OHSU

Maternal-fetal Medicine Fellowship

Portland, Oregon

Division Overview Program Overview Important Links Contact Information


Overview of Maternal-Fetal Medicine Division

Faculty

Division Description

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.

Goals

Clinical

For the coming year, the division will sustain growth in the Perinatal Center; expand our services in collaboration with Southwest Washington Medical Center, Salem Hospital, and Kaiser; enlarge our outreach education program; and continue to serve our ethnically diverse patient population.

Research

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 Units Network.

Overview of Maternal-Fetal Medicine Fellowship

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.

Fellowship Education

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:

  • Training in the clinical investigative process from initial trial design to data analysis and presentation;
  • The expertise to enter an independent phase of career development and an academic research career;
  • The integration of principles in molecular and cell biology, new pharmacology techniques, genomics and medical informatics into the curriculum and mentored experience;
  • A mentored research experience of intensive, practical and supportive training leading to academic products such as grant applications and peer-reviewed publications.

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.

Chorionic Villus Sampling (CVS)  

A formal training program is offered, which is tailored to prepare the fellow to be proficient in both trans-cervical and trans-abdominal CVS techniques.

Graduate Medical Education

In addition to weekly Departmental Grand Rounds, the Division of Maternal-Fetal Medicine holds weekly Fellow’s conferences. This protected time includes a rotating schedule of lectures from Maternal-Fetal Medicine attendings and from providers in other medical specialties. Other regularly scheduled events include joint Neonatology and Maternal-Fetal Medicine conferences, Perinatal Ultrasound conferences, and journal-clubs. Overall, these conferences and lectures encompass topics such as high-risk clinical management, maternal-fetal physiology, genetics and teratology, infectious diseases, neonatology, ultrasonography, obstetrical anesthesia, obstetrical critical care, and perinatal pathology.

Fellowship Rotation

The duration of the fellowship is three years, with each year being divided equally into clinical and research blocks.

The rotation schedule for the first and second year Maternal-Fetal Medicine fellows includes 6 months of clinical time, which is divided equally into 2 months of Ultrasound, Perinatal clinic, and Labor and Delivery. During this time, the fellows are also supervising the resident High-Risk Obstetric clinic, which is held weekly.  During the remainder of the year, the fellows are given time to dedicate to developing, implementing, and completing research projects in areas of interest to them (please see Fellowship Research below)

The third year of the Maternal-Fetal Medicine fellowship, follows a similar divided clinical and research framework. During the clinical rotations however, the fellow is given the opportunity to have electives, which may include spending time with other fields pertinent to our patient care, such as endocrinology or pediatric cardiology. The research time in the third year is dedicated to completing the fellowship research projects and to prepare the manuscripts for submission. This time is also used to prepare for the pursuit of research funding for those interested in a career in academic medicine.


Fellowship Research

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.

Research Examples

Representative examples of the types of research and potential mentors are illustrated below:

bissonnette_john 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.

Aaron CaugheyDr. Aaron Caughey's research interests incorporate methodology from clinical epidemiology, biostatistics, health economics, health policy, and the decision sciences to examine questions in predominantly four clinical areas: prenatal screening and diagnosis of birth defects and genetic disorders, how the management and outcomes of pregnancies change by week of gestation, the risks and benefits of various modes of delivery including: spontaneous vaginal delivery, operative vaginal delivery, and cesarean delivery, and the epidemiology and outcomes related to diabetes in pregnancy. His work in these three areas has led to more than 160 original authored or co-authored manuscripts. Recently, his focus has been on how the week of gestation at term interacts with mode of delivery, management, and outcomes of pregnancy including induction of labor, expectant management of pregnancy, and elective cesarean delivery and demonstrated that effects of induction of labor on the risk of cesarean delivery are likely overstated by traditional epidemiologic studies. 

Lowell_smallThe 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.

frias 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.

HohimerDr. 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).

maylie_jamesDr. 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).

periera-leoDr. 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

tolosaDr. 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. Tolosa is the Primary Investigator for the Maternal-fetal Medicine Units Network. His clinical interests include preterm labor, ultrasound in pregnancy, maternal disease in pregnancy and prenatal diagnosis.

 

Important Links


CONTACT INFORMATION

For questions regarding the OHSU Maternal-fetal Medicine Fellowship, please contact:

Angela Espinosa, Fellowship Coordinator: 503 494-2685

Email inquires may be sent to rojasa@ohsu.edu (please put MFM Fellowship in subject line). 

 

Application Form and Instructions

The Maternal-Fetal Medicine Fellowship Program is a specialty participating in ERAS. 

Please go to the ERAS http://www.aamc.org/medstudents/eras/fellowship_applicants/ to apply. 


In order to match with the Maternal-Fetal Medicine Program you must also be registered with the National Resident Matching Program.  

Applications will be considered until May 31, 2012.  

 

Contact Address

Oregon Health & Science University

Attn: MFM Fellowship Program
Angela Espinosa
Mail code L-466
3181 S.W. Sam Jackson Park Road
Portland, Oregon 97239

tel: 503 494-2685 • fax: 503 494-4473