for an outstanding academic environment for training the next generation of academic Maternal-Fetal Medicine specialists grounded in a thorough understanding of maternal and fetal physiology and pathophysiology. Our program is based on the ABOG Guidelines for Training in Maternal-Fetal Medicine. We emphasize extensive and encompassing research program led by internationally known researchers in parturition and fetal origins of adult disease. The research program includes training in molecular biology and assay systems. A major feature of the research program will be the opportunity to work with several different animal models, including the baboon. The fellow will have an extensive number of highly qualified potential mentors from which to choose for their research training. We have ongoing research programs into a variety of maternal and fetal disorders using different animals models. In addition, we have adequate patient volume for clinical studies. The 12 month clinical training period will emphasize genetics, ultrasound, and maternal complications of pregnancy, including diabetes and hypertensive disorders of pregnancy. One month will be spent in the critical care units under the direction of the Department of Surgery. Exposure to neonatology and obstetric anesthesiology will occur in the first six months of the clinical program. We provide for the maximum of six months of elective time to allow the fellow to complete research or clinical training depending on the specific needs of the fellow. Our program is designed to position fellows for success in research and clinical care as they begin a productive academic career.

 

The clinical facilities available for training in Maternal-Fetal Medicine include the South Texas Women’s Perinatal Center, Methodist Hospital, St. Luke's Baptist Hospital, the University Health Center Downtown, and University Hospital.

 

The University Health Center Downtown clinic and the South Texas Women’s Perinatal Center are referral centers for Maternal-Fetal Medicine in San Antonio and parts of south Texas. These sites contain ancillary staffing and capital equipment sufficient for complete patient care, including procedure rooms with state of the art ultrasound machines and storage systems, and antepartum testing suites. The 2 facilities combined function 10 half-day sessions per week, accommodating approximately 15-20 patients daily. New patient visits number over 400 per year. Emphasis is placed upon treatment of difficult medical and genetic complications of pregnancy as well as an array of fetal anomalies. Fellows will gain experience in basic evaluation of the high risk pregnant patient, ultrasonography and related sonographic tools, invasive prenatal diagnosis techniques, amnioreduction, cordocentesis, fetal echocardiography, and training in nuchal translucency. Preconceptional and genetic counseling is also the basis of many consultations.

 

The schedule of the fellowship is made up of clinical and research rotations. During the first year, 6 months are spent on clinical rotations and 6 months are spent doing research. During the research experience, the fellow still participates in a continuity clinic and call responsibilities. The Fellow in their first year of training will be primarily responsible for seeing patients at the STWPC, the University Health Center Downtown clinics as well as attending to hospital activities on labor and delivery and the antepartum inpatient service. A designated faculty member is present at each session for supervision. Fellows also participate in consultations at the other facilities should they arise. Time is also spent with the Obstetrical Anesthesia and Neonatology faculty during inpatient rotations.

 

A weekly clinical conference is held by the Division. The agenda includes administrative issues as well as research updates.

 
 

Research Training

 

The academic facility of the Department of Obstetrics and Gynecology houses over 12,000 square feet of laboratory space. Specific laboratories are dedicated to molecular biology, cell biology, neuroendocrinology, reproductive immunology, electron microscopy, radioimmunoassays, and infectious disease. The Fellows may utilize any or all of these facilities, in order to acquire specific laboratory skills.

 

The laboratory experience begins soon after entry into the program. Individualized training is designed to teach Fellows research techniques, experimental design, data evaluation, and manuscript submission for publication of their research project. The Center for Pregnancy and Newborn Research is an integral part in the fellow’s research experience and the generation and completion of the thesis project.

 

In the RIA/Cell and Molecular Biology laboratories, Fellows are exposed to the technical aspects of measuring steroid and protein hormone levels in biological specimens. This training involves methods of extraction and isolation of hormones, preparation of standard curves for the assay and the quantification of unknown amounts of hormones/proteins in the specimens. In addition, methods of data analysis and trouble shooting various assay problems are presented. Complementary training in the detection, measurement and assay techniques for hormone receptor proteins may be acquired. Fellows will also learn standard molecular biology techniques including in situ hybridization, RNA/DNA isolation and Northern and Southern blotting, polymerase chain reaction (PCR), RNA estimation using reverse transcription PCR and other methods. Procedures for studies of mitogen signal transduction and preparation of transfected cell lines useful for these analyses are presented. Training in the ART laboratory includes methods of semen analysis, preparation of semen samples for intrauterine insemination, gamete/embryo in vitro culture techniques, an micromanipulation techniques including intracytoplasmic sperm injection and assisted hatching.

 

During the basic laboratory training, the Fellow will participate in a specific research project(s). Major research areas include: 1) cell biology of endometriosis and endometrium, 2) neuroendocrinologic aspects of reproduction (hypothalamic-hypophyseal axis, pineal, pituitary), 3) gamete and embryo development and cryopreservation, 4) drug abuse and reproduction, 5) molecular biology of reproductive tissues, 6) mitogen mediated signal transduction during regulation of cell proliferation 7) genetics of polycystic ovary syndrome and 8) placental function.

 

In addition to these opportunities, experience has shown that some fellows are capable of, and benefit from, developing a project of their own initiation. This opportunity will also be available. We have found that this decision is best made by the fellow and the Program Director.

