Maternal-Fetal Medicine Greenville - Curriculum

Ultrasound and Prenatal Diagnosis

Our prenatal ultrasound suite operates every day, and includes five ultrasound rooms with state-of-the-art GE Voluson E10 ultrasound machines. The maternal-fetal medicine practice has nearly 15,000 outpatient visits each year, including more than 1,000 fetal echocardiograms annually. We serve as the tertiary care center for the Upstate region of South Carolina, and receive referrals and transfers from a wide region. Our fellows will be included in the care and management of all patients in our practice.

Annually, our practice performs:

30,000 total ultrasound examinations
5,800 anatomic surveys
1,000 fetal echocardiograms
300 evaluations of multiple gestations

In addition to a full-time genetic counselor in our office, we have a clinical partnership with the Greenwood Genetic Center, which provides our office with genetic counselors. The Greenwood Genetic Center is a nonprofit institute with a national reputation which provides clinical genetic services, diagnostic laboratory testing, educational programs and resources, and research in the field of medical genetics. Greenwood Genetic Center is also home to a pediatric genetics fellowship program.

Simulation training

In order to complement clinical experiences, fellows will also participate in a robust schedule of simulation training. The Greenville HealthCare Simulation Center has 22 dedicated rooms for simulation training, and state-of-the-art obstetric trainers including SimMom and Noelle. Simulation training at the Southeast MFM Fellows bootcamp, hosted by Wake Forest University every summer. This day-long training includes amniocentesis, CVS, cordocentesis and fetal shunts. Simulation training in Greenville will also cover management of uncommon obstetric emergencies including amniotic fluid embolism, acute fatty liver of pregnancy, diabetic ketoacidosis, sepsis and maternal cardiopulmonary arrest.

Additional certification training, which will provided to fellows through classroom-based didactic training through national certifying groups, includes:

Management of Medically and Surgically Complex Pregnancies

Inpatient

Greenville Memorial Hospital is the tertiary care hospital and Level I regional trauma center for the Upstate region of South Carolina. The full complement of pediatric and adult consultative services is available. GMH has medical, surgical, pediatric, cardiovascular and neurologic intensive care units with more than 100 ICU beds available. There is also an 80-bed neonatal intensive care unit. We accept approximately 450 antepartum transfers annually. Additionally, we see many outpatient referrals from this same population.

GMH has 15 labor and delivery rooms, three of which have labor tubs. There are 23 antepartum rooms, 36 postpartum rooms, 3 operating rooms dedicated for obstetric surgeries and 8 obstetric PACU beds. In-house anesthesia services are available 24 hours per day, 7 days per week. The obstetric operating rooms run scheduled cases 6 days per week, and emergency surgeries are done every day of the week. There are approximately 3,500 births at GMH annually.

Outpatient

Fellows will work with MFM Faculty in two main outpatient clinical office locations on the Greenville Memorial Hospital main campus, the Memorial Medical Office Building and the Prisma Health OB Center.

In the Memorial Medical Office Building, five ultrasound/procedure rooms are available. There are five GE E10 ultrasound units. The ultrasound suite preforms more than 15,000 studies annually. There are two exam rooms, and two beds for non-stress testing. Additionally, there are two consultation rooms that are used for genetic counseling. In addition to a physician reading room, each physician also has their own administrative office space in this building.

In the Prisma Health OB Center, 18 exam rooms are available for obstetric patients, 3 beds for non-stress testing and one ultrasound room used for limited scanning for viability and fetal position only. There are approximately 25,000 outpatient office visits for pregnant women, and approximately 30% of that volume was considered to be high risk due to medical or other obstetrical complications of pregnancy. Full-service laboratory testing facilities are also available on-site, as well as three full-time social workers to provide ongoing case management. There is one physician workroom available for charting.

Within our division, we have several specialty programs specifically designed to provide comprehensive, evidence-based care for women with high risk pregnancies.

