From bedside to lab to bedside - research that gives hope to desperate mums

Professor Euan Wallace has dedicated his entire clinical and research career to improving human pregnancy - from fundamental discovery research to changes in government policy, he has strived to make the health of mothers and their babies healthier and happier. As Carl Wood Professor of obstetrics and gynaecology at Monash University, he is proud to lead one of the world's most innovative research groups in women's health.

As an obstetrician who treats the most at-risk pregnancies in Victoria, Euan is particularly excited by his research team's latest promising treatment, which could reduce brain and lung damage in stressed fetuses. Now in a world-first clinical trial - Protect-Me - together with his colleagues Dr Kirsten Palmer and A/Prof Suzie Miller, Euan is assessing melatonin as a neuroprotectant for severely growth restrited fetuses. In essence, preventing cerebral palsy in the womb.

It's research that has been a decade in the making and is typical of the innovations coming out of The Ritchie Centre at Monash.

'We start with a clinical problem in our wards, develop experimental models to mimic it, unpick the pathways along which it occurs, develop treatments and bring them back to the clinic - a bedside-to-bench-to-bedside approach that is one of our strengths.' he says.

The Ritchie Centre s based at the Monash Medical Centre, the teaching hospital linked to Monash University, and is the research division of the univerity's Department of Obstetrics and Gynaecology. The Centre is also one of the research clusters within the Hudson Institute of Medical Research..

It brings together basic scientists, medical researchers, doctors, nurses, as well as sociologists and even engineers to solve problems that perinatal medical staff - who treat mothers and babies before, during and after birth - face every day.

One of the group's biggest challenges is intrauterine growth restriction, where a fetus grows slowly or not at all. It occurs in about one in 20 pregnancies, and although it is not always a serious problem, when it is it can trigger the damaging cycle of inadequate oxygen.

Seven out of 10 cases of cerebral palsy have their origins in such an event in the womb rather than at birth because, as Euan says, 'the placenta is not plugged in properly'.

'We need to take the baby as far as we can in the pregnancy to give it its best prospects for survival. But at the same time, we need to acknowledge that injury is going on and these babies have a 10-fold increased risk of cerebral palsy in years to come.'

This delicate balancing act of trying to prolong a difficult pregnancy, care for a stressed fetus and act when birth is necessary, is at the heart of much of Euan's work.

But advances in obstetrics can create new problems, requiring new solutions. For example, babies born at just 24 weeks can survive now, unlike 30 years ago, but face a lifetime of chronic lung disease, which can worsen with age.

'These are children who we expect to have really bad lung disease in their 40s and 50s,' Euan says. 'But we can't be sure how bad because we don't have any adults, born at 24 weeks, aged 40 yet.'

The desire to repair organs damaged in the womb or at birth has led to another promising treatment, which uses stem cells from the amniotic sac within the placenta.

Amniotic stem cells are special because, unlike stem cells taken from embryos, they are simply collected from placentas that will be discarded anyway. They also don't carry the risk of producing tumours and, potentially, can be transplanted into any human being to repair damaged organs, not just the one they came from.

Research into their use is in its early stages at the Ritchie Centre but gives hope that we might soon be able to repair the damaged lungs of a very premature baby or the brain of a stressed fetus at risk of cerebral palsy.

While Euan and his team are heroes to many anxious parents, he sees them as the real fighters.

'The drive and emotions underlying having children are fundamental and powerful. It's a genuine privilege to be able to provide care for these families - to see the challenges that mothers and babies face, come back to the laboratory and our scientists and say, 'These are the issues, let's cure them.''