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| Perinatology/Maternal-Fetal Medicine | ||||||||||
FELLOWSHIP IN MATERNAL-FETAL MEDICINE
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| Division Overview | Program Overview | Important Links | Contact Information |
FacultyLowell Davis, M.D., Professor, Division Chief and Fellowship Program Director Sally Segel, M.D., Assistant Professor and Fellowship Assistant Director John Bissonnette, M.D., Professor Robert Brace, Ph.D., Adjunct Professor John Buckmaster, M.D., Assistant Professor Cecilia Cheung, Ph.D., Adjunct Professor Charlotte Clock, M.D., Assistant Professor Antonio Frias, M.D., Assistant Professor Sig-Linda Jacobson, M.D., Associate Professor James Maylie, Ph.D., Professor Karen Oh, M.D., Assistant Professor Leonardo Pereira, M.D., Assistant Professor Juha Rasanen, M.D., Ph.D., Assistant Professor Roya Sohaey, M.D., Associate Professor Jorge Tolosa, M.D., Associate Professor Solange Wyatt, M.D., Assistant Professor |
StaffMaria Regimbal, Division/Practice Manager Elizabeth Haebe, Administrative Assistant Sarah Percival, Administrative Assistant FellowsLeah Bernard, M.D. Katherine Gesteland, M.D. Jason Hashima, M.D.
More InformationFaculty bios are available on the faculty page of this site and on OHSUwomenshealth.com. |
The Maternal-Fetal Medicine Division is committed to developing and maintaining a Center of Excellence by providing the highest quality high-risk obstetrical care in a patient-centered environment, while contributing to the academic environment through research and teaching.
For the coming year, the division will sustain growth in the Perinatal Center, expand our services with the collaboration of REI, Southwest Washington Medical Center and Kaiser, enlarge our outreach education program, and continue to serve our ethnically diverse patient population.
The division will maintain our commitment to research. We will strive to maintain our strength in basic science research while expanding into clinical research and global perinatal health. The division will participate in exciting endeavors by expanding our basic science program and acceptance of our participation in the Maternal-Fetal Medicine Unit Network.
Our fellowship is designed to introduce fellows to basic and clinical research as well as provide a strong basic background in clinical maternal-fetal medicine. Since the start of the fellowship program in 1982, over 50% of our fellows have pursued academic careers. Several former fellows have received national research funding as Principal Investigators. This attests to the scientific environment available. We also have a strong clinical program that provides ample inpatient and outpatient experience for those applicants that desire a track in clinical perinatology. clinical, or translational research programs exist in infectious diseases, hypertension in pregnancy, ultrasonography, prematurity prevention, and clinical proteomics.
Human Investigation Program (HIP). Our Fellows are required to take a two-year graduate program entitled the Human Investigations Program (HIP) that fulfills all American Board criteria for graduate courses in epidemiology and biostatisitics. The primary objective of HIP is to increase the number and level of competency of patient-oriented clinical investigators and the course is directed toward young investigators and fellows.
The HIP Program is designed to provide fellows and junior faculty with:
The HIP program is directed by Dr. Cynthia Morris and Dr. Thomas Becker of the School of Public Health. Successful completion of the Human Investigations Program leads to a graduate Certificate of Human Investigation awarded by Oregon Health & Science University.
A formal Chorionic Villus Sampling training program is offered, which includes both trans-cervical and trans-abdominal CVS techniques.
In addition to weekly departmental Grand Rounds, there are alternating weekly conferences in Neonatal Care or in Ultrasound/Prenatal Diagnosis. Special areas of education directed specifically toward Fellows are lead by faculty members of the division or collaborators and include high-risk clinical management, maternal-fetal physiology, genetics and teratology, infectious diseases, neonatology, ultrasonography, obstetrical anesthesia, obstetrical critical care, and perinatal pathology.
