Special Delivery
The SMFM ENewsletter

President's Forum 
Matt Granato, LLM, MBA
Dear SMFM Members:

On behalf of the Board of Directors, I want to thank those of you who applied to serve on an SMFM committee in 2019.  This year, we had a tremendous response to the call for applications.

The application process is now closed and committee chairs  are reviewing the 379 applications we received. This year's list of applicants was impressive, many with extensive contributions to the Society and our membership. We will let applicants know if they have been selected no later than October 15.
In the meantime, please make sure that your SMFM online profile is up-to-date and complete.  The profile aids the committee chairs in ensuring that prospective members reflect the diversity of the SMFM. We consider diversity in terms of gender, place of work, length of membership, stage of career, race/ethnicity and geographic location. Access and update your profile on the SMFM website.   
The SMFM Board of Directors is committed to transparency and diversity in the committee selection process.  We hope to give opportunities to as many members as possible in 2019. As such, once the committee chairs have reviewed the applications and made their selections, the staff liaisons will gather to review the selections and ensure that same person or people have not been selected for multiple committees. We hope to spread the volunteer opportunities among as many qualified members as possible.   
Thanks again for your interest in a volunteer leadership position and for all that you do to make SMFM a stronger organization.  We hope you will continue to be actively involved in the activities of the Society by participating in our online communities, social media efforts, the state liaison network, meetings or through other opportunities as they arise.  
Should you have questions or feedback, please contact me directly or use the online suggestion box, which allows members to provide anonymous feedback.      
Matt Granato, LLM,  MBA 

39th Annual Pregnancy Meeting Updates 
Dr. Lorraine Dugoff
Planning is well underway for SMFM's 2019 Annual Meeting, which will take place on February 11 - 16 in Las Vegas, Nevada. Registration for the meeting will open in October.

On behalf of the entire Annual Meeting Program Committee, I want to thank those who submitted abstracts. This year, we received 2,022 abstracts, which is 75 more than we received in 2018!  Abstract acceptance notifications will be sent the first week of October. Please be on the lookout for an email from our vendor, Precis Abstract Management, with additional details around October 4 or 5.
Late Breaking Abstracts
We will welcome your late-breaking abstracts from October 12 to November 12. Late-breaking abstract submissions must meet the following criteria:
  • The research must be new and of sufficient scientific importance to merit special consideration after the standard abstract deadline. Abstracts should describe either large clinical studies or high-impact translational research that could not be completed prior to the original deadline.
  • Clinical studies must be prospective in design.
  • Late-breaking abstracts cannot be a revision of an abstract submitted prior to the submission deadline.
We will share a link to the submission site and additional details next month. 

Making #SMFM19 More Family Friendly 
We are offering childcare services for the first time in response to the demand expressed in our member survey. SMFM is subsidizing a pilot program which will be limited to 18 children per hour on a first-come, first-served basis. Please refer to our FAQ document for additional details.
Because space in the childcare program is limited, we encourage you to reserve your child's space as soon as possible. This is a separate registration process from the Annual Meeting course selection and is now open. 
To register for childcare services, please click here.
Regardless of whether you plan to use our childcare services, we encourage you to bring your family. Baby-wearing and feeding is welcome throughout The Pregnancy Meeting ™. Additionally, we will have dedicated, private space to pump or feed your child, to soothe a crying baby or just to burn off some energy for a rambunctious toddler. Please be respectful of the speakers and do not bring crying children into the scientific sessions.
Below are some of the functions that will take place during the meeting to help you in deciding what days/times you might want to use the childcare services or an extra set of
hands. Note: times may change slightly.
Function Name
February 11-13 
Postgraduate Courses, Workshops, and Symposiums
Wednesday, February 13
8:00am- 2:30pm
Postgraduate Courses
Wednesday, February 13
Scientific Forums
Wednesday, February 13
Resident Forum
Thursday, February 14
Welcome and Oral Plenary Session 1
Thursday, February 14
Meet-the-Fellows Reception (Invitation Only)
Friday, February 15
Welcome from Foundation for SMFM and Oral Plenary Session 2 (Fellows)
Saturday, February 16
Awards Ceremony (Thurs and Fri) Sessions
Saturday, February 16
Oral Concurrent and Poster Sessions

