True self-care in maternal-fetal medicine begins with boundaries.

Mind the gap: fetal physiology from bench to bedside.

Effect of virtual interviewing on applicant approach to and perspective of the Maternal-Fetal Medicine Subspecialty Fellowship Match

795 Differences in NIH funding in maternal fetal medicine by gender and rank

Objective: To assess factors associated with residents' decisions to pursue or forego fellowship training in maternal-fetal medicine (MFM). Methods: A survey utilizing multiple-choice, Likert, ordinal and categorical scale questions was distributed to all (n = 2337) postgraduate year (PGY) 3 and 4 obstetrics and gynecology residents in accredited US training programs during the 2001-02 academic year. The 18-question survey sought demographic and residency training details, quality of interactions with the MFM faculty and fellows, and information about 13 specific factors that might influence a resident's decision to pursue MFM training. Results: Surveys were returned by 642 (27%) residents, equally divided between PGY 3 and 4. Only 90 (14%) residents reported either ongoing consideration of, or having already applied for, MFM training (MFM group), while 278 (43%) had considered MFM training, but chose to either stay in general practice or pursue another fellowship (neutral group). The remaining 274 (43%) reported never having considered MFM (never group). The three groups were similar with regard to demographic characteristics and residency training; however, the MFM group ranked the quality of teaching by the MFM faculty significantly higher than the neutral and never groups. Encouragement by the MFM faculty, salary during fellowship and the 3-year (as opposed to 2-year) duration were reported to be the strongest influencing factors and were significantly different from ten other factors considered in the survey (p < 0.05). Conclusion: Major positive factors influencing the pursuit of MFM training are the quality of educational experiences and encouragement from the MFM faculty. Conversely, the duration and the perceived financial burden of the 3-year training program appear to be significant deterrents.

I should say first of all that I am an Obstetrician and Gynaecologist with a subspecialty qualification in maternal – fetal medicine (MFM) and my opinions are my own! A large majority of doctors who enter Obstetrics and Gynaecology do so for a love of the duality this area provides. One is faced with managing medical problems and finding non-invasive solutions combined with the challenges of being a surgeon and using ones’ surgical skills to heal. We get the best of both worlds and can treat a wide range of conditions with our skill set. This mixture of skills means we can expect to be autonomous in our care of women. Those of us who then subspecialize into MFM are generally a very driven and altruistic group, otherwise we would specialize in more lucrative areas of Obstetrics and Gynaecology. As described in the last edition of Obstetric Medicine, 1 doctors entering the field of Obstetric Medicine are physicians, with their mighty brain power, who are captivated by the extra challenge of the altered environment of pregnancy. When these two groups meet to care for women with medical disorders of pregnancy, two groups of high functioning, driven and challenge seeking Doctors are brought together. So how do the two disciplines work together? I have worked in several maternity units both with and without Obstetric Physicians. At National Women’s Health in Auckland we have a vibrant and well staffed MFM department and separate Obstetric Medicine department. Women are seen in outpatient clinics by both disciplines in a joint clinic and are then discussed after where plans can be changed as a result. Women who are inpatients are under the care of an MFM specialist but there will be close consultation where necessary with an Obstetric Physician and a weekly meeting to discuss issues and ongoing care. In general, the system works very well and is of great benefit to the woman’s care as she has all her care under one roof rather than being shunted off to different clinics at different times. Not surprisingly, we have our moments when strong personalities clash. We can end up in debates where it really feels as if there are too many cooks involved. Within MFM and Obstetric Medicine there is a large area of clinical overlap and then there are also areas which are clearly the domain of one or the other discipline. Questions such as ‘How should the Induction of Labour be performed?’ and ‘Is this cardiotocogram recording acceptable?’ are the domain of the MFM doctor. An Obstetric Physician who enters this debate will be told they are straying into MFM territory! On the other hand, questions like ‘Is this ECG normal?’ and ‘What is the current recommended treat

