Residents spend 21 months in total on the high-risk maternal-fetal service during the four-year residency, either on the Maternal-Fetal Medicine (MFM) rotation or on Night Float.

Structure

Sentara Norfolk General Hospital (SNGH), the primary regional perinatal center for southeastern Virginia, northeastern North Carolina and the eastern shore of Virginia, has an on-site fetal diagnostic unit for non-stress tests and diagnostic fetal ultrasound. The hospital is connected to a 56-bed Level 3 Neonatal Intensive Care Unit at Children's Hospital of The King's Daughters (CHKD).

Residents are involved in both inpatient and outpatient care as an integral part of the high-risk obstetrics program. The outpatient high-risk obstetrics clinic at Hofheimer Hall on the EVMS campus provides perinatal consultations for comprehensive obstetrics, ultrasounds and genetic counseling. Residents examine between 12-15 high-risk patients in each clinic, managing patients with chronic medical problems (such as hypertension, diabetes, sickle cell disease, lupus and renal disease), multi-fetal pregnancy and fetuses with known genetic disease and congenital malformations. The clinic also includes diabetic clinical educators who work closely with residents.

The SNGH inpatient component of the high-risk obstetrics program is an active service with approximately 500 maternal transports accepted yearly. Residents are involved in the care of these patients.

Teaching

On Thursday mornings during protected didactic time, high-risk patients on the academic obstetrics service (AOS) are discussed. Patients with maternal disease, known fetal abnormalities and the antepartum and intrapartum challenges they pose are discussed. A quarterly joint pediatric/maternal-fetal medicine conference attended by a multidisciplinary team analyzes perinatal outcomes of high-risk patients.

During protected didactic time, there are six annual perinatal case conferences for radiology and obstetrics/gynecology residents that cover topics regarding cardiac, genetic, CNS, renal and surgical fetal anomalies.

Maternal-Fetal Topic Rounds are conducted weekly on Labor & Delivery. A resident prepares an assigned topic and leads the discussion with the supervising attending.

Supervision

The high-risk obstetrics service is supervised by seven fellowship-trained, board-certified maternal-fetal medicine (MFM) sub-specialists.
The Diabetes in Pregnancy Program located at Hofheimer Hall at EVMS has two certified diabetic nurse educators and a certified nutritionist with special training in diabetes management. Approximately 1,010 active outpatients and 175 inpatients with diabetes of varying severity are enrolled annually in the program. These patients are either being co-managed with referring physicians or are receiving complete obstetrics care through the department's program.

The Division of Maternal-Fetal Medicine also provides care in a supportive clinical environment for HIV-positive pregnant women and their families.

Together with the Children's AIDS Research and Education Center at CHKD and the combined immune-deficiency clinic in the adult infectious disease clinic located at Hofheimer Hall (EVMS), a sero-positive woman is guaranteed the most comprehensive and up-to-date HIV care in Virginia. We provide care to more than 95 percent of the HIV-positive pregnant women in southeastern Virginia. Residents are involved in the management of these patients. Since the establishment of the HIV in Pregnancy program, we have had no cases of vertical transmission among patients cared for in this setting.

The Division of Gynecology supervises the teen pregnancy program. This clinic is supported by Virginia's Department of Social Services and is dedicated to meeting the needs of pregnant females under the age of 18. The average age of a teen patient is 15 years. The clinic, held one afternoon per week, provides prenatal care while utilizing available educational and social support resources. More than 90 percent of the teens attending the program are able to and are encouraged to continue schooling throughout their pregnancy. Goals of the program are to teach adolescent women about the importance of continuing their education, parenting and life-coping skills after delivery and contraception.

First-, second-, and fourth-year residents attend teen pregnancy clinic. Residents participate in 100 percent of the teen's care; they counsel teens regarding nutrition, exercise and high-risk behaviors and annually deliver approximately 100 patients at SNGH. Teen clinics also teach residents about the emotional and psychological aspects of teen pregnancy.

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