The in-patient facilities at the University of Maryland Medical Center (UMMC) occupy two floors of the south inpatient tower. A total of 22 antepartum and postpartum beds are currently located on the sixth floor in our Mother-Baby (MBU) Unit. The 40-bed neonatal intensive care unit and the term nursery are on this floor as well. Immediately above this unit, on the seventh floor, is Labor & Delivery (L&D).
Labor & Delivery consists of three traditional labor rooms, four LDRPs, three operating/cesarean delivery rooms, a four-bay recovery room, and a two bed triage area. All labor rooms have upgraded automated equipment for central monitoring of maternal vital signs and electronic fetal monitoring. A portable ultrasound machine with Doppler capabilities is permanently located on the Labor & Delivery floor. Invasive maternal physiologic monitoring equipment is portable and can be used in any of the labor rooms. The obstetrical anesthesia service maintains offices on within Labor & Delivery and is on-site 24 hours a day. Maternal blood gas analysis is performed in a satellite laboratory run by the Department of Pathology immediately adjacent to the NICU. This service is available 24 hours a day. Amniotic fluid testing for fetal lung maturity, infection and chemistries is available 24 hours a day as well.
Adjacent to Labor & Delivery is a five-bed maternal Intermediate Care Unit which opened on October 31, 2005. The Intermediate Care Unit (ICU) is used for initial evaluation of high-risk antepartum patients who need close observation for maternal and/or fetal problems, but not yet ready for induction and/or Labor & Delivery.
The outpatient facilities in which the Maternal-Fetal Medicine fellows work are located both on and off the UMMC campus.
In 2008, the Center for Advanced Fetal Care (CAFC) underwent an extensive renovation. The re-opened facility, a 6380 square-foot site, is located on the sixth floor of the north inpatient tower, doubling the previous size of the unit. The CAFC utilizes a multi-disciplinary team approach for the diagnosis and management of families with fetal structural, growth, infectious or maternal medical abnormalities. Our new facility has a spacious waiting room and reception area. A report and data/image management area is equipped with a GE Viewpoint reporting and image processing system. Our nine ultrasound/procedure rooms are each equipped with a GE Voluson E8 ultrasound. There is also a conference/research room with teleconference capabilities and three research computer work stations, two genetic counseling consult rooms, two physicians' consult rooms/offices and a lab area for specimen handling. The Antenatal Testing Unit is now an integral part of the CAFC, consisting of a five-bed unit in which biophysical and electronic fetal heart rate monitoring is performed. The antenatal testing unit is equipped with three GE Logicbook ultrasounds.
The CAFC serves patients from throughout the State of Maryland, and from adjacent parts of Delaware, Pennsylvania, Virginia, West Virginia and beyond. It is at this site that most antepartum and genetic testing is performed. Anomaly scans, targeted imaging, fetal echocardiograms, nuchal translucency, invasive fetal procedures and genetic testing are performed in the CAFC. It is here that the fellows undergo the bulk of the ultrasound training. More invasive procedures such as fetal blood sampling and transfusion, or intrauterine laser may also be performed in the Labor & Delivery suite as indicated.
The CAFC is staffed by Maternal Fetal Medicine subpecialists, RDMS certified sonographers, genetic counselors and dedicated nurses. Consultations with pediatricians, neonatologists, pediatric surgeons and social work and pastoral care services are coordinated through the CAFC, and may take place within the CAFC to maximize patient convenience.
The Department of Obstetrics and Gynecology at Mercy Medical Center, chaired by MFM division member Robert O. Atlas, MD, is fully integrated with our Department at UMSOM. Under his direction the Center for Advanced Fetal Care at Mercy Medical Center, serves an additional training site for the fellow. The CAFC at Mercy Medical Center provides the same spectrum of care as the university hospital based CAFC with the exception of invasive fetal procedures. The fellows spend two months in the CAFC at Mercy Medical Center during their second year to gain an additional training in an outpatient maternal fetal medicine practice setting. Training opportunities include: targeted sonography, amniocentesis, CVS, maternal fetal medicine and genetic consultation. The 2200 square-foot center consists of a waiting room, a reception area, a report and data/image management area, three ultrasound/procedure rooms and four exam rooms in which biophysical and electronic fetal heart rate monitoring is performed.
The Division of Maternal Fetal Medicine maintains a private MFM practice on the UM Baltimore campus and also sees MFM consults at an outreach site in Frederick, Maryland. Fellows have the option to participate at these sites during their second and third years in order to be exposed to yet another aspect of perinatal practice. The fellow, while on clinical rotations, may accompany a member of the MFM division to these consult clinics and see a full spectrum of patients referred from local practitioners for consultation, ultrasound evaluation and amniocentesis with visits up to once a week, depending on the site. The fellows' participation at all sites is under the direct supervision of MFM faculty. This clinical experience is designed to prepare the fellow to function as an expert consultant in MFM by exposing the fellow to a different type of patient population from that seen in an inner city hospital and not to generate income for the fellow or the division.
The University of Maryland Women's Health Center at Western-Penn is located one block south of UMMC, and it is here that the High Risk Pregnancy Clinic meets. The space consists of a large waiting room, clerical and administrative spaces, four consultation rooms and eight exam rooms. The high-risk pregnancy clinic is in session three half days per week. For two of these clinics the fellow leads a team of residents and medical students take part in all sessions. The fellow spends one session per week in the High Risk Pregnancy Clinic and sees patients under the supervision of a faculty perinatologist. The faculty member is present in the clinic at all times to provide close supervision of and consultation to the fellow, while at the same time allowing the fellow to teach and direct the clinical activities of residents and students. The goal of this organized clinical experience is to allow the fellow progressively more responsibility in evaluating and managing complex antepartum patients, while at the same time assuring close supervision and availability of faculty. Fellows attend the High Risk Pregnancy Clinic during research months throughout their first, second and third years. This clinic experience serves as a continuity clinic for the fellows.