Hotel Accommodations
You can reserve your hotel room at the discounted, group rate of $255 per night. All official Annual Meeting activities will be held at Caesars Palace. Visit the hotel's website or call + 1 (866) 227-5944 and mention SMFM's 39th Annual Pregnancy Meeting to reserve yo ur room. SMFM recommends booking directly with the Caesars Palace to avoid any housing scams.
Finally, as new information is available, it will be posted on the SMFM website at: www.smfm.org/2019. I encourage you to continue to check back and look forward to seeing you in Las Vegas.
Warm regards,

Lorraine Dugoff, MD
2019 Scientific Program Chair

Health Policy and Advocacy
There has been a flurry of activity as the end of the federal governmnet's fiscal year (FY) comes to a close and Congress aims to finish up work before the November 6 elections.
Maternal Mortality Legislation
Legislation that SMFM has endorsed, the Preventing Maternal Deaths Act, has been slated for a Congressional hearing with the House of Representatives' Committee on Energy and Commerce. This hearing is the result of a groundswell of support from MFMs, OB-GYNs, women and their families. The hope is that once the House side weighs in on the legislation and passes it, the legislation will move quickly through the Senate for passage.
PREEMIE Act Reauthorization
Another important piece of legislation for SMFM passed its first hurdle and has been approved by the Senate. The PREEMIE Reauthorization Act continues important federal programs aimed at reducing preterm birth and its consequences. This bipartisan legislation supports federal research and promotes known interventions and community initiatives that will further reduce preterm birth. More specifically, it will renew CDC research and programs on preterm birth; reauthorize activities that promote healthy pregnancies and prevent preterm birth; extend the Secretary's Advisory Committee on Infant Mortality and update the Committee's charge to include severe maternal morbidity; and establish a coordinated effort within the U.S. Department of Health and Human Services (HHS) to oversee and coordinate all activities related to preterm birth, infant mortality and other adverse birth outcomes. This legislation now moves to the House for consideration.
Funding Bills
Congress has agreed to, and the Senate already passed, its Labor-Health and Human Services-Education spending bill for fiscal year 2019, which begins on October 1, 2018. This is the first time since 1996 that this appropriations bill would be passed before the end of the fiscal year and not as a continuing resolution. This is a HUGE deal as this legislation is a behemoth and by far the most controversial of all of the appropriations bills. Highlights include:  
  • There are NO policy riders related to Title X or Planned Parenthood.
  • The bill provides $12 million for CDC's safe motherhood initiative, which is for the maternal mortality review committees.
  • The bill provides an additional $12 million for Healthy Start to specifically look at reduction of maternal mortality. This funding would support nurse practitioners, certified nurse midwives, physician assistants and other maternal-child health advance practice health professionals. 
  • The bill provides $3 million for the Alliance for Innovation on Maternal Health (AIM) program (this has never been specifically included before and shores up Congressional support for AIM).
  • The bill provides $23 million to HRSA's Title V program for state demonstrations to implement evidence-based interventions to address critical gaps in maternity care service delivery and reduce maternal mortality.
The hope is that the House will pass the package in the next week and send the legislation to the President for his signature. Learn more about the appropriations process and maternal mortality legislation that SMFM has been working on for some time with this quick video from Chief Advocacy Officer, Katie Schubert.  
Regulatory Update
As it does every year, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule related to the Medicare physician fee schedule (PFS). Although the MFM patient population is most unlikely to be covered by Medicare, there was a proposal included in the proposed rule that decreased reimbursement for office visits and consultations that occur with other services. SMFM submitted a comment letter that echoed the comments of the American Medical Association (AMA) and other physician organizations. The main concern is that should the Medicare program adopt this proposal, private payers and Medicaid will ultimately adopt it as well, creating barriers to access to care for high-risk pregnant women.