The study aimed to better understand how neonatology and maternal fetal medicine (MFM) physicians convey information during antenatal counseling that requires facilitating shared decision-making with parents facing options of resuscitation versus comfort care after extremely early delivery STUDY DESIGN: Attending physicians at US centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. The survey assessed information conveyed, processes for facilitating shared decision-making (reported separately), and clinical experiences. Neonatology and MFM responses were compared. Multivariable logistic regression analyzed topics often and seldom discussed by specialty groups with respect to respondents' clinical experience and resuscitation option preferences at different gestational weeks. In total, 74 MFM and 167 neonatologists representing 94% of the 81 centers surveyed responded. Grouped by specialty, respondents were similar in counseling experience and distribution of allowing choices between resuscitation and no resuscitation for delivery at specific weeks of gestational ages. MFM versus neonatology reported similar rates of discussing long-term health and developmental concerns and differed in all other categories of topics. Neonatologists were less likely than MFM to discuss caregiver impacts (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.11-0.18, p < 0.001) and comfort care details (OR: 0.19, 95% CI: 0.15-0.25, p < 0.001). Conversely, neonatology versus MFM respondents more frequently reported "usually" discussing topics pertaining to parenting in the NICU (OR: 1.5, 95% CI: 1.2-1.8, p < 0.001) and those regarding stabilizing interventions in the delivery room (OR: 1.8, 95% CI: 1.4-2.2, p < 0.001). Compared with less-experienced respondents, those with 17 years' or more of clinical experience had greater likelihood in both specialties to say they "usually" discussed otherwise infrequently reported topics pertaining to caregiver impacts. Parents require information to make difficult decisions for their extremely early newborns. Our findings endorse the value of co-consultation by MFM and neonatology clinicians and of trainee education on antenatal consultation education to support these families. · Neonatology versus MFM counselors provide complementary information.. · More experience was linked to discussing some topics.. · Co-consultation and trainee education is supported.. · What information parents value requires study..

Aim. To determine agreement of cardiac anomalies between maternal fetal medicine (MFM) physicians and pediatric cardiologists (PC) in fetuses with single umbilical artery (SUA). Methods. A retrospective review of all fetuses with SUA between 1999 and 2008. Subjects were studied by MFM and PC, delivered at our institution, and had confirmation of SUA and cardiac anomaly by antenatal and neonatal PC follow-up. Subjects were divided into four groups: isolated SUA, SUA and isolated cardiac anomaly, SUA and multiple anomalies without heart anomalies, and SUA and multiple malformations including cardiac anomaly. Results. 39,942 cases were studied between 1999 and 2008. In 376 of 39,942 cases (0.94%), SUA was diagnosed. Only 182 (48.4%) met inclusion criteria. Cardiac anomalies were found in 21% (38/182). Agreement between MFM physicians and PC in all groups combined was 94% (171/182) (95% CI [89.2, 96.8]). MFM physicians overdiagnosed cardiac anomalies in 4.4% (8/182). MFM physicians and PC failed to antenatally diagnose cardiac anomaly in the same two cases. Conclusions. Good agreement was noted between MFM physicians and PC in our institution. Studies performed antenatally by MFM physicians and PC are less likely to uncover the entire spectrum of cardiac abnormalities and thus neonatal follow-up is suggested.

addresses new insights, novel developments, ongoing challenges, recent discoveries, and future 42 perspectives in the field. This Research Topic aims to illuminate the key advancements achieved over 43 the past decade in Clinical Trials related to Neonatal and Perinatal Medicine. This Special Issue seeks 44 to bridge the gap between research and clinical practice, fostering a deeper understanding of new 45 possibilities and encouraging discussions within the perinatal and neonatal medicine communities. The 46 thematic series covers various topics that interest the perinatal and neonatal communities. 47In the area of pharmacokinetics and pharmacodynamics, Yeung et al. highlight the principles 48 and unique considerations for optimal design of neonatal clinical trials. [1] The paper by Jilani and 49 colleagues, through a literature review applying the RAND/UCLA Appropriateness Method and 50 thematic analysis, found that the interactional relationship between the opioid-exposed birthing person 51 and infant is the foundational principle that clinically defines the dyad to better support bedside care, 52 surveillance, and research.[2] Jumani and co-workers conducted a multicenter retrospective study to 53 evaluate the short-term effects of opioids during therapeutic hypothermia (TH) for neonatal 54 encephalopathy. Their study showed that opioid use during TH was associated with adverse short-term 55 outcomes and highlighted the need for longer-term cohort studies.[3] The paper by Köber All claims expressed in this article are solely those of the authors and do not necessarily represent those 97 of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product 98 that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed 99 or endorsed by the publisher. 100 101

