Contents
•	Research Opportunities
•	Didactic Activities
•	Grand Rounds Events
•	Post Graduate Education

Research Opportunities

The research opportunities for the Maternal-Fetal Medicine fellows are based on the following elements:

1. AVAILABILITY OF LARGE OBSTETRICAL POPULATION.
The Division of Maternal-Fetal Medicine is based at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. The hospital is a tertiary perinatal referral center for a catchment area that includes over 18,000 deliveries per year. Patients referred for maternal or fetal complications are cared for by the UMDNJ/Robert Wood Johnson Medical School residents and fellows under the direct supervision of Maternal-Fetal Medicine faculty members. The MFM Division directly cares for approximately 180 high risk obstetrical patients per year in their private practice as well as 180-200 patients transported per year from other health care facilities. This is in addition to the other deliveries by clinic and private patients.

The Antenatal Testing Unit (ATU) at Robert Wood Johnson University Hospital is staffed with 16 sonographers who cover 7 examination rooms equipped with state-of-the-art ultrasound machines with color flow Doppler capabilities. 3D/4D ultrasound equipment is also used for fetal dysmorphology examinations. Over 100,000 ultrasound examinations have been performed since 1994. The MFM fellows and faculty provide the entire coverage for the ATU in which a variety of procedures are carried out including targeted sonography to assess fetal anomalies, nonstress tests, biophysical profiles, Doppler velocimetry, fetal echocardiography, percutaneous umbilical blood sampling, chorionic villus sampling and amniocentesis.

The Division has established a new program in collaboration with Robert Wood Johnson University Hospital to provide invasive fetal surgery and therapy procedures for the treatment of complex problems of pregnancy. The New Jersey Center for Fetal Diagnosis and Therapy at UMDNJ-Robert Wood Johnson University Hospital can provide fetal shunting procedures and endoscopic laser therapies for a variety of fetal condisions including bladder obstruction, lung cysts, and twin-twin transfusion sundrome. The Center combines the diagnostic capabilities of our ultrasound unit with the surgical techniques of our faculty to provide services that are not otherwise available in our region.

2. LARGE MFM DIVISION WITH DIVERSITY IN CLINICAL TALENT AND EXPERTISE

The Division of Maternal-Fetal Medicine consists of 8 full-time faculty MFM physicians. The diversity in talent and expertise of the MFM physicians are reflected in their functional titles as follows:

Joseph C. Canterino, MD
Associate Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center
Director, Perinatal Genetics

Susan Janeczek, DO
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Director, Undergraduate Medical Education in Maternal-Fetal Medicine
Director, Diabetes in Pregnancy Program

Maria E. Martins, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Director, Chorionic Villus Sampling Services

Paul Matta, DO
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Myriam Mondestin-Sorrentino, MD
Assistant Professor
Associate Director, Pregnancy Loss Evaluation Service
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Michael V. Muench, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Yinka Oyelese, MD
Assistant Professor
Director, High-Risk Pregnancy Services
Department of Obstetrics, Gynecology and Reproductive Sciences

3. BASIC RESEARCH FACILITIES

The OB/GYN Department Perinatal Biology laboratories, directed by Morgan R. Peltier, PhD, are located in New Brunswick, New Jersey adjacent to our clinical and academic offices and offers resources for cell biology studies, protein analysis, PCR and immunohistochemistry. Areas of interest include a) inflammation pathways, b) mycoplasma virulence, c) and immunity mechanisms of the cervix, vagina, and placenta. Additional laboratory facilities located in Piscataway, New Jersey are directed by William Moyle, PhD and four technicians. The research activities of this group fall into two broad categories, namely (a) studies of the structure and function of glycoprotein hormones and (b) studies of the structure and function of the receptors of glycoprotein hormones. The main focus of the laboratory is to provide new information about the interactions of reproductive hormones and their receptors as related to fertility and pregnancy. An additional research laboratory is being established within the department to support a variety of molecular biology related studies involving RNA expression, PCR, protein isolation, electron microscopy and immunohistochemistry. Basic research opportunities also exist in collaboration with: (1) the Department of Pediatrics Genomics Laboratories; (2) the Division of Neonatology Cytokine/Inflammation program; (3) the Rutgers School of Pharmacy Extracellular Matrix laboratories directed by Emmy Gordon, PhD; (4) the environmental laboratories of the Environmental and Occupational Health Sciences Institute; (5) Proteomics New Jersey Medical School, Newark; and (6) UMDNJ Child Health Institute, New Brunswick.

