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Fellowship Program in Maternal-Fetal Medicine

THIS PROGRAM PARTICIPATES IN THE ELECTRONIC RESIDENCY APPLICATION SERVICES (ERAS). INTERESTED APPLICANTS ARE ENCOURAGED TO APPLY VIA ERAS.

I. GENERAL DESCRIPTION

This fellowship program provides comprehensive training in Maternal-Fetal Medicine. The division is staffed by 9 core faculty members. The clinical bases for the fellowship are at Robert Wood Johnson University Hospital and Jersey Shore University Medical Center, two major regional perinatal centers. The Maternal-Fetal Medicine Division serves a referral network in Central New Jersey with a catchment area of approximately 10,000 deliveries a year.

The fellow participates in a variety of clinical activities which cover the entire range of Maternal-Fetal Medicine practice, supplemented by formal lectures, conferences, courses and research activities. The division includes a large Antepartum Testing Unit with ample exposure to diagnostic ultrasound, amniocentesis, chorionic villus sampling, fetal echocardiogram, a perinatal genetics section (an obstetrician/geneticist and 2 genetic counselors) and critical care obstetrics. The research activities of the division cover clinical, basic science, and epidemiology areas and the fellow is expected to participate in several projects. Our division’s laboratory is studying molecular mechanisms of human parturition. Within the department and university, there are many basic science research opportunities.

One of many strengths of our department is population-based research, with a full-time perinatal epidemiologist employed by the department. An extensive computer network involving antepartum ultrasound data, as well as intrapartum and outcome data, are available to facilitate clinical research. A regional perinatal computerized data system is also available for research.

2. THE FACULTY OF MFM DIVISION.
The Division of Maternal-Fetal Medicine consists of accomplished physicians as follows:

Todd Rosen, MD
Program Director, Fellowship Program for Maternal Fetal Medicine
Director, Maternal-Fetal Medicine Division
Department of Obstetrics, Gynecology and Reproductive Sciences
Robert Wood Johnson Medical School

Joseph Canterino, MD
Associate Professor
Jersey Shore University Medical Center
JSUMC Rotation Director, Fellowship in Maternal-Fetal Medicine
Director, Perinatal Genetics

Valeria DiStefano, MD

Assistant Professor

Department of Obstetrics, Gynecology and Reproductive Sciences

William MacMillan, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences

Paul Matta, DO
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Marlene Schwebel, JD, APN
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Director, High Risk Perinatal Center at RWJUH

Bingbing Wang, PhD

Assistant Professor

Director, Perinatal Translation Laboratory

3. BASIC RESEARCH FACILITIES.
The OB/GYN Department Perinatal Biology laboratories, directed by Bing Bing Wang, PhD, are located in New Brunswick, New Jersey adjacent to our clinical and academic offices and offers resources for cell biology studies, protein analysis, PCR and immunohistochemistry. Areas of interest include a) inflammation pathways, b) mycoplasma virulence, c) and immunologic function of the cervix, vagina, and placenta. Additional laboratory facilities located in Piscataway, New Jersey are directed by Dr. William Moyle, PhD and four technicians. The main focus of the laboratory is to provide new information about the interactions of reproductive hormones and their receptors as related to fertility and pregnancy. Basic research opportunities also exist in collaboration with: (1) the Department of Pediatrics Genomics Laboratories; (2) the Division of Neonatology Cytokine/Inflammation program; (3) the Rutgers School of Pharmacy Extracellular Matrix laboratories directed by Dr. Emmy Gordon; (4) the environmental laboratories of the Environmental and Occupational Health Sciences Institute; (5) Proteomics laboratories of New Jersey Medical School, Newark; and (6) the UMDNJ Child Health Institute.