NICHD Strategic Planning Process
The Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) is undertaking a strategic planning process. If you are interested in learning more, they are engaging in listening sessions and seeking public input. SMFM is working on guiding principles for initiatives that the organization feels are important in terms of research in pregnancy. We encourage our members to engage in the process. Learn more here.

Foundation for SMFM 
2018 Queenan Fellowships for Global Health Recipients
The Foundation for SMFM is pleased to announce that the 2018 Queenan Fellowships for Global Health have been awarded to the following individuals:
F.B. "Will" Williams, MD, MPH, a second-year Maternal-Fetal Medicine Fellow at the University of Vermont, is the recipient of the Investigator-Initiated Research Project Award for his project, "Maternal Histoblood Group Antigen Genotype as a Predictor for Rotavirus Vaccine Response in Breastfed Infants in Bangladesh." His project mentors are Drs. Benjamin Lee and Marjorie Meyer from the University of Vermont and Dr. Jeffrey Stringer from the University of North Carolina.  His research interests include health disparities, maternal comorbidities and health systems strengthening.
D'Angela Pitts, MD, a second-year Maternal-Fetal Medicine Fellow at the University of Michigan, is the recipient of the Visiting Teaching Fellowship and will spend two months as a visiting faculty member at Korle Bu Teaching Hospital in Accra, Ghana in March and April 2019. She will interact with their staff and physicians through lectures and presentations in high-risk obstetrics relevant to resource-limited settings, continuing the efforts of Dr. Timothy Johnson and Dr. Lucie Moravia in Ghana. She plans to 
incorporate global health work into her career in academic medicine as an MFM.

