Path to a Fellowship in Maternal-Fetal Medicine

Performing an ultrasound on Erin Distad, Jennifer Krupp will finish her ob/gyn residency this year before beginning her fellowship.

Sometimes, circuitous paths lead people to doing exactly what they had hoped to do with their lives when they were young children. That's what has enfolded for Jennifer Krupp, MD '05, a fourth-year resident in the University of Wisconsin Hospital and Clinics' Obstetrics and Gynecology Residency Program.

In August, while enjoying dinner at home with her husband, Mike, and their two children, she was reflecting on the past three years, when the family moved to Madison for her residency.

"It was a beautiful evening, our 13th wedding anniversary and our children, Michael, 11, and Hannah, 9, had made stir-fry for us using vegetables from our garden," she says. "They had found the recipe at the grocery store and wanted to make it a special night for all of us."

There was also more to celebrate than the couple's anniversary.

"Everything had come together perfectly," says Krupp. "We had all grown to love Madison, but I had begun applying for positions all over the country. Then I learned I received a fellowship in maternal-fetal medicine in the UW Department of Obstetrics and Gynecology."

Krupp will begin the three-year fellowship in 2009 once she completes the obstetrics and gynecology residency. The residency is the ideal launching pad into the highly coveted fellowship program, according to Sabine Droste, MD, director of the UW ob/gyn residency program.

"Many applicants are drawn to our program, not only because of its excellent academic setting, but also because it opens doors to specialty paths such as gynecologic oncology, reproductive endocrinology and maternal-fetal medicine," says Droste, associate professor of medicine at the UW School of Medicine and Public Health (SMPH).

The selection process for the residency program is fierce since it consistently is ranked in the top third of the 249 ob/gyn programs in the country.

"Typically, we receive 300 applications for six positions each year," says Droste, who has directed the UW program for 10 years. When the field is narrowed to 60, she and others on the admissions committee interview and review the final applicants.

The UW program is unique, Droste adds.

"It's an innovative mix of top-notch instruction at an academic teaching facility combined with community-based hospitals," she says, noting that the program's clinical obstetrical facilities are based at Meriter Hospital in Madison. "This combination leads to a larger surgical volume and opportunities for residents to see a patient population that's a representative cross-section of the community. It's an excellent training ground for residents."
 
Two pivotal events played key roles in Krupp's decision to apply to the UW ob/gyn residency and eventually specialize in high-risk obstetrics: her experiences with the birth of her own children. When she was pregnant with Michael and Hannah, early in both pregnancies she was put on bed rest.

"These were formative situations that motivated me to want to be part of a complex problem-solving team," Krupp says. "Because of my own life experiences, I have a special interest in women's health and high-risk obstetrics, particularly when health problems like diabetes and heart and kidney diseases impact a woman during her pregnancy."

Of the many lessons Krupp has learned in her residency, one stands out as perhaps the most profound.

"Unexpected things can happen when you least anticipate them," she says.

She remembers one challenging situation that led to a deeper understanding of obstetrical training.

"We did a Cesarean section on a woman in her early 20s with placenta previa," says Krupp. A common pregnancy complication that can cause excessive bleeding before or during delivery, placenta previa can lead to hemorrhage, additional morbidity and mortality for both the mother and her child.

Not long after Krupp and the team performed the C-section, the patient took a turn for the worse in the recovery room.

"We had to do an emergency hysterectomy, something I had never done before," says Krupp. Following the two back-to-back surgeries, Krupp studied placenta previa and potential outcomes for an upcoming "Morbidity and Mortality" conference.
 
Three weeks after doing the uncommon sequence of C-section followed by a hysterectomy, another woman presented with the same situation requiring the same sequence of procedures.

"It was uncanny that there would be two such situations in such a short period of time," says Krupp. "But the second time, I had a better understanding of what to expect."

Krupp's passion for medicine was instilled in her when she grew up on a farm outside the small town of Waubeka, Wisconsin-population about 200.

When she was a young girl, Krupp says, "I was always working with animals, trying to fix them when they were sick."

After graduating from high school, she asked herself: "What if helping has no boundaries?" The answer led her to pursue a career as a nurse and then a nurse practitioner.

A volleyball scholarship took her to the University of Alaska, where she earned a bachelor's degree in nursing. Three years later, she followed with an MS in nursing from Marquette University in Milwaukee. For three years Krupp worked as an RN at Milwaukee County Hospital, and four more as a geriatric nurse practitioner before feeling the same urge she had had as a young girl to learn as much as she could about medicine. She made the decision to expand her medical knowledge by applying to medical school.

She was thrilled when she was accepted to the SMPH. She and her family were living in Port Washington at the time. Mike, an electrician, continued to work for a local company while Jennifer commuted back and forth to Madison, about an hour and 45 minutes each way.

During her first two years of medical school, Krupp used her care-giving skills to help her father-in-law, Lou, who had multiple health problems.

"He was legally blind from complications due to diabetes. He had several strokes, and had his leg amputated below the knee," she says. "He died during my third year in medical school."

Krupp earned her MD in late spring 2005 and stayed in Madison until her family joined her in the fall.

Today, Krupp is working with Ian Bird, MD, SMPH professor of medicine and director of the Endocrinology Reproductive Physiology Program at Meriter Hospital, on a research project involving preeclampsia, a common disease of pregnant women characterized by high blood pressure and the presence of protein in the urine.

The project entails collecting a segment of the umbilical cord after the baby is born to examine endothelial cells that line the cord vein, comparing women with and without preeclampsia.

"So far, we have found there are changes in the cellular signaling of these cells, which may lead to some of the complications fetuses experience in women with preeclampsia," Krupp says.

Looking back on the past three years, Krupp admits that residency life can be exhausting, but she gives the program high marks.

"It's an exhilarating environment that has only helped make us better doctors," she says. "There are so many opportunities for training and for experiencing the rewards of sharing in patients' lives."

It's also the only specialty centered on happy, healthy babies, adds Droste.

"You never grow tired of being part of those special times," she says.

by Sharyn Alden
This article appears in the fall 2008 issue of Quarterly.