A Nankai Trough earthquake is highly likely to occur in near future, and perinatal medical resources and care in Kochi Prefecture may be insufficient after such an event. Therefore, we evaluated the medical and public health measures needed to prepare for caring for pregnant women in Kochi Prefecture in the aftermath of such an earthquake and the potential action plans for the prefecture. We estimated that immediately after an earthquake, approximately 30 pregnant women will require urgent medical treatment, most of whom will be in the prefectural capital, Kochi City, and perinatal medical care in Kochi City may be insufficient. Therefore, we used the projected flooding areas to divide Kochi City and its surrounding areas into 3 areas and allocated at least one Disaster Liaison for Pediatrics and Perinatal Medicine (DLPPM) to each disaster base hospital in those 3 areas. In a disaster, the DLPPMs will serve as key individuals in their respective areas and coordinate the allocation of medical care. A DLPPM will be allocated also within the Disaster Medical Response Headquarters of Kochi Prefecture and be responsible for overseeing perinatal care in the whole of Kochi Prefecture. Our study shows that estimating the number of affected pregnant women and requirement for perinatal medical care is an effective way to prepare realistic disaster measures and to enable a specific plan to be formulated for effective allocation and management of DLPPMs. We believe that our system can serve as a model in perinatal disaster medicine.

Gender medicine is an innovative medical approach that studies how some biological variables are influenced by the male or female sex and gender. This issue is under debate because it characterizes the impact of tailored or individual medicine. In this scenario, the aim of this study is to study the correlation between heavy metal exposure and pathologies of neurodevelopment, according to the sex of newborns. In particular, this is an observational study under the name of the Neurosviluppo Project, involving 217 mother-child couples. The correlation with phenotype small for gestational age and congenital malformations were studied, but above all we focused on the pattern of placental permeability to heavy metals. Our results are specifically related to foetal medicine and investigate the impact of foetal sex in transplacental metal exposure. Our results did not show any significant differences related to foetal sex in terms of congenital malformations or the other variables taken into consideration. However, because these conclusions are the first related to the gender medicine in transplacental foetal medicine, they could be a marked background for further studies. Considering the lack of data in literature regarding foetal sexual medicine and transplacental exposure, these study results are pioneering in terms of sexual foetal medicine. Possibly in the future, studies regarding the correlation between foetal sex and obstetrics outcomes will be performed.

New technologies pave way for fetal personalized medicine

The Nuffield Council on Bioethics (2006) report Critical Care Decisions in Fetal and Neonatal Medicine: Ethical issues addressed three areas of concern to professionals and the public: fetal medicine, the borderline of viability, and critical care decision making for babies receiving intensive care. Common principles and initial recommendations for professional practice are presented in the report which is based on wide consultation. While many professionals may feel that the report re-iterates current good practice, it also demonstrates inequity and inconsistency in practice across the country. Royal Colleges and other interested parties need to act to address these inconsistencies and further develop consensus guidelines. The need for transparency in decision making and for a true partnership approach to all aspects of fetal and neonatal care is reaffirmed, with recommendations for action by government and professional bodies as well as by professionals delivering obstetric and neonatal care and their educators.

Haemodynamics edition of seminars in fetal and neonatal medicine

ObjectivesPerinatal Palliative Care1 supports the needs of parents, who following antenatal diagnosis of a life limiting fetal condition (likely to result in fetal/neonatal death)2 choose to continue their pregnancy. Uptake...

We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level. This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models. Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR: 0.70; 95% CI: 0.58-0.85) and pregnancy-related mortality (aIRR: 0.83; 95% CI: 0.71-0.98) compared with states with low MFM density, corresponding to 7.29 (AME: 95% CI: 3.58-11.00) and 5.57 (AME: 95% CI: 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared with low MFM density states (aIRR: 1.02; 95% CI: 0.87-1.20). High MFM-density states have a decreased risk of maternal mortality compared with low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality. · An association between MFM physician density and maternal mortality is unclear.. · States with higher MFM density had a lower risk of maternal mortality than those with fewer.. · This study highlights the importance of increasing MFM access in underserved areas to potentially reduce maternal mortality..