4. EPIDEMIOLOGY AND BIOSTATISTICS

Cande Ananth, PhD, MPH is Director of the Section of Epidemiology and Biostatistics for the Department. He is always available to the MFM fellows and participates in the weekly research meetings of the Division. He supervises his own externally funded research program in addition to supporting Divisional research needs. He has collaborated with Division members on over 100 publications since 1996.

5. AVAILABILITY OF FULL-TIME RESEARCH NURSING STAFF

The Division of Maternal Fetal Medicine has one full-time nurse researcher. The research nurse is experienced in protocol development, study coordination, data collection, data base design and patient recruitment. In addition, she is available to assist with informed consent and enrolling patients into clinical research protocols.

6. AVAILABILITY OF COMPUTERIZED PERINATAL DATA SYSTEMS

The MFM Division has already in place and fully functioning two clinical information systems for the Labor and Delivery Suite and the Antenatal Testing Unit (ATU). The Labor and Delivery Suite has just converted to a new clinical computer system from GE, and the Antenatal Testing Unit System uses the latest reporting and image archiving system from OBserver TM VisionChips, Aliso Viejo, CA). The hospital system has bedside terminals in each of the labor-delivery-recovery rooms, operative areas, surgical recovery beds, perinatal triage unit (loft), and high risk beds on the in-patient antepartum unit. The systems function as an electronic medical record. The OBserver TM computer system (in the ATU) runs on a departmental wide network. There are 5 data entry workstations located in the Antenatal Testing Unit. The ultrasound machines in the Antenatal Testing Unit have a direct interface to OBserver TM, thus providing the capability for the direct downloading of biometric information and images acquired during the ultrasound evaluations.

7. AVAILABILITY OF A CLINICAL RESEARCH CENTER

The clinical research center of the Robert Wood Johnson Medical School is a combined in-patient and out-patient facility with extensive experience in administration of clinical research protocols. It includes 12 licensed in-patient beds with a capacity to expand to 16, including 4 beds equipped with electronic monitors for electrocardiographic and invasive physiologic studies. There are also 4 out-patient clinic rooms in the facility with a phlebotomy suite which can accommodate several hundred patient visits per week. The center offers the fellows the opportunity to conduct safety and tolerability studies, as well as pharmakokinetic drug trials.

8. DIVISIONAL RESEARCH INTERESTS

Pre-Pregnancy Health

• Screening strategies to correctly identify women at high-risk for perinatal
  complications
• Folic acid supplementation to prevent birth defects
• Treatment of medical conditions that can affect perinatal outcomes
• Define racial and ethnic contributions to pre-pregnancy health that affect perinatal outcomes
• Pre-pregnancy evaluations of previous medical, obstetric and neonatal complications to help design treatment strategies for before, during and after pregnancy

Preterm Birth Research

• Infection
• Apoptosis (programmed cell death)
• Ultrasound as a screening tool to predict preterm birth
• Population-based risk factor analyses
• Population-based infant outcome studies
• Preterm infant follow-up studies (prediction of morbidity and mortality, respiratory function, neurodevelopmental function)
• The extracellular matrix in membranes, cervix and uterus
• The extracellular matrix in newborn vascular adaptation to life outside the uterus
• Immunologic aspects of prematurity (inflammation, immune tolerance, immune system dysfunction)

Hypertensive Diseases of Pregnancy

• Screening for at-risk women using ultrasound and Doppler evaluations
• Monitoring and managing pregnancies with preeclampsia
• Placental abnormalities with preeclampsia
• Blood clotting disorders (thrombophilias) as risk factors
• Population-based risk factor analyses
• Population-based infant outcome studies
• Markers of oxidative stress with preeclampsia
• Prevention trials
• Vascular reactivity

Fetal Growth

• Non-invasive ultrasound Doppler assessments of altered maternal vascular reactivity and uteroplacental blood flow blood flow
• Management of pregnancies at high risk for abnormal fetal growth
• Mechanisms of fetal and neonatal nutritional compromise
• Neonatal and infant outcomes
• The long-term consequence of abnormal fetal growth
• Population-based risk factor and outcome studies
• Prevention trials

