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
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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
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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.