Maternal-Fetal Medicine fellows care for patients with high-risk pregnancy needs in University of Iowa Hospitals & Clinics. Approximately 70% of patients delivered at the UI Hospitals & Clinics have medical, surgical, or obstetrical complications of pregnancy. There are almost 500 antepartum admissions per year. We have approximately 2,500 deliveries per year in our hospital.

High-Risk Obstetric Clinic (HROB Clinic)

The High-Risk Obstetric Clinic is scheduled five half days per week. Women are seen for consultations prior to or during pregnancy and for ongoing prenatal care when they need to deliver in our hospital. The indications for care run the spectrum of maternal risk factors. 

Each fellow is assigned to a HROB clinic for a half day each week. This is considered a continuity clinic for the fellows. The patients that are seen in clinic will then identify the fellow as their HROB doctor. The patient will be able to form a patient-physician relationship with the fellow. The fellow will then be responsible and held accountable for their patient’s plan of care.

Obstetrical Ultrasound

The fellow’s primary role will be as a sonographer trainee with hands-on ultrasound scanning. The fellow, along with our senior sonographer will perform hands-on scanning with graduated responsibility to proficiently perform full anatomy scans. The patients should primarily be the first trimester dating scans, second trimester screening ultrasounds, and follow-up growth ultrasounds. The selection of patients will change as the fellow’s skill advances throughout the rotation. The goal of this rotation is to learn and be able to identify normal fetal anatomy and fetal anomalies.

Fetal Diagnosis and Treatment (FDT) Clinic

Women with suspected or known fetal diagnoses are seen in the FDT Clinic. This clinic is staffed by registered sonographers, registered nurses, certified genetic counselors, and maternal-fetal medicine physicians. The fellows are responsible for the management and clinical care of patients in this specialized clinic under the direct supervision of the MFM physicians.

The fellow is expected to gain experience in counseling women about their ultrasound findings and testing options. The FDT Clinic provides expertise in prenatal diagnosis and ultrasound-guided procedures. The list of procedures performed includes:

• Chorionic villus sampling
• Amniocentesis for genetic and other indications
• Multifetal and selective reduction
• Miscellaneous procedures for drainage of fetal fluid accumulations, placement of shunts, etc.

The fellows will gain experience in performing these procedures. Additionally, the fellows participate in the Perinatal Care Conference for women with complex fetal disorders. This is a multidisciplinary conference with representatives from maternal-fetal medicine, genetic counseling, neonatology, nursing, perinatal palliative care, social work, and other pediatric subspecialties as needed. The pregnant woman and her family are included as well.

Antepartum Service

On this service, the fellows are expected to act as the functional attending staff in evaluating and determining management for the antepartum and postpartum patients. They are fully supervised and given real time feedback from the MFM faculty. They round daily with the MFM attending, antepartum resident, and the antepartum nurse practitioner/hospitalist. 

Labor and Delivery Supervisor

This rotation is incorporated in the antepartum rotations. The fellow is expected to be the functional attending staff in the evaluation and management of labor and delivery patients. Expectations include acting as primary attending staff on decisions and management of all labor and delivery patients, discussing all management plans with the staff attending labor and delivery, and teaching and supervising residents and medical students also scheduled on labor and delivery.

Medical Intensive Care Unit (MICU)

During this rotation, the fellows will be trained in critical care. This rotation is typically scheduled in the third year. The goal of this rotation is to give the MFM fellow hands-on experience in the medical management of critically ill patients.

Elective Rotations

We offer several elective rotations which include advanced obstetric ultrasound, endocrinology, infectious disease, blood bank medicine, medical genetics, fetal echo/adult congenital heart disease, family planning, and research. The fellow can choose among these electives or consult with the program director to design an elective in a specific clinical area of interest.

Research

The second full year of the MFM Fellowship is dedicated to research. During this year, the fellow takes graduate courses and focuses on their research interests. Two graduate courses are required in statistics and epidemiology. While on research, the fellow will have 10% clinical time with a half day clinic.

Education and Conferences

Departmental Education

The Department of Obstetrics and Gynecology Morbidity and Mortality (M&M) Conference is held on Tuesday mornings. During this time, cases from the preceding week are presented by the residents and discussed by the department. The fellows are encouraged to participate in this learning experience.

The Department of Obstetrics and Gynecology Grand Rounds follows the M & M conference. Grand Rounds consists of speakers from within the department, as well as invited guests from other medical institutions. The second-year and third-year fellows are expected to present one Grand Rounds conference per year. The third-year fellow typically presents his/her research thesis.

Fellows Didactic Sessions

Didactic sessions are held on Mondays to systematically review all basic science and clinical aspects of maternal-fetal medicine as described in the Guide to Learning. The format varies and includes traditional lectures, journal clubs, and maternal case review. Lecturers include faculty from the division and department and invited guests from other departments.

The fellows are encouraged to attend the Critical Care Fellowship Didactic Conference when the topics are relevant to MFM.

Departmental Quality and Safety Conferences

In compliance with Accreditation Council for Graduate Medical Education (ACGME) and American Board of Obstetrics and Gynecology (ABOG) requirements, fellows are expected to participate in quality and safety activities. The third-year fellow participates in the Severe Maternal Morbidity and Mortality Review Conference which entails case review and discussion.