 

There are also numerous ongoing clinical studies involving preterm birth and dental hygiene, stillbirth, and diabetes in pregnancy. Some of these studies involve patients being seen in the different clinical facilities mentioned above. We are also a clinical center for the National Children’s Study (MOTOR, stillbirth, etc.)

 
 

Didactic

 

The educational component of the program includes formal courses in the Graduate School of Biomedical Science and numerous weekly conferences. Didactic instruction involves both basic science and clinical aspects of maternal and fetal medicine.

 

A graduate level course in biostatistics and one additional graduate level course are required. The biostatistics course covers material germane to medical research: 1) descriptive statistics, 2) use of computers, 3) confidence intervals, 4) t-tests, 5) p values, 6) chi-square analysis, 7) analysis of variance, 8) regression and correlation analysis, 9) multiple regression analysis and 10) time series analysis. An ancillary computer workshop in statistics and statistical design of experiments is also available.

 

The graduate school offers several courses pertinent to Fellowship training. They include 1) Computer Science, 2) Developmental Genetics, 3) Methods in Cell and Molecular Biology, 4) Endocrinology of Reproduction, 5) Experimental Immunology and Immunopathology, 6) Immunobiology, 7) Neuroendocrinology, 8) Molecular Genetics and 9) Reproductive Physiology.

 

The Maternal-Fetal Medicine Didactic Conference is held each week and presentations on selected topics are given by the Faculty and Fellows. Topics are selected to review fundamental and current information on Maternal-Fetal Medicine as outlined by the Board publication, "A Guide to Learning in Maternal-Fetal Medicine." Journal clubs are held in the basic science and clinical areas. A Journal Club format is utilized periodically to discuss recently published articles of special significance. Topics and articles are selected from major areas of interest in Maternal-Fetal Medicine. The Journal Club encourages fellows to keep abreast of new ideas and technical development, and often generates novel research investigations. Monthly conferences are held with the neonatology department and include the Perinatal Mortality conference and the Multidisciplinary Prenatal Diagnosis Conference.

 
 

Weekly Schedule

 

The tables below illustrate the weekly schedule for the three years of fellowship training. During the clinical months (6 in year 1, 6 in year 3) the rotations are spent in the various high-risk clinics (Tuesday/Friday – diabetes in pregnancy clinic; Thursday – Genetics and MFM clinic; Monday/Tuesday/Wednesday/Friday – ultrasound/prenatal diagnosis clinic). Time not spent in clinic is spent on labor and delivery and the inpatient antepartum service. During the inpatient experience time is spent with the obstetrical anesthesia service as well as the neonatology service. One month during the clinical months is spent in the trauma intensive care unit. Teaching residents and medical students is an integral part of the fellowship. During the research months (6 in year 1, 12 in year 2) time is spent in the Center for Pregnancy and Newborn Research where the fellow’s thesis is developed. Clinical research is ongoing and also available for the fellow to pursue (see research section). During the research months the fellow attends the Genetics and MFM clinic or continuity and ultrasound clinic _ day per week. Call responsibilities continue during the research months as well. The final 6 months of year 3 is elective time to complete the thesis and/or obtain further clinical experience particular to the fellow’s interests.

 
  Schedule for Fellows - Year I – clinical (July –September, April - June)
  Monday Tuesday Wednesday Thursday Friday
7:30 am Division meeting Antepartum conf. C-section conf. Basic science journal club Antepartum conf.
9:00 am  Ultrasound clinic Diabetes and ultrasound clinic Ultrasound clinic Genetics and MFM clinic Diabetes and ultrasound clinic
12:30 pm     Grand Rounds Dept of Ob/Gyn    
1:00 pm Ultrasound clinic Ultrasound clinic High risk continuity clinic Ultrasound clinic

 

  Schedule for Fellows - Year I – research - (October – March)
  Monday Tuesday Wednesday Thursday Friday

7:30 am

Division meeting  Antepartum conf.  C-section conf. Basic science journal club  Antepartum conf.
8:30 am Research Research Research Genetics and MFM clinic Research

12:30 pm

    Grand Rounds Dept of Ob/Gyn    

1:00 pm

 Research  Research High risk continuity and ultrasound clinic  Research

Research

 

  Schedule for Fellows - Year II – research - (July - June)
  Monday Tuesday Wednesday Thursday Friday

7:30 am

Division meeting Antepartum conf.  C-section conf. Basic science journal club Antepartum conf.
8:30 am Research Research Research Genetics and MFM clinic Research
12:30 pm     Grand Rounds Dept of Ob/Gyn    
1:00 pm Research Research High risk continuity and ultrasound clinic Research Research

 

  Schedule for Fellows - Year III – clinical (July –December); elective (January – June)
  Monday Tuesday Wednesday Thursday Friday
7:30 am Division meeting Antepartum conf. C-section conf. Basic science journal club Antepartum conf.
9:00 am Ultrasound clinic Diabetes and ultrasound clinic Ultrasound clinic Genetics and MFM clinic Diabetes and ultrasound clinic
12:30 pm   Grand Rounds Dept of Ob/Gyn    
1:00 pm Ultrasound clinic Ultrasound clinic High risk continuity clinic   Ultrasound clinic