Maternal-fetal Medicine Fellowship
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Our NEXT CYCLE FOR FELLOWSHIP INTERVIEWS IS SCHEDULED FOR JULY 20, 2015 and AUGUST 24, 2015. Fellowship applications through ERAS will be accepted until April 30, 2015.
Overview of Maternal-Fetal Medicine Division
- Leonardo Pereira, M.D., M.C.R., Fellowship Program Director and Division Chief of Perinatology/Maternal-Fetal Medicine
- See all maternal-fetal medicine faculty
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 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.
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.
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:
- 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.
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.
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.
Representative examples of the types of research and potential mentors are illustrated below:
Dr. Aaron Caughey
Dr. 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 four areas has led to more than 200 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.
Dr. Lowell Davis
Dr. Davis's focus is the fetus' development of the coronary vasculature and cardiac function that is made hypoxic by chronic anemia. Under conditions of chronic fetal hypoxemia (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 is the Director of Project 1 "Role of Adenosine for Coordinating Myocyte Function and Vascular Growth in the Anemic Fetal Heart" in the Program Project Grant "Maternal Fetal Signalling and Lifelong Consequences" PI Dr. Kent Thornburg. Together with Sonet Jonker and George Giraud they are investigating adult coronary-circulation programming during fetal development by studying myocyte and endothelial cell function in fetal anemia.
Dr. Antonio E. Frias
Antonio Frias' clinical experience in caring for high-risk pregnancies inspires his dedication to develop improved methods to identify and treat pregnancies with placental dysfunction. Dr. Frias specializes in using advanced imaging of the placenta to understand factors that affect placental development and nutrient transport. A specific focus is the impact of maternal nutrition on placental function, reproductive outcomes, and fetal programming. The adverse obstetric outcomes attributed to both obesity and diabetes in humans are confounded by an inability to separate the contributions of maternal diet. Dr. Frias' research resulted in the first report of placental hemodynamic abnormalities in a primate placenta that are secondary to a high fat diet, suggesting that a Western style diet may have an independent impact on the adverse obstetric and neonatal consequences reported in the obese human population. As the placenta regulates nutrient flow from mother to fetus, it likely occupies a central role in mediating the adverse obstetric/neonatal risks associated obese and/or diabetic pregnancies. Current assessments of placental function (both clinical and research) are limited by an inability to link in vivo placental perfusion with functional outcomes, such as histopathology and nutrient transport. Dr. Frias and his collaborators have developed new imaging protocols, both MRI and ultrasound, to quantify placental blood flow creating perfusion maps that can be correlated with placental histopathology and nutrient transport. These novel studies will set the framework for understanding how the placenta develops and adapts to adverse conditions and will lead to exciting future studies of blood flow on nutrient transfer, and perhaps improved imaging techniques to identify placental dysfunction in humans. Given the central focus of the placenta on fetal development, Dr.Frias collaborates with scientists and clinicians at OHSU from the divisions of pathology, cardiology, endocrinology, and the Advanced Imaging Research Center. Dr. Frias also supports the NHP work at ONPRC by providing imaging capabilities to scientists in the Division of Reproductive& Developmental Sciences (DRDS) and the Division of Neuroscience. Dr.Frias is supported by the NIH and the Gates Foundation.
Dr. James Maylie
Dr. Maylie's role as a Ph.D. in MFM is basic research. For the past 15 years, the collaboration of Dr. Maylie's laboratory with Dr. Adelman's laboratory in the Vollum Institute at OHSU, has been dedicated to understanding the structure, and physiological roles of several different K+ channels. During this time, we cloned the SK channel family and discovered that they are heteromeric assemblies with calmodulin that mediates their Ca2+ gating. We first examined their functional importance in the skeletal muscle suggesting that their aberrant T-tubular expression in denervated and myotonic dystrophic skeletal muscle provides the basis for the apparent paradox that a hyperpolarizing Kx channel may underline the hyperexcitability in these conditions. We then described the first role for SK channels in synaptic transmission and in their modulation of induction threshold of synaptic plasticity at Schaffer collateral to CA1 synapses that correlates with its affect on learning and memory paradigms. Subsequently, we showed that SK2 channels and CA1 are themselves plastic, via activity-dependent SK2 trafficking, that contributes to the activity-dependent LTP at Schaffer collateral to CA1 synapses. The main goal of my current research is to show that synaptic SK2 channels and NMDARs are physically coupled by the binding of 14-3-3 dimers that requires LTP -dependent PKA phosphorylation of SK2 and NR2A. We are funded by R01 MH081860, SK channels: Roles and mechanisms for dendric excitability and plasticity, R01 NS38880, Molecular Physiology of SK2 Channels in CA1 Neurons, R01NS065855, SK2 channels as novel neuroprotective targets against cerebral ischemia, and 1R01MH093599, Coupled LTP-dependenet trafficking of synaptic SK channels and NMDARs.
Dr. Leonardo Pereira
Dr. Pereira's research focuses on preterm labor, intrauterine inflammation and cell free fetal DNA analysis. He has completed clinical trials on women with prior preterm birth and multifetal gestations and analyzed amniotic fluid, serum, and cervical-vaginal fluids proteins in these cohorts. He is part of a larger collaborative interested in developing a rapid serum assay to predict preterm birth at the bedside and to detection of intrauterine inflammation noninvasively. He hopes to expand these efforts to interantional sites and he works closely with Dr. Jorge Tolosa in the Global Network for Perinatal and Reproductive Health (GNPRH) to accomplish this, as well as to promote capacity building and education in developing countries. For more information about the GNPRH and it mission visit www.gnprh.org Dr. Pereira's research has been funded by the NIH, March of Dimes, and several Oregon foundations. In addition, Dr. Pereira has a strong interest in noninvasive prenatal testing (NIPT, or cell-fee fetal DNA) and was a co-author and site PI for a prospective study comparing first trimester screening to NIPT in a low risk population, published in the New England Journal of Medicine (2015).
Dr. Jorge Tolosa
Dr. 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.
Dr. Nicole Marshall
Dr. Marshall's research combines basic science, epidemiology, and clinical studies to focus on two main areas: the developmental origins of health and disease and the effect of maternal obesity on perinatal outcomes. Dr. Marshall is currently studying the impact of maternal diet and body composition, including fat and muscle mass, on placental function and fetal growth. Dr. Marshall's research is supported by a National Institute of Health Career Development K23 award under the mentorship of Dr. Kent Thornburg, director of the Heart Research Center, and Dr. Jonathan Purnell, Endocrinology.
For questions regarding the OHSU Maternal-fetal Medicine Fellowship, please contact:
Gretchen Roa, Fellowship Coordinator: 503 494-2685
Email inquires may be sent to firstname.lastname@example.org (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.
Oregon Health & Science University
Attn: MFM Fellowship Program
Mail code L-466
3181 S.W. Sam Jackson Park Road
Portland, Oregon 97239