The first year will predominantly be spent doing research with the exception of two months of clinical service. One of these months will be spent on the fetal echocardiography service which rotates pediatric cardiology fellows along with Maternal-Fetal Medicine fellows. During the second month, the fellow will serve as staff for the obstetric service, determining obstetric care for all in-house patients and consults. This will give a total of 2.8 months clinical time and 9.2 months research time as during 8 of the research months 10% of the time is spent covering labor and delivery .5 day. With the first year committed largely to research and course work, the fellow should be able to choose an area of research early on in the fellowship and complete a project including submission of a manuscript before the end of the third year.
In the second year the fellow will spend 5.7 months clinical time and 6.3 months research effort based on the coverage of labor and delivery .5 day per week throughout the year and high-risk clinic .5 day per week during the clinical months. During the research months, no more than .5 day per week will be spent on clinical work.
In the third year the fellow will cover for 10 months of the year .5 day per week in labor and delivery as well covering high-risk clinic .5 day per week. This will result in 1.8 months elective, 5.7 months clinical and 4.5 months research. The elective time will be used to further development in areas perceived by the fellow and program director as advantageous for career development. Thus, the total clinical time is 14.2 months, total research time is 20 months and elective time is 1.8 months.
The fellow's choice of research is determined by the fellow's interests and the availability of a mentor. As a group of investigators we have found it best that the fellow choose a topic of research rather than being assigned to a specific area of research. At the initial interview and during the first two months of the fellowship, the fellow has the opportunity to discuss in detail, with individual faculty, current research projects and interests. Criteria to be used in selection of a project will include the resources necessary to result in completion, the mentor's track record in training, the compatibility of the fellow and mentor and the hypothesis to be tested. Once the fellow has chosen an area of interest and a specific mentor agrees to accept the fellow in their laboratory, progress will be ascertained by discussion between the mentor and the fellowship director, Dr. Davis, at four-month reviews and by presentations at research conferences.
The division is also committed to excellence in research. Division members serve as Principal Investigators on seven NIH grants and Co-investigators on nine NIH grants. Division members, as Principal Investigators have been awarded $2,254,327 in NIH funding. In addition, division members serve as Co-investigators on grant awards totaling $2,702,880. Divisional research activities include studies on the role of infection in preterm birth, cytokine polymorphisms as risk factors for prematurity, fetal adaptation to anemia or hypoxemia, and fetal programming of adult disease.
Dr. John Bissonnette studies control of respiration in genetically modified mice. There are two projects currently being studied in his laboratory. In unanesthetized female mice heterozygous for the DNA binding protein Mecp2 basal respiratory pattern and the ventilatory response to hypoxia and hypercapnia are being investigated. Mecp2 is mutated in 80% of girls with Rett Syndrome. Included in the phenotype of Rett Syndrome are respiratory disturbances characterized by apnea. Since the Mecp2 gene is on the X chromosome a number of cells have a null mutation due to X inactivation. Work to date (Respiration in MECP2 deficient mice-International Rett Syndrome Association) shows that Mecp2 +/- female mice have a respiratory pattern characterized by slower frequency and deeper tidal volumes than wild type. This pattern starts at an age before motor symptoms of the disease develop. This suggests that mechanisms other than abnormal gene expression in central respiratory neurons may underlie the respiratory problems. The role of lung development and structure are areas of active interest.
