The accidental obstetrician

Chance played a big part in the career path of Scotsman Euan Wallace, who now treats the most at-risk pregnancies in Victoria. By Larissa Dubecki.

Euan Wallace
Euan Wallace has been at the Monash Medical Centre for 20 years.

Euan Wallace AM began his career quite by accident. He wanted to be a GP, but training in his native Scotland involved a compulsory unit in obstetrics and gynaecology. A 12-month stint in an Edinburgh hospital followed, “which I loved’’; then, as fate would have it, his boss  forced  him into research.

“It was a gap they had to fill – I was the idiot who came along first,” he says with a laugh. There is a point to his tale, beyond a self-deprecating sense of humour: “It’s a story I tell to our medical students, because it transformed me forever. I just loved research  –  it changed how I thought, how I behaved as a clinician. It changed my career forever.’’

He’s been at the Monash Medical Centre for 20 years now and has gone thoroughly native – as his membership of North Melbourne Football Club will attest – despite the fact his Melbourne experience was originally intended to be a brief one. “I finished training and came here for  a  year to work with David de Kretser, a competitor of mine … I came to work with him with the intent of going back to Edinburgh with a view to ongoing collaboration, but I ended up staying.”

The whys of the stay are multifaceted yet humanly straightforward. He and his wife arrived with their two young children (they later added a third, who’s now in Year 9) for 12 months, but he was subsequently offered an ongoing position at Monash (University and Health). “I loved the ‘can-do’  approach  of the University, so we stayed,” Wallace says. “We also liked the big round yellow thing in the sky that we didn’t see very much of in Scotland. My wife, Karen, was very happy here and was very keen to stay.”

Based at the Monash Medical Centre, the Ritchie Centre is the research arm unifying Monash University’s Department of Obstetrics and Gynaecology, and the Department of Paediatrics. Its remit of women’s and infants’ health is dizzyingly broad, covering everything from innovative stem  cell  therapies to what Professor Wallace refers to as “old-fashioned gynaecology”.

Wallace is both clinician and researcher. It’s that point of crossover between hospital bedside and science bench that he believes holds the key to scientific breakthroughs that may well change the practice of medicine forever.

“I would contest they complement each other. I’m a better doctor for doing research, and my research is better because I’m a doctor,” he says. “One of the fun things about the Ritchie Centre is we have discovery scientists whose work is so much better because they’re  working  side-by-side with clinicians. Clinicians will constantly challenge them. They’ll ask, ‘Why are you doing that, because it’s of no relevance to us?’ Their research is kept honest by clinicians, and clinicians will have their eyes opened in turn.”

“One of the fun things about the Ritchie Centre is we have discovery scientists whose work is so much better because they’re working side-by-side with clinicians.”

A specialist obstetrician who treats some of the most at-risk pregnancies in Victoria, Professor Wallace is particularly excited about a potentially game-changing breakthrough in the prevention of cerebral palsy, the most common cause of childhood disability.

The Ritchie Centre’s Neurodevelopment and Neuroprotection Unit is the only research group comprehensively looking at what causes cerebral palsy and whether it’s possible to protect against it – despite the fact that every 15 hours a baby is born in Australia with a brain injury that  will  cause cerebral palsy. That equates to roughly one in every 400-450 births, much higher than the combined number of children born with Down syndrome and those children who will go on to develop cancer.

Promising new therapies are emerging through the group’s work. Antioxidants have been identified as a useful agent to mop up oxygen free radicals, which can have devastating effects on the developing brain of a foetus deprived of oxygen or nutrients due to a problem with the placenta. Currently,  no  treatments are available to expectant mothers diagnosed with Intra-Uterine Growth Restriction (IUGR) other than increased monitoring, but the group, led by Suzie Miller, has found in world-first human trials that giving antioxidants to expectant mothers diagnosed with IUGR effectively “dampens’’  free radicals and prevents brain damage.

Considering that 40 to 50 per cent of CP cases are associated with low birth weight, the impact of this is hard to underestimate. The next phase of the study, of a much larger randomised trial, is in the planning stages.

“This is first-world medicine … If they’re successful it will transform the care of the pre-term infant forever, because if you wait until the baby is born the damage has already happened. Seven out of 10 cases of CP happen in utero. It all looks very exciting.”

Wallace specialises in maternal complications such as pre-eclampsia, but the Ritchie Centre’s multidisciplinary team of scientists, medical researchers, doctors, nurses, sociologists and psychologists is pursuing vast areas of enquiry concerning maternal, foetal and infant health.

There’s world-leading research around endometriosis and infertility, teasing out the reasons behind an ethnic predisposition to stillbirth, and a recent breakthrough indicating the optimal time to cut the umbilical cord in pre-term and sick babies (a discovery Professor Wallace says promises to  alter  the practice of medicine globally).

And then there’s the current Ritchie Centre trial of giving placental stem cells to pre-term babies to prevent lung damage and irreparable, devastating damage to bowel tissue. Clinical trials giving preventative stem cells to pre-term babies will kick off next year. Another radical stem cell-based  therapy  is being used to treat pelvic organ prolapse, a common condition in women who have given birth.

“Currently, surgical correction for that is very ordinary, but developing stem cell-based therapies collect cells from the lining of the uterus, grow them in a lab and re-implant them, giving back a woman her pelvic floor. It’s a fantastic concept. If they can pull this off they’ll  revolutionise  what is a very unsexy bit of gynaecological research that’s not talked about very much, yet is very common,” says Wallace. “It’s brilliant stuff.”

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