Fellows Corner
Successful Failing
Dr. Chris Pettker
By: Chris Pettker, MD 
"Failure is not an option." This is the defining quote of Apollo 13, the film based on the ill-fated 1970 mission to the moon, where an equipment malfunction leads to a failure in power, heat, and oxygen con. The brilliance of the film is that despite knowing the ending (the astronauts make it home safely!), there is no loss in thrill and suspense as we watch the teams apply ingenuity and courage to classic problem solving, all in a minivan traveling through space at several miles per second.
The quote is ubiquitous in popular culture despite two fundamental problems. First, it is totally made up. The writers for the movie came up with this line, nearly 25 years after the event, following interviews with the flight directors of the mission. Gene Kranz, the mission control director, never said it, even in interviews, and it is attributed to another member of the team who recounted, " When bad things happened, we just calmly laid out all the options, and failure was not one of them. We never panicked, and we never gave up on finding a solution." Hollywood has such an amazing way of spinning and manufacturing truth. Even though the quote is apocryphal, you can actually buy pins and T-shirts that say "Failure is not an option," at the Smithsonian Air and Space Museum in Washington, DC.
The quote is also problematic because its glibness misconstrues the involvement of failure in the event. Certainly, the mission teams could not literally plan for a complete failure to return the astronauts to Earth. However, the mission became inextricably linked with failure, specifically the mitigation of failure. Failure came to define the parameters of the mission, so much that NASA even now considers it a "successful failure." Recognizing and highlighting failure turned out to be a source of strength.
I bring this up to reframe classic thinking about failure. The normal, common reaction to failure is dejection, humiliation and withdrawal. Though it is harder and less natural, we are better off approaching failure with of reflection, humility and a sense of progress. We don't talk enough about our own individual failures, even though they can be important points for us to share with our colleagues to help ourselves and to help them. Even the prospect of failing is haunting and paralyzing; all of us remember the hours before our oral board examinations.
As physicians, researchers and administrators we will most certainly fail. Failure is an unpalatable option, though in our world it should probably be considered an inevitability. We may miss a diagnosis leading to a delay in treatment; I don't need to remind obstetricians about the possibilities of failure in clinical practice. An experiment will have opposite results of what we expected or a research paper will get rejected from multiple journals. We might, in hindsight, give a mentee bad advice. The contemplation of these failures can sometimes be a sickening realization of inadequacy. We are frightened by them, and we often work to encase them in dark corners of our minds and conversations. This is normal, but it is not necessarily healthy.
I have made a living off of failures - my own and others - in the world of patient safety and quality improvement.  One of the core principles of a high-reliability organization is being 'preoccupied with failure,' those of the past and the future.  The best organizations are those that openly discuss failure, sharing lessons from the past and looking for potential failures in every corner. As painful as this is, until we get past the fear of failure and the dejection that comes in the face of it, we will have a hard time preventing the next one. At Yale-New Haven Hospital, our safety and quality meetings begin by announcing how long it has been since our last serious safety event. We literally start the meeting by talking about the last time we failed. This gives a frame of reference for why we are doing the work of that meeting, but it also acknowledges to everyone in the room that we are preoccupied with failure and that there is a safe space to discuss it.
Recently I did a podcast for SMFM with my colleague, Dr. Heather Lipkind, on " Getting Back Up ."  Heather and I have worked together for over a decade and in the podcast we discuss two of our personal experiences to highlight the devastation that clinicians feel in the wake of the adverse events. The 'second victim', the caregiver who experiences the critical event of a patient, is a real phenomenon is a common contributor to caregiver mental health and burnout issues. The podcast reviews the concept and also resources for supporting second victims. We did it again for our health system to an audience of over 1,200 people.  It was a revelatory experience for both of us as we could feel each individual in the room connecting with stories about some of our hardest times as physicians. What seemed most important in the feedback was how sharing our stories helped people open up about their own experiences. It was a sign that we do not do enough to talk openly with our colleagues about our disappointments, sadness and worries. Sharing these things can help us find meaning in them even in the worst situations and allows us to rebuild together in our professional communities.
For those that can't just live off anecdotes, research also shows that being transparent about failure makes us happier and more productive. A recent New York Times article called, " Talking about Failure Is Crucial for Growth. Here's How to Do It Right ," came out right after I started writing this piece. Given my word limit, I am thankful for the serendipitous timing. It is a must read for anyone who is interested in improving their wellness and thriving in our challenging profession. The concepts of "failing fast" and "failing well" are being used more and more in the business world and are now being embraced in the world of healthcare quality improvement and thus deserve some of your attention.
Some now consider the Apollo 13 mission "NASA's finest hour." Imagine that. A mission that did not achieve its objective of landing on the moon can be considered a triumph. The episode is a classic study in how a focus on recognizing and salvaging failure can achieve success. Unfortunately, NASA also has well documented low points where this didn't happen, like the Challenger and Columbia space shuttle disasters. Investigations have shown that the avoidance of direct, open and transparent discussions about failure led to tragic and unnecessary loss of life. In the end, our capabilities as individuals will be proven less by our successes than by our responses to challenges and failures. They can be positive life-defining moments, but only if you choose them to be that way. And this will only happen if we are as merciful and humble about our colleagues' failures as we would want them to be for our own.

