Maternal-Fetal Medicine Qualifying Exam Preparation
Blueprint
The content of the Qualifying Examination will be based on the blueprint for Maternal-Fetal Medicine. The major categories and subcategories are shown below indicating the percentages of the categories. The questions will be in a multiple-choice, one best answer form.
Medical Disorders
- Evaluate, diagnose, and manage medical disorders
- Provide preconception, post-delivery counseling (including contraception) for patients with medical disorders
- Counsel patients about maternal physiology, fetal and neonatal implications of their medical condition(s)
- Counsel patients on impact of medical disorders on delivery timing
- Counsel patients with medical disorders regarding drugs and biologics
- Manage antenatal care for patients with medical disorders
- Manage intrapartum and postpartum care for patients with medical disorders
Critical Care
- Evaluate and diagnose critical care conditions
- Manage critical care conditions and interpret hemodynamic monitoring
- Identify critically-ill patients and facilitate transfer to higher level of care
- Manage antenatal care and delivery timing for critically-ill patients
- Manage intrapartum and postpartum care for critically-ill patients
- Counsel critically-ill patients regarding drugs and biologics
- Manage massive obstetrics hemorrhage
- Manage obstetric coagulopathy
Preterm Labor and Preterm Premature Rupture of Membranes (PPROM)
- Identify risk factors for preterm birth
- Counsel patients on risk-reduction strategies for preterm birth
- Counsel patients on limits of viability, prognosis, and management
- Manage PPROM
- Manage preterm labor and delivery
- Manage cervical insufficiency
Hypertensive Disorders
- Manage hypertensive disease in pregnancy
- Manage preeclampsia
- Manage eclampsia
Multiple Gestation
- Counsel and manage patients on associated complications and pregnancy outcomes based on chorionicity for twin gestations
- Counsel and manage high-order multiple gestations
- Counsel patients on indications and risks associated with fetal reduction
Fetal Demise
- Provide preconception counseling for recurrent pregnancy loss
- Evaluate and manage patients with a fetal demise and/or recurrent pregnancy loss
- Evaluate and manage patient for bereavement and/or postpartum depression
Procedures Relating to Obstetrical Complications
- Amniocentesis and amnioreduction for fetal lung maturation
- External cephalic version
- Peripartum hysterectomy
- Cervical cerclage
- Chorionic villus sampling
- Cordocentesis and fetal transfusion
Obstetric Anesthesia
- Counsel medically-complicated patients regarding the different anesthetic options including benefits, risks, and contraindications (e.g. systemic analgesia and sedation, general anesthesia, regional anesthesia); for example, cardiac arrest, respiratory arrest, aspiration pneumonitis, hypotension, high spinal or total spinal, convulsions, neuropathy, headaches, hypothermia
- Identify, diagnose, and co-manage anesthetic complications (e.g. cardiac arrest, respiratory arrest, aspiration pneumonitis, hypotension, high spinal or total spinal, convulsions, neuropathy, headaches, hypothermia)
Management of Obstetrical Complications
- Amniotic fluid embolism (AFE)
- Acute fatty liver of pregnancy (AFLP)
- Placental abruption
- Abnormal placentation (e.g. acceta, increta, percreta, vasa previa and placenta previa)
- Gestational trophoblastic disease
- Ruptured uterus
- Cholestasis of pregnancy
- Uterine anomalies
- Ovarian masses
- Dermatologic conditions (e.g. PUPPS, herpes gestationis)
- Fetomaternal hemorrhage
- Trauma
- Abnormally-implanted pregnancies (abdominal, cervical, and c-section scar)
Ultrasound
- Perform and interpret 1st trimester ultrasound for singleton and multiple gestations
- Perform and interpret 2nd and 3rd trimester ultrasound
- Recognize normal and abnormal maternal, fetal, and placental anatomy
- Apply knowledge of the limitations of ultrasound to determine need for additional imaging modalities
- Determine indication for and perform Doppler studies (umbilical artery and MCA, color, m-mode)
- Determine indication for and perform 3D and 4D ultrasound
- Perform and interpret cervical length assessment
- Manage disorders of amniotic fluid volume
- Perform and interpret fetal echocardiography
- Perform ultrasound assessment of chorionicity
Evaluation, Management, and Diagnosis of Fetal Complications
- Fetal structural abnormalities
- Fetal growth restriction
- Genetic disorders (e.g. chromosomal abnormalities, DiGeorge's, skeletal dysplasia, syndromes)
- Fetal hydrops
- Isoimmunization
- Alloimmune thrombocytopenia
- Fetal Infections
- Obtain a genetic history and perform a three-generation pedigree, perform preconception genetic counseling, and counsel patients on Mendelian patterns of inheritance (e.g. autosomal dominant, autosomal recessive, co-dominant, X-linked recessive, X-linked dominant) and non-Mendelian patterns of inheritance (e.g. trinucleotide repeat disorders, imprinting, uniparental disomy, mitochrondrial inheritance, germline mosaicism, multifactorial and polygenic inheritance)
- Counsel patients on benefits and limitations of PGS/PGD (preimplantation genetic diagnosis)
- Counsel patients on and perform expanded and ethnicity-based carrier screening
- Counsel patients on different methods of aneuploidy screening and interpret results
- Counsel patients on prenatal testing (e.g. fetal karyotype, chromosomal microarray, biochemical and molecular tests, whole exome sequencing)
Ethics and Professionalism
- Systematically engage in practice review to identify health disparities
- When engaged in shared clinical decision making, incorporate patient, family, and cultural considerations in making treatment recommendations
- When providing care for patients, consider psychological, sexual, and social implications of various treatment options
Patient Safety
- Systematically analyze the practice for safety improvements (e.g. root cause analysis)
- Systematically engage in practice reviews for safety improvements (e.g. root cause analysis)
- Incorporate the standard use of procedural briefings, "time outs", and debriefings in clinical practice
- Participate in the review of sentinel events, reportable events, and near misses
- Implement universal protocols (e.g. bundles, checklists) to help ensure patient safety
Interpersonal and Communication Skills
- Communicate to patient and family regarding adverse outcomes and medical errors
- Demonstrate sensitivity and responsiveness when communicating with a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
- Provide comprehensive information when referring patients to other professionals
Systems-Based Practice
- Incorporate considerations of cost awareness and risk-benefit analysis in patient care
- Provide care with multidisciplinary teams to promote patient safety and optimize patient outcomes
Practice-Based Learning and Improvement
- Design or participate in practice or hospital quality improvement activities
Evidence-Based Medicine
- Incorporate evidence-based practices and national guidelines to improve practice patterns and outcomes
- Implement evidence-based protocols to enhance recovery after surgery (ERAS)