4. AVAILABILITY OF COMPUTERIZED PERINATAL DATA SYSTEMS.
The MFM Division has already in place and fully functioning, two clinical information systems for the Labor and Delivery Suite and the ultrasound unit. A newly updated GE Viewpoint computer system for our ultrasound unit runs on a departmental wide network. There are data entry workstations located in the ultrasound examination rooms and workstations in the dedicated reporting rooms. This data storage and reporting system provides the capability for the direct downloading of biometric information acquired during the ultrasound evaluations, as well as image archiving. The described perinatal data systems provide a unique opportunity for the fellows to conduct clinical research studies. RWJUH also has a computerized medical record for Labor and Delivery.

5. AVAILABILITY OF A CLINICAL RESEARCH CENTER.
The clinical research center of the Robert Wood Johnson Medical School is a combined in-patient and out-patient facility with extensive experience in administration of clinical research protocols. It includes 12 licensed in patient beds with a capacity to expand to 16, including 4 beds equipped with electronic monitors for electrocardiographic and invasive physiologic studies. There are also 4 out-patient clinic rooms in the facility with a phlebotomy suite which can accommodate several hundred patient visits per week. The center offers the fellows the opportunity to conduct many safety and tolerability studies, as well as pharmacokinetic drug trials. A new pediatric clinical research center is also in development.

6. DIVISIONAL RESEARCH INTERESTS

  • Patterns of Normal Embryonic Growth.
  • Prenatal Cytogenetic Diagnosis by Array-Based Copy Number Analysis. NIH Grant funded.
  • Hospital Survey of Contemporary Management of Women at Risk for Preterm Delivery.
  • Do Women Who Have First Trimester Down Syndrome Screening Require Serum MSAFP Screening? A Decision Analysis.
  • Thrombophilia Polymorphisms and the Risk for Adverse Pregnancy Outcomes.
  • Do Women Reliably Report Their Smoking Histories During Pregnancy?
  • Exploration of a Model for CRH Regulation in the Human Placenta. Institutionally funded for a period of four years. Laboratory opening July 2010.