Practice Management Resources
Advance Registration Closes September 21
Advanced registration for the 2018 Practice Management Conference (previously called the AMFMM Annual Business Meeting) closes September 21. Register now to secure your seat for the conference, which will take place on October 4-5 is Scottsdale, AZ. Earn CME and learn about MFM marketing, growth strategy,  EHR optimization, use of advanced practice clinicians and more. View the full program and register on the SMFM website.
Supercharge your Coding Skills 
Code faster and more accurately, achieve compliance and maximize reimbursement with SMFM's updated and improved Coding Course on October 18-19 at the Hilton Philadelphia City Avenue Hotel.   A block of rooms has been reserved for course attendees at a discounted, group rate of $152 per night. To enjoy this special rate, reserve your room on Hilton's website or call +1 (800) 445-8667. Please identify your affiliation with the SMFM fall Coding Course when calling.  The special room rate will be available until September 26 or until the group block is sold-out, whichever comes first. 
Monthly C oding Tip: Vanishing Twin 
A vanishing twin (or fetal resorption) is a fetus in a multi-gestation that fails to develop or dies in utero and is then partially or completely resorbed. Fetal numbering is most commonly determined by ultrasound. The baby positioned lowest in the uterus is usually given the designation of "Baby A." Most commonly, Baby A will be born first in a vaginal delivery.  
In the case of a vanishing twin, the correct twin that vanished should be properly identified. In ICD-10 numbering, fetus 1 would indicate baby/fetus A. Fetus 2 would be baby/fetus B, etc. When coding the continuing care of the pregnancy, the ICD-10 codes linked below are useful to indicate the fetus being evaluated.
For detailed coding information on continuing pregnancy after intrauterine death of one fetus or more with codes based on trimester and fetus number visit the coding tip section of the SMFM website.
Additional coding tips for MFM, can be found on the SMFM website.
Patient Education Resources
MotherToBaby Fact Sheets
MotherToBaby, a service of the non-profit Organization of Teratology Information Specialists, creates and maintains patient- and provider-friendly bilingual (English/Spanish) fact sheets on a wide variety of exposures during pregnancy and breastfeeding. Fact Sheets can be downloaded at no-cost.
NEW - August 2018
Additionally, in August 2018, MotherToBaby updated the following fact sheets: Alcohol, Apremilast, Depression, Duloxetine, Formoterol, Gaucher Diseases, Malaria, Nausea and Vomiting in Pregnancy, Olanzapine, OnabotulinumtoxinA, Phenylephrine, Pseudoephedrine, Vaccines, and Zika Virus. 
To view all fact sheets, click here . If you cannot find a facts sheet on a specific exposure of interest, please contact one of MotherToBaby's experts at + 1(866) 626-6847 (phone), + 1 (855) 999-3525 (text) or email and live chat.
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Funding Opportunities
Federal Grant Funding Announcement
The Maternal and Child Health Bureau launched the Addressing Opioid Use Disorder in Pregnant Women and New Moms Challenge on September 19. This Challenge will award up to $375,000 for innovative solutions to help women get safe and effective care and treatment.  
MCHB is now accepting submissions for Phase 1 of the Challenge. Additional details are available on the MCHB website.  Sign up online to to get the latest news or follow #MCHBGrandChallenges on social media.  
AMAG-SMFM Heath Policy Award  
We are currently accepting applications for the AMAG-SMFM Health Policy Award. This award provides up to $25,000 per applicant to support research that explores an aspect of health care policy. Applications are due October 19, 2018 and funds are available only to SMFM members.  Additional details can be found on the SMFM website. 
Global Health
Dr. Robert Goldenberg
The SMFM Global Health Committee plans to highlight a member's work in global health. This month's member is Robert Goldenberg, MD. 
Dr. Robert Goldenberg is a professor at Columbia University in the Department of Obstetrics and Gynecology. He was previously the chair of Ob/Gyn at the University of Alabama Birmingham. He is a member of the Institute of Medicine and has published over 500 journal articles. He has had a long career in global health which includes leading the NIAID HIVNET 024 study to examine the use of antibiotics to prevent chorioamnionitis related maternal to child transmission of HIV.  
He was also a co-founder the Center for Infectious Disease Research in Zambia that has provided care to more than 200,000 people infected with HIV, as well as conducted substantial research on maternal and neonatal health and HIV MTCT. We caught up with Dr. Goldenberg and asked him about his amazing career and how he got to where he is today.
Q: How did you end up in Alabama which is a long way from New York?
A: I was always interested in the South. In college, I majored in history with most courses on the post-Civil War south. I attended medical school at Duke and then had the opportunity to work with the then-chair at University of Alabama, Dr. Charlie Flowers. Charlie was deeply committed to improving the health for all women in Alabama through the provision of care and training Ob/Gyn residents who would eventually provide care throughout the state. He encouraged me to work as the Director of Maternal and Child Health for the state, which I did while a faculty member at UAB for five years. Through that experience, I learned the importance of combining Ob/Gyn with public health, which actually set me on the course I have followed throughout my career and which then eventually lead me to global health.
Q: What made you decide to go into global health?
A: While certainly all problems in the U.S. related to pregnancy outcome haven't been solved, the problems in many low-income countries dwarf the problems we have here. Maternal mortality may be 100 times greater and stillbirth and neonatal mortality 10 to 20 times greater. The potential to make a difference working in low-income countries is much greater.
Q: What has been the most rewarding thing in your career? 
A: There have been many rewards, but most important has been the long-standing relationships with interesting, committed people who are highly invested in improving outcomes for women and children throughout the world.
Q: What are some of the projects that you are currently doing? 
A: For the last 18 years, I have worked with a group in Pakistan as part of the NICHD global network (with sites in India, Africa and Central America) doing large scale randomized trials on interventions to improve outcomes. These include trials on ultrasound, nutrition, aspirin, newborn resuscitation and corticosteroids. I am also working on several Gates Foundation funded projects to determine cause of death for stillbirths and neonates in Ethiopia, Pakistan and India.
Q: What advice would you give to residents/fellows who are interested in global health? 
A: Having an interest is not enough; neither is visiting a site for a one-month rotation. If one wants to build a career in women's and children's global health, a long term perspective is necessary. One must build a solid relationship with a site, spend significant time there, discover important questions that will have an impact on health, and design studies that answer those questions. To be credible, the results of those studies must be published.
Q: How do you spend your time now both at work and outside of work?
A: I have a full time job at Columbia but mostly work from my home or travel to work on the global health projects. I spend much of my time working on projects or writing papers and especially editing papers from our foreign sites. We live close to the ocean in Connecticut, and I spend a lot of my spare time swimming, kayaking and bird watching. 
New Checklists
The SMFM Patient Safety and Quality Committee has developed three new patient safety checklists. We encourage you to incorporate the checklists below into your clinical practice to help  promotes consistency in obstetrical care and contribute to safe, efficient, high-quality patient care. 
For all of our patient safety checklists, visit the SMFM website.

