Maternal Fetal Medicine Fellowship

Truman Medical Centers


TMC Hospital Hill

Truman Medical Center

Truman Medical Centers are a two-hospital, not-for-profit health system located in Kansas City, Mo. Our downtown location, TMC Hospital Hill, is the largest provider of outpatient specialty care in Kansas City, operates the busiest adult emergency department in the city and has one of the top Level 1 trauma centers in the Kansas City metropolitan area. Our suburban hospital, TMC Lakewood, is located near Lee’s Summit and provides a range of specialty and outpatient services.

Truman Medical Centers have received top clinical quality ratings from University Health System Consortium (UHC) in the areas of patient safety, performance improvement, and adult ICU care. TMC has also been named a top performer in heart attack and heart failure care by the Missouri Medical Quality Initiative program; one of “America’s Best Hospitals” for asthma treatment by U.S. News and World Report; a “Top 100 Hospital” by Solucient for rating among the highest in improved patient outcomes and financial performance; a “Most Wired Hospital” by Hospitals and Health Networks; and along with the University of Missouri-Kansas City, received the designation of National Center of Excellence in Women’s Health by the United States Department of Health and Human Services (US DHHS).

The in- and out-patient teaching at TMC is distributed throughout the week under the direct supervision of the MFM Faculty. The inpatient teaching consists of daily rounds of the hospitalized antepartum patients with the MFM faculty with frequent participation of the Neonatology and Anesthesia Departments. The MFM faculty directly supervises and educates the fellows in providing inpatient consultations, management of maternal fetal high risk admissions, clinical evaluations, interpretation of maternal and fetal tests, advanced ultrasound imaging, formulation of management plans, and fetal invasive procedures including fetal blood sampling, intrauterine transfusion and bladder shunt placement. The fellows and the MFM faculty attend weekly MFM case discussion sessions, joint monthly sessions with Neonatology, and monthly multidisciplinary integrated case management conferences at the quaternary Fetal Health Center at CMH.

The outpatient teaching includes sessions in high risk clinics three mornings a week during which the fellows are taught how to provide ambulatory consultations on maternal fetal complications. In the prenatal diagnostic center, the fellows spend a minimum of 2 full days a week receiving education and training in fetal anatomical and targeted ultrasound examinations, fetal echocardiography, genetic counseling and genetic amniocentesis. The fellows also participate in the weekly multidisciplinary high risk planning conference that formulates management plans for all new high risk patients seen during the week. The MFM faculty is present in all the above activities.

Inpatient:

TMC operates a tertiary perinatal care center serving Kansas City and Jackson County, Missouri and the surrounding area. The BirthPlace at TMC has a 48-bed obstetrical unit with the following: 10 labor/delivery/recovery rooms (LDRs); 6 single-occupancy antepartum rooms (that can also be used as LDR rooms); 4 double-occupancy rooms (8 beds) for antepartum or postpartum patients depending on demand; and 12 double-occupancy postpartum rooms (24 total beds) for mothers with their babies. Antepartum and labor beds have fetal monitoring capability (including that related to monitoring multiples) with a central monitor located at the nurses’ station with on-line recording of traces.  The unit has a 6-bed triage area, 2 delivery/surgical suites, and a 4-bed recovery area.  An in-house anesthesia service operates 24/7.Inpatients have access to the 4 advanced ultrasound units located in the Prenatal Diagnostics Suite (located on the same floor as the BirthPlace).  Additionally, there is a dedicated portable ultrasound device for inpatients of women’s and infants’ services; two other units are typically used for outpatients but are available for inpatient use as may be necessary.

Since TMC operates a high-risk perinatal center, it has a tertiary level III neonatal intensive care unit (NICU) licensed for 19 beds and located on the same floor as its obstetrical beds.  A small nursery is also used for assessment of infants following birth and short-term observation.  A transitional room is available for use by parents and newborns just prior to the infant’s discharge from the neonatal intensive care unit.  The NICU of CMH has 60 beds that can be accessed via a bridge between TMC and CMH.  Newborns may also be transferred by ambulance.

Supervision of the fellows: The MFM faculty members who are on call 24/7 supervise the fellows on all aspects of in-patient high risk obstetrical care.  Along with the fellows, they conduct daily patient rounds, and supervise the fellows in providing consultations, determining appropriate management plans and performing invasive procedures.

Availability of consultative services: Being an academic medical center, comprehensive multidisciplinary consultation services are available 24/7 at TMC.

Availability of critical unit: Obstetrical patients requiring ventilatory assistance and critical care are generally admitted to the medical or surgical intensive care service. Moreover, each LDR and recovery area bed is equipped for pulse oximetry, non-invasive blood pressure and EKG monitoring.  EKG monitors are capable of monitoring and displaying two invasive pressures (arterial line and central venous pressure or pulmonary arterial pressure).

Outpatient

TMC provides outpatient women’s care services in the Women’s Health and Wellness Center which is located on the same floor of the hospital as inpatient women’s and infant services.  Notably, this Center has the continuing designation as the UMKC/TMC National Center of Excellence in Women’s Health by the US DHHS. This clinic operates daily, providing a total of 9 morning and afternoon sessions per week. A high-risk clinic and a diabetic clinic for insulin-dependent pregnant patients are provided during several sessions each week. Social workers, case managers, an obstetrical educator and interpreters are also accommodated in space that affords obstetrical patients easy access to a range of special services. The MFM division provides ultrasonography, non-stress testing, biophysical profile, Doppler ultrasound (umbilical and middle cerebral arteries, ductus venosus), prenatal diagnosis/genetic counseling services in the completely renovated Prenatal Diagnostic Suite Advanced fetal imaging including comprehensive echocardiography, amniocentesis, and other antepartum procedures are performed by the MFM faculty.

a. Supervision: The fellows are supervised on site by the MFM faculty member providing coverage for the high risk obstetrical clinics. Under the guidance of the faculty, the fellows provide consultation and supervision of the residents.  At the Prenatal Diagnostic Center, the MFM faculty provide on site supervision of the fellows performing advanced ultrasound imaging and MFM consultation

b. Facility: The Women’s Health and Wellness Center has a net square footage of nearly 20,000. A total of 17 examination rooms are used for these clinics. The obstetrical clinics utilize approximately 12,000 square feet. Portable Doppler fetal heart monitors and an ultrasound unit are available for use during these clinics. The completely renovated Prenatal Diagnostic Center has a reception/waiting area, 2 staff offices and 4 examination/procedure/consultation rooms and a conference room with a large screen LCD screen for audiovisual needs for case conferences and quality reviews.  Four state-of-the-art Philips iU22 ultrasound units are available for use by MFM faculty. The equipment is dedicated to the MFM service.

c. Sharing of the facility and equipment: The obstetrical clinic is dedicated to the general obstetrical and MFM practice. The equipment is not shared with any other department. The Prenatal Diagnostic Center facility and the ultrasound devices are exclusively used for the MFM service.