Fetal and Neonatal Brain Development

• Normal and abnormal fetal behavior as a predictor of neurologic function
• New techniques for assessing fetal and neonatal neurologic function
• Imaging: Ultrasound, (MRI), and EEG
• The role of oxidative stress and inflammatory injury in neurologic development
• The effects of abnormal fetal growth and low birth weight on neurologic function
• Predictors of developmental outcomes
• Interventions to improve developmental outcomes in at-risk infants
• Long-term follow-up of at risk infants

Birth Defects and Prenatal Diagnosis

• Epidemiological studies of congenital abnormalities
• Improved ascertainment and tracking of diagnosed congenital abnormalities
• UMDNJ New Jersey Fetal Abnormalities Registry which is a cooperative effort with the NJ Department of Health and Senior Services and the Centers for Disease Control and Prevention, Atlanta, GA.
• Etiology studies
• Application of cost efficient screening strategies
• New diagnostic modalities (testing and imaging)
• Management of diagnosed congenital abnormalities
• Short and long-term outcomes
• Economics of congenital abnormalities

Early Origins of Adult Disease

• Fetal growth restriction/malnutrition
• Prematurity
• Congenital malformations
• Infection
• Hypoxia
• Interventions that can moderate the impact of these conditions on later health
• Follow-up outcome studies

Pregnancy Loss

• Epidemiology
• Cost-effective and evidence-based evaluation strategies
• Immunologic mechanisms of fetal loss
• Disorders of blood clotting systems and fetal loss
• Placental dysfunction
• Gene-environment interactions
• Prevention studies

Perinatal Health Economics

• Information systems development and implementation
• Cost effectiveness/benefit analyses
• Database design and data management
• Relevant outcome assessments
• Condition specific care research

Perinatal Epidemiology and Outcomes Research

• Black-white disparities in adverse perinatal outcomes in the US, including prematurity, fetal growth restriction, fetal and infant mortality.
• The role (both content and timing) of prenatal care on adverse perinatal outcomes.
• Provide recommendations on indication-specific "optimal" prenatal care in the US.
• Secular and temporal trends in the incidence of preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
• Causes of temporal trends in preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
• The role of age, period and birth cohort effects on preterm delivery and small for gestational age births among US blacks and whites.
• Risk factor profiling of obstetric complications among singleton and twin births in the US.
• Gene-environment interactions, as well as familial aggregation of placental abruption, fetal growth restriction, and stillbirth, through family-based case-control studies.
• Developing innovative statistical methodologies for analysis of studies, especially focusing on methods for longitudinal and repeated measures (clustered) data.

III. NARRATIVE DESCRIBING DIDACTIC ACTIVITIES

The didactic activities consist of the following lecture series and conferences:

A. Lecture Series

1. Ob/Gyn/Resident lecture series (every Monday 12 noon to 1:00 p.m.);
2. Ob/Gyn Resident/MFM Fellow/Chairman’s Obstetric case review (every Monday and Wednesday 4:00 – 5:00 p.m.);
3. Grand Rounds lecture series (every Friday of the month, 8:00-9:00 a.m.); and
4. MFM core curriculum lecture series (given by fellow on the last Wednesday of the month, 4:30-5:30 p.m.).

B. Conferences

1. Fetal Ultrasound Diagnosis and Management Conference (every Wednesday 12 noon to 1:00 p.m.);
2. Combined MFM/Neonatal Conference (every second and fourth Wednesday of the month, 1:00-2:00 p.m.);
3. Perinatal Genetics Conference (every first Wednesday of the month 1:00-2:00 p.m.);
4. MFM Journal Club (given by the fellow the third Wednesday of the month, 1:00-2:00 p.m.);
5. Perinatal Pathology Conference (fifth Wednesday of the month 1:00-2:00 p.m.);
6. MFM Patient Care Conference (every Friday 12 noon to 1:30 p.m.)
7. Departmental Morbidity and Mortality Conference (every third Wednesday of the month, 8:00-9:00 a.m.).

C. MFM Research Meetings

MFM research meetings are conducted every Wednesday from 4:30-6:30 p.m., except the last Wednesday of each month, which is dedicated to MFM core curriculum topics as well as Journal Club. These include epidemiology and biostatistics core and laboratory research techniques lectures every other month.