University Lectures

Numerous outstanding University of Iowa and Carver College of Medicine lectures are scheduled throughout the year and fellows are encouraged to attend when possible.

Program Accreditation

The Maternal Fetal Medicine Fellowship Program at University of Iowa Hospitals & Clinics is accredited by the Accreditation Council for Graduate Medical Education.

Information specific to program requirements for a maternal fetal medicine fellowship training program and milestones for fellow performance are available with ACGME’s Obstetrics and Gynecology Review Committee (RC).

Board Certification

The American Board of Obstetrics and Gynecology (ABOG) is an independent, non-profit organization that certifies obstetricians and gynecologists in the United State. Visit their website for information on board certification requirements.

Departmental Education

The Department of Obstetrics and Gynecology Morbidity and Mortality (M&M) Conference is held on Tuesday mornings. During this time, cases from the preceding week are presented by the residents and discussed by the department. The fellows are encouraged to participate in this learning experience.

The Department of Obstetrics and Gynecology Grand Rounds follows the Morbidity and Mortality conference. Grand Rounds consists of speakers from within the department, as well as invited guests from other medical institutions. Each fellow presents at one Grand Rounds conference per year.

Didactic Sessions

Didactic sessions are held on Mondays to systematically review all basic science and clinical aspects of maternal-fetal medicine as described in the Guide to Learning. These include lectures by the faculty, fellows, and invited guests from other departments. 

Maternal-Fetal Medicine Journal Club

Maternal-Fetal Medicine Journal Club is a conference where faculty members and fellows collaborate on the presentation of articles.

University Lectures

Numerous outstanding University and College of Medicine lectures are available and fellows are encouraged to attend when possible. Opportunities include other departmental grand rounds and invited speakers.  

Program Accreditation

The Maternal Fetal Medicine Fellowship Program at University of Iowa Hospitals & Clinics is accredited by the Accreditation Council for Graduate Medical Education.

Information specific to program requirements for a maternal fetal medicine fellowship training program and milestones for fellow performance may be found at the ACGME’s Obstetrics and Gynecology Review Committee (RC).

Board Certification

The ABOG-American Board of Obstetrics and Gynecology is an independent, non-profit organization that certifies obstetricians and gynecologists in the United State. Visit the American Board of Obstetrics and Gynecology for information on board certification requirements. 

Maternal-Fetal Medicine (MFM) Research Opportunities for Fellows

Providing outstanding research training is a major objective of this fellowship program with the goal of each fellow completing a thesis that meets the requirements of the American Board of Obstetrics & Gynecology (ABOG). The fellow will receive a minimum of 12 months of protected time for research per ABOG and Accreditation Council for Graduate Medical Education (ACGME) guidelines. The first-year fellow has a four-week rotation mid-year to develop areas of interest and identify possible mentors. The goal of this rotation is to choose a project, identify a mentor, develop an outline for the proposed study, and begin an Institutional Review Board (IRB) application.

Research mentors can be within and external to the Department of Obstetrics and Gynecology. An ideal research mentor will provide guidance for the design, completion, and publication of the research thesis. The research mentor will be an established scientist with extensive extramural funding in the form of National Institutes of Health (NIH) grants or other large non-University of Iowa sources. 

The second year of our fellowship is the designated research year. This year has been designed so that clinical involvement is limited to no more than 10% of the fellow’s time. In the third year, additional months of electives focusing on specific clinical or research areas will also be assigned to each fellow under the direction of the program director.

There are multiple areas of research in the Department of Obstetrics and Gynecology, Carver College of Medicine, and the university at large. Perinatal research is being conducted by members of the division and the departments of medicine, pediatrics, anesthesia, genetics, psychiatry, orthopedics, and epidemiology. Most laboratories on campus are open to fellow participation. There are university-wide core facilities to support research.

Reproductive Science Research

Within the department there is the Reproductive Science Research Division. This division is well-funded and houses the Women’s Health Tissue Repository. This bio-repository includes the maternal Fetal Tissue Bank, the Paternal Contributions to Children’s Health Biobank, the Well Woman Bank, the Reproductive Endocrinology and Infertility Biobank, and the Gynecologic Malignancies Biobank. We have ultrasound reporting software and image storage available for ultrasound-based research projects.

Rural Maternal Health Disparities Research

There is an emerging opportunity for UI MFM Fellows to study rural maternal health disparities due to a recent grant award. In September 2019, the MFM Division, in partnership with the Iowa Department of Public Health (IDPH) received a five-year, $10 million grant from the Health Resources & Services Administration (HRSA) to improve maternal health outcomes in the state.

Iowa is one of nine states to receive a State Maternal Health Innovation Program grant from HRSA. The award will be used to create and implement innovative strategies to address disparities in maternal health and improve maternal health outcomes, with a particular emphasis on preventing and reducing maternal death and severe maternal illness. Areas of emphasis include expansion of maternal telehealth programs and the development and implementation of a rural track for the OBGYN residency, the Iowa Maternal Quality Care Collaborative (IMQCC), a mobile simulation unit, and certified nurse-midwifery training program.

Stephen Hunter, MD, PhD, UI professor of obstetrics and gynecology, vice chair for obstetrics and co-director of the Iowa Statewide Perinatal Care Program, is the principal investigator on the grant, and the team includes UI faculty in the departments of Obstetrics and Gynecology and Epidemiology, and staff at the IDPH.