7. DIVISIONAL RESEARCH INTERESTS

  • Pre-Pregnancy Health
  • Screening strategies to correctly identify women at high-risk for perinatal
    complications
  • Folic acid supplementation to prevent birth defects
  • Treatment of medical conditions that can affect perinatal outcomes
  • Define racial and ethnic contributions to pre-pregnancy health that affect perinatal outcomes
  • Pre-pregnancy evaluations of previous medical, obstetric and neonatal complications to help design treatment strategies for before, during and after pregnancy
  • Preterm Birth Research
  • Infection
  • Apoptosis (programmed cell death)
  • Ultrasound as a screening tool to predict preterm birth
  • Population-based risk factor analyses
  • Population-based infant outcome studies
  • Preterm infant follow-up studies (prediction of morbidity and mortality, respiratory function, neurodevelopmental function)
  • The extracellular matrix in membranes, cervix and uterus
  • The extracellular matrix in newborn vascular adaptation to life outside the uterus
  • Immunologic aspects of prematurity (inflammation, immune tolerance, immune system dysfunction)
  • Hypertensive Diseases of Pregnancy
  • Screening for at-risk women using ultrasound and Doppler evaluations
  • Monitoring and managing pregnancies with preeclampsia
  • Placental abnormalities with preeclampsia
  • Blood clotting disorders (thrombophilias) as risk factors
  • Population-based risk factor analyses
  • Population-based infant outcome studies
  • Markers of oxidative stress with preeclampsia
  • Prevention trials
  • Vascular reactivity
  • Fetal Growth
  • Non-invasive ultrasound Doppler assessments of altered maternal vascular reactivity and uteroplacental blood flow blood flow
  • Management of pregnancies at high risk for abnormal fetal growth
  • Mechanisms of fetal and neonatal nutritional compromise
  • Neonatal and infant outcomes
  • The long-term consequence of abnormal fetal growth
  • Population-based risk factor and outcome studies
  • Prevention trials
  • Fetal and Neonatal Brain Development
  • Normal and abnormal fetal behavior as a predictor of neurologic function
  • New techniques for assessing fetal and neonatal neurologic function
  • Imaging: Ultrasound, (MRI), and EEG
  • The role of oxidative stress and inflammatory injury in neurologic development
  • The effects of abnormal fetal growth and low birth weight on neurologic function.
  • Predictors of developmental outcomes
  • Interventions to improve developmental outcomes in at-risk infants
  • Long-term follow-up of at risk infants
  • Birth Defects and Prenatal Diagnosis
  • Epidemiological studies of congenital abnormalities
  • Improved ascertainment and tracking of diagnosed congenital abnormalities
  • UMDNJ New Jersey Fetal Abnormalities Registry which is a cooperative effort with the NJ Department of Health and Senior Services and the Centers for Disease Control and Prevention, Atlanta, GA.
  • Etiology studies
  • Application of cost efficient screening strategies
  • New diagnostic modalities (testing and imaging)
  • Management of diagnosed congenital abnormalities
  • Short and long-term outcomes
  • Economics of congenital abnormalities
  • Early Origins of Adult Disease
  • Fetal growth restriction/malnutrition
  • Prematurity
  • Congenital malformations
  • Infection
  • Hypoxia
  • Interventions that can moderate the impact of theseconditions on later health
  • Follow-up outcome studies
  • Pregnancy Loss
  • Epidemiology
  • Cost-effective and evidence-based evaluation strategies
  • Immunologic mechanisms of fetal loss
  • Disorders of blood clotting systems and fetal loss
  • Placental dysfunction
  • Gene-environment interactions
  • Prevention studies
  • Perinatal Health EconomicsInformation systems development and implementation
  • Cost effectiveness/benefit analyses
  • Database design and data management
  • Relevant outcome assessments
  • Condition specific care research
  • Perinatal Epidemiology and Outcomes Research
  • Black-white disparities in adverse perinatal outcomes in the US, including prematurity, fetal growth restriction, fetal and infant mortality.
  • The role (both content and timing) of prenatal care on adverse perinatal outcomes.
  • Provide recommendations on indication-specific "optimal" prenatal care in the US.
  • Secular and temporal trends in the incidence of preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
  • Causes of temporal trends in preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
  • The role of age, period and birth cohort effects on preterm delivery and small for gestational age births among US blacks and whites.
  • Risk factor profiling of obstetric complications among singleton and twin births in the US.
  • Gene-environment interactions, as well as familial aggregation of placental abruption, fetal growth restriction, and stillbirth, through family-based case-control studies.
  • Developing innovative statistical methodologies for analysis of studies, especially focusing on methods for longitudinal and repeated measures (clustered) data.

III. NARRATIVE DESCRIBING DIDACTIC ACTIVITIES

The didactic activities consist of the following lecture series and conferences:

A. Lecture Series
Ob/Gyn/Resident lecture series (every Monday 12 noon to 1:00 p.m.);
Ob/Gyn Resident/MFM Fellow/Chairman’s Obstetric case review (every Monday and Wednesday 4:00 – 5:00 p.m.);
Grand Rounds lecture series (every Friday of the month, 8:00-9:00 a.m.); and
MFM core curriculum lecture series (given by fellow on the last Wednesday of the month, 4:30-5:30 p.m.).

B. Conferences
Fetal Ultrasound Diagnosis and Management Conference (every Wednesday 12 noon to 1:00 p.m.);
Combined MFM/Neonatal Conference (every second and fourth Wednesday of the month, 1:00-2:00 p.m.);
Perinatal Genetics Conference (every first Wednesday of the month 1:00-2:00 p.m.);
MFM Journal Club (given by the fellow the third Wednesday of the month, 1:00-2:00 p.m.);
Perinatal Pathology Conference (fifth Wednesday of the month 1:00-2:00 p.m.);
MFM Patient Care Conference (every Friday 12 noon to 1:30 p.m.)
Departmental Morbidity and Mortality Conference (every third Wednesday of the month, 8:00-9:00 a.m.).

C. MFM Research Meetings
MFM research meetings are conducted every Wednesday from 4:30-6:30 p.m., except the last Wednesday of each month, which is dedicated to MFM core curriculum topics as well as Journal Club. These include epidemiology and biostatistics core and laboratory research techniques lectures every other month.