Fellowship Training Program in Maternal-Fetal Medicine

Faculty

The clinical and research activities of the Division of Maternal-Fetal Medicine offer a diverse training program, supported by physician scientists and academic clinicians. This provides exposure to different practice approaches, patient populations, and experiences throughout the course of fellows training.                                     

• Thomas Kelly, MD - Director, Division of Perinatal Medicine; Director, Maternity Services; Director, Fourth Year Sub-intership

Expertise - medical complications of pregnancy and fetal diagnosis.

• Jerasimos Ballas, MD

Expertise - maternal chronic illnesses including diabetes and hypertension, ultrasound evaluation of fetal abnormalities, and management of invasive placentation.

• Andrew Hull, BMBS, FRCOG, FACOC - Director, Fetal Diagnosis and Treatment Center

Expertise - medical complications affecting pregnancy, including HIV.  Fetal disorders such as isoimmunization and complex birth defects; and placental disorders such as invasive placentation.

• Leah Lamale-Smith, MD

Expertise - performing invasive fetal procedures for prenatal screening and diagnosis, including chorionic villus sampling (CVS), amniocentesis, and fetal blood sampling and intrauterine transfusions.

• Louise Laurent, MD, PhD - Vice Chair, Translational Research; Director, Perinatal Research

Expertise - treating women who are at risk for preeclampsia or fetal growth restriction.

• Thomas R Moore, MD - Interim Chief Medical Officer

Expertise - treating women with chronic medical complications of diabetes and prenatal diagnosis of fetal abnormalities

• Sandy Ramos, MD - Director, Maternal-Fetal Medicine Fellowship Program; Director, Diabetes and Pregnancy Program

Expertise - treating women with chronic medical complications such as diabetes to help ensure safe deliveries of healthy infants while maintaining optimal health of mothers.  She is also experienced in managing invasive placentation and other fetal high-risk conditions.

• Robert Resnik, MD (Emeritus)

Expertise - Maternal medical disorders, fetal growth disturbances and placental invasion.

• Maryam Tarsa, MD - Director, Department Quality

Expertise - fetal imaging and treating pregnant women with autoimmune disorders, cardiac disorders, and transplant recipients.  She also cares for women having twins or higher-order multiples.

• Douglas Woelkers, MD

Expertise - preeclampsia, placental insufficiency, thrombophilia, and coagulation disorders

• Richard Wolf, DO

Expertise - fetal imaging, amniotic fluid abnormalities, blood clotting disorders during pregnancy and blood group (Rh) incompatibility

Structure and Rotations

Structure and rotations are reflected in the block diagram. Click to view our AY 2019-2020 block diagram.

Fellows are encouraged to attend the Department Grand Rounds scheduled on Wednesday afternoons as well as seminars and conferences provided by other departments and institutions. Also, fellows participate in paid night call rotation in obstetrics and gynecology.

Clinical Experience

Training of fellows is centered at UCSD's Jacob's Medical Center in La Jolla, with a delivery rate of approximately 260 per month, of which 50-60% are high-risk, encompassing a wide range of complex obstetrical problems.  UCSD Medical Center has an outstanding Neonatal Intensive Care Unit adjacent to the delivery unit.

An especially strong aspect of our training program is our Fetal Care and Genetics Center, a multidisciplinary unit receiving referral patients from throughout San Diego County, located near our campus in La Jolla.  This center is staffed with geneticists, our own Maternal-Fetal Medicine faculty, and dedicated fetal sonographers.  Affiliated with the center are specialists in the disciplines of pediatric urology, neurosurgery, nephrology, teratology, and perinatal pathology. 

Education

Our aim is to prepare academic leaders for a career in MFM with a solid foundation for leadership. Specific educational activities are organized to maximize the fellowship education opportunity:

UCSD

• Weekly didactic sessions with the entire clinical faculty, sonographers, and genetic counselors. Sessions are 1.0 hour long and consist of interactive seminars on subjects relevant to MFM, anesthesia, NICU, critical care, and placental pathology.  
• Bimonthly Department Grand Rounds with faculty, residents, fellows and invited speakers. Sessions are 1 hour long. Fellows are expected to attend and participate in the MFM Grand Round lecture which occurs once annually.
• Department Morbidity and Mortality (M&M) conferences with faculty, residents and fellows. Sessions are 1 hour long and recur the 2^nd, 3^rd and 4^th Wednesday afternoon.
• Fetal Diagnosis Conference is a multidisciplinary group discussion of cases followed from prenatal diagnosis through delivery.  Fetal and maternal outcomes are reviewed.  Continuing treatment and management plans are also reviewed.  There is also a guest speaker invited to discuss important fetal diagnosis topics.  The conference occurs every 2nd and 4th Tuesday of the month.
• OB Quality Meeting is a monthly meeting where OB quality goals are discussed.  These include, CMQCC benchmarks, NTSV rate, and OB hemorrhage.  The conference occurs every 2nd Wednesday of the month.
  

Additional conferences include:

• Infectious Disease Core Lecture every 1st and 3rd Wednesday
• NICU M&M every 1st Wednesday
• Quarterly MFM/OB journal club at faculty homes.  Sessions are 2 hours long and consist of critical review of selected manuscripts.
  

Conferences Outside of UCSD

• SMFM annual pregnancy conference
• UCLA annual fetal echo conference
• SMFM first year fellows retreat
• GOHO second year ultrasound course
• Banner critical care in obstetrics symposium
• UCSF genomics boot camp
• UCIC meeting

Research

The majority of clinical fellows conduct a primary prospective translational research project, as well as secondary projects that typically involve clinical or ultrasound activities under the leadership of the faculty or an affiliated research mentor. Projects usually are focused on placental dysfunction, morbidly adherent placentation, and spontaneous preterm birth.  Aims include the discovery of exosomal, metabolomic, and microbiome biomarkers for a variety of pregnancy complications, as well as the elucidation of the molecular mechanisms underlying these conditions.

The structure of the fellows’ research and clinical service activities is flexibly determined, based on the needs and desires of each individual fellow. In accordance with ACGME certification standards for Maternal- Fetal Medicine, 12 months of the fellowship is protected for clinical or basic science research.  The remainder involves diagnostic ultrasound, perinatal consultation, and intensive inpatient management of complicated pregnancies. Fellows function at the Attending Physician level and thus are responsible for an appropriate proportion of resident and medical student teaching. Fellows typically publish 2-6 manuscripts and present regularly at Society for Maternal-Fetal Medicine and Society for Reproductive Investigation meetings. A list of our recent fellows and the academic programs to which they have been recruited following completion of fellowship follows.