The focus of Dr. Lowell Davis's and Co-investigator Dr. Hohimer's research is the fetus' development of the coronary vasculature and cardiac function that is made hypoxic by chronic anemia (RO1 NIHLB 45043 Water Compartmentalization in Chronic Fetal Anemia). Under conditions of chronic fetal anemia the heart adapts physiologically by increasing stroke volume, heart weight, capillary size and number as well as increasing coronary conductance. An increase in coronary conductance translates as an ability to achieve a greater flow at the same driving pressure. These changes induce persistent differences in the coronary vasculature that remain into adulthood, even if the anemia does not persist after birth. Dr. Davis, along with Dr. Kent Thornburg and Dr. George Giraud, is investigating adult coronary-circulation programming during fetal development by studying cardiac function in these adults. They have shown that the changes stimulated by fetal anemia go beyond coronary conductance. For example, adults that were anemic as fetuses have greater systolic indices of contractility (Emax and dP/dt) than adults that were not anemic in-utero when subjected to a hypoxic episode. This is consistent with the hypothesis that fetal anemia stimulates a greater coronary and functional reserve that remains for life. In addition Dr. Davis studies the regulatory mechanisms of amniotic fluid volume along with Job Faber, Debra Anderson and Roger Hohimer (RO1 HD-37376 Homeostatic control of amniotic fluid volume). Dr. Davis also serves as Program Director for the Oregon BIRCWH Program. The five year NIH sponsored training program provides an opportunity for basic and clinical junior faculty scientists to enhance their research capabilities.
Dr. Antonio E. Frias studies placental vascular development and the fetal cardiovascular response to aberrant placental development. Dr. Frias is supported by the Women's Reproductive Health Research Grant (WRHR NIH K12HD001243). Dr. Frias did a postdoctoral research fellowship supported by the Reproductive Scientist Development Program (RSDP) that resulted in the identification of a novel guidance receptor that stabilizes the vasculature.
Dr. A. Roger Hohimer studies the development of the heart as well as the cerebral vasculature in the perinatal period. To pursue the fetal origins of adult-disease hypothesis, Dr. Hohimer has developed expertise in measuring cardiovascular function in murine models. Mice are an ideal animal model for such studies because of genetic manipulations that are possible in this species. In brief, the fetal-origins hypothesis proposes physiologic and structural adaptations during the perinatal period, while promoting short-term survival, may have long-term effects on adult health. Areas of interest in the laboratory include whether perinatal hypoxia (simulated, high-altitude and anemia) or dietary stress (high-fat and calorie-intake) will "program" the adult heart or vascular reactivity of blood vessels. Dr. Hohimer is also interested in the fetal cerebral circulation and how vascular factors contribute to brain development and damage. He is a coinvestigator with Dr Steven Back (RO1 Cellular Mechanism of Fetal White Matter Injury) in studying the causes of periventricular leukomalacia and with Dr. Davis (RO1 NIHLB 45043 Water Compartmentalization in Chronic Fetal Anemia).
Dr. Sig-Linda Jacobson has a long-term interest in pre-eclampsia. She was a Collaborator in the international MAGPIE trial (Magnesium Sulphate for Treatment of Pre-eclampsia) organized by the United Kingdom Medical Research Council. OHSU was the only US site of the 175 hospitals in 33 countries which participated. A follow-up study, of mothers and infants enrolled in the trial to evaluate if there are long-term risks or benefits of magnesium sulphate therapy, is being considered. Dr. Jacobson will continue to ensure OHSU's participation.
Dr. James Maylie's laboratory uses a multidisciplinary approach to study the role of potassium channels in genetic disorders (R01 NS37014 Molecular and Cellular Physiology of Episodic Ataxia). Episodic Ataxia (EA1) is an inherited autosomal dominant human neurological disorder. The principal symptoms of EA1 are myokymia and episodic attacks of generalized ataxia that are diminished by carbonic anhydrase inhibitors such as acetazolamide. EA1 is due to missense point mutations in KCNA1, the gene encoding the voltage-gated delayed rectifier potassium channel, Kv1.1; most mutations alter the biophysical properties of Kv1.1 channels. In the cerebellum, Kv1.1 is localized to axonal branch points and the pinceau synaptic structure of GABAergic interneurons that innervate the Purkinje cells. To understand the cellular consequences of EA1 mutations in Kv1.1 that result in ataxia, and the mechanism by which acetazolamide reduces the ataxia, ES cell-mediated homologous recombination was used to produce a transgenic mouse model of EA1 harboring the EA1 mutation V408A. In the EA1 mice, cerebellar Purkinje neurons revealed an increased frequency and amplitude of spontaneous inhibitory postsynaptic currents (IPSCs) resulting in an overall increase in GABAergic inhibitory control. These experiments will establish a link between altered electrophysiology and behavior in EA1 and demonstrate a precise connection between altered Kv1.1 channel biophysical function and the consequence of the altered channel function in neurons in vivo. The use of transgenic technology to develop mouse models of disease will permit an understanding of EA1 and the possibility of new pharmacological treatments for this disease. In particular, analyses of our data indicate that there is a gender bias for the stress-induced phenotype observed in these mice; females are more susceptible than males. Interestingly, EA1 patients shows gender-specific differences in susceptibility and etiology; in particular pregnancy precipitates attacks of ataxia and some women only began having symptoms post-puberty. Furthermore, GABA receptors are targets for direct modulation by gonadal steroid metabolites. This findings taken together, suggest that the EA1 mice may be an excellent model for understanding the complex interplay between stress and reproductive hormones. Dr. Maylie is also a coinvestigator with Dr. Adelman R01 GM58259-05 in studying the SK channel (R01 Molecular Physiology of SK Channels in CA1 Neurons and R01 NS38880 Drosophila SK channels: ICS and the mammalian slow AHP).
