Women's Health Research

Our research into women’s health in the Department of Obstetrics and Gynaecology had its origins in IVF- research that resulted in Australia’s first IVF baby in 1980. Today, women’s health researchers focus on the breadth of obstetrics and gynaecology issues, including pelvic organ prolapse, endometriosis, endometrial cancer, and fertility and pregnancy disorders. Our research into IVF continues, aiming to investigate factors that affect success and what means can be used to improve this. This research targets improving embryo as well as endometrial quality and into how IVF processes can be improved for both mother and baby. Research into pregnancy disorders seeks to discover new therapies that may translate into clinical care particularly for disorders of placentation.

The majority of our research is collaborative within our department, within Monash University, Monash Health nationally and internationally. We pride ourselves on intra and inter generational care from embryo to end of life. Clinical research activities have taken increasing prominence in recent years, through recruitment of new research leaders and the development of early career researchers including clinicians. Now the department hosts multiple NHMRC- and