Diabetes in Pregnancy (link under development)
Fetal Care Clinic for pregnancies complicated by fetal anomalies (link under development)
Magdelene Clinic (link under development)
CenteringPregnancy group prenatal care
Fetal echocardiography clinic with pediatric cardiology

Conferences

MFM Division Fellow’s Weekly Didactic Lecture Series

Weekly protected time for fellow lectures has been scheduled, and has also been integrated into the faculty schedules in order to encourage attendance by as many faculty members as possible. The lectures will be based on current literature (journal articles) as well as material covered in the primary texts for the specialty and current peer-reviewed evidence-based practices. Fellows will be provided with the following text books to assist them in preparing for these lectures:

Creasy and Resnick’s Maternal Fetal Medicine Principles and Practice
Gabbe’s Obstetrics: Normal and Problem Pregnancies
Norton’s Callen’s Ultrasonography in Obstetrics and Gynecology
Bianchi’s Fetology: Diagnosis and Management of the Fetal Patient

Bianchi’s Fetology: Diagnosis and Management of the Fetal Patient

High Risk Clinic Conference

This multidisciplinary conference is held weekly, immediately following the fellows’ continuity clinic, and is staffed by maternal fetal medicine-attending physicians in collaboration with the fellows, residents, nurses and clinic case managers. The purpose is to review the plans for women receiving care in the fellows clinic and high risk clinic, to ensure continuity and coordination of care.

Diabetes Clinic

The diabetes clinic is held twice weekly, and is staffed by maternal fetal medicine attending physicians, residents, diabetes educators and pharmacists in collaboration with the endocrinology practice. We have the capacity to manage pregnant diabetic women using insulin pumps as well as to apply and interpret continuous glucose monitors. Fellows attend the clinic one half day per week when they are on the high risk service.

Fetal Care Conference

This is a multidisciplinary conference held monthly, which includes participation from MFM, neonatology, genetics, and various pediatric sub-specialists (cardiology, surgery, neurosurgery, etc.) It includes a review of ultrasonographic images from pregnancies complicated by fetal anomalies. The purpose of the meeting is primarily educational, but it also typically includes delivery planning and initial postnatal planning. Fellows will be actively involved in presenting cases at this conference.

Placenta Accreta Spectrum Team conference

Our department has a multidisciplinary PAS Team, including maternal fetal medicine, general obstetrics and gynecology, gynecologic oncology, obstetric anesthesia, surgical intensive care, urology and pathology. This group meets monthly to review cases of suspected placenta accreta, and to create delivery plans for these complex patients. MFM Fellows present ultrasonographic imaging, and coordinate much of the delivery planning for these cases, in collaboration with the MFM division faculty.

Ultrasound Fetal Boards

This conference is led by the maternal fetal medicine specialty sonographers, and is focused on improving competencies in advanced obstetric imaging.

Quality Improvement

One of our explicit goals for our MFM fellows is to develop administrative leadership skills useful for managing an inpatient obstetric unit. For this reason, we will have fellows serve on the Women’s Operations Committee (WOC), which includes nursing, anesthesia, maternal-fetal medicine, general obstetrics, and the residency program. This group meets monthly, and is actively engaged in quality improvement activities. Fellows will complete a quality improvement project during their fellowship, which will be introduced at the beginning of their second year of fellowship. Fellows will use the framework of “Plan-Do- Study-Act” or PDSA cycles outlined by the Institute for Healthcare Improvement to guide their projects, and ideally these projects will result in presentations and publications.

Training in Clinical Research

Our curriculum allows each fellow to have 12 months of dedicated research rotations, to ensure adequate time to complete the thesis before graduation. Fellows will be assigned a faculty mentor with similar research interests in order to support the thesis project at every step of design, data collection, data analysis, presentation and publication.

Within the Department of Obstetrics and Gynecology, our Division of Research includes five full-time nurses, and this infrastructure and expertise is available to support our fellows’ clinical research projects. For fellows with an interest in basic science, we have a shared central laboratory with a cell culture room and histology workstation for immunohistochemistry. We have a good working relationship with our pathology department for processing of tissue harvested for research purposes.

We encourage our fellows to submit their research to state, regional, national and specialty society meetings and for publication in major medical journals.