ISUOG World Congress
SMFM has partnered with ISUOG on a pre-Congress Course that will be live-streamed from the World Congress in Singapore this October.

Title - From Genetics to Obstetric Management: Essential Genetics in Practice

When - October 20, 2018 (participate live or access the recording at a later time) 
What - Appropriate for all delegates, this state-of-the-art course explores genetics as applied in everyday clinical practice. Attendees will gain an understanding of different molecular technologies and their associated advantages and limitations. Learn about appropriate use of testing tools and developments of screening programs with technological advances. Hear debates between leading clinicians about what genetic tests mean and how they influence clinical practice.
The course is co-chaired by Drs. Lorraine Dugoff (SMFM) and Angeline Lai (ISUOG). Key speakers include Baskaran Thilaganathan, Jon Hyett, Aris Papageorghiou, Fabricio da Silva Costa,  Ann Tabor, and many more. For more information and to register, please visit the ISUOG website. 
Survey for MFMs
Joint Periviability Counseling Between Obstetrics and Neonatology  
Please consider completing the survey here regarding periviability counseling. The survey should take about five minutes to complete and is intended to assess the frequency with which JOINT antenatal counseling is provided between OB and neonatology at the time of threatened preterm delivery in the periviable period, defined as 22-24 weeks gestation for the purpose of this survey. Secondary goals are to assess teaching and training that providers receive regarding periviability counseling.

This survey is being sent to neonatologists, MFMs and obstetricians. Responses are anonymous without any request for names or identifying information, and participation is voluntary. Please note that by participating in this survey you are giving consent for the researchers to publish aggregate results of the survey through presentation and/or publication of findings. This study has been reviewed as exempt by Weill Cornell Medicine's Institutional Review Board.

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