Dr. Leonardo Pereira’s research focuses on the development of point-of-service tests for use in developing countries and rural areas of the U.S. Dr. Pereira is currently supported by the Women’s Reproductive Health Research Grant (WRHR NIH K12HD001243-06 Identification of biomarkers of intra-amniotic infection and preterm birth by proteomic analysis) and the Kuse Family Foundation Grant (Identification of biomarkers for Intra-amniotic infection by protein analysis: an early warning system for prematurity). Dr. Pereira collaborates extensively with Dr. Srinivasa Nagalla in the Proteomics Laboratory developing rapid, noninvasive tests for intra-amniotic infection and prediction of preterm birth. Furthermore, Dr. Pereira works closely with Dr. Jorge Tolosa in the Global Network for Perinatal and Reproductive Health (GNPRH) to promote research, capacity building, and educational opportunities for young faculty and fellows with an interest in international collaborations in developing countries. For more information about the GNPRH and its mission visit www.gnprh.org.
Dr. Segel received her medical degree from Stanford University School of Medicine. She completed her residency in Obstetrics and Gynecology and fellowship in Maternal Fetal Medicine at the University of Pennsylvania. Her clinical interests include multiple gestations, preterm labor, preterm premature rupture of fetal membranes, incompetent cervix, and prenatal diagnosis.
Dr. Jorge Tolosa received his medical degree from Pontificia Universidad Javeriana in Colombia. He completed fellowships in Perinatology at the University of London in 1988 and in Clinical Epidemiology at the University of Pennsylvania in 1990. He completed Fellowship in Maternal Fetal Medicine and residency in Obstetrics and Gynecology at Pennsylvania Hospital in Philadelphia, in 1993 and 1996, respectively. He worked as a Senior Staff fellow at the Perinatology Research Branch of the NIH in 1997. He is actively involved in research focusing on infectious diseases, prevention of premature birth, prevention of post-partum hemorrhage, smoking in pregnancy, effects of pesticides on reproductive health. He coordinates the activities of the Global Network for Perinatal and Reproductive Health, which conducts applied research in prevention of maternal and neonatal death and disability, mainly in developing countries. His clinical interests include preterm labor, ultrasound in pregnancy, maternal disease in pregnancy and prenatal diagnosis.
See other maternal-fetal medicine faculty.
Sally Segel, M.D.
Fellowship Assistant Director
503 494-2101
email: (please put MFM Fellowship in subject line)
Applications are due July 1, 2008 for the 2009-2010 fellowship position. Click here to download the application. Submit to Maria Regimbal at the address below.
Attn: Maria Regimbal
Division of Maternal-Fetal Medicine
Mail code L-456
3181 S.W. Sam Jackson Park Road
Portland, Oregon 97239
The format and content of this page were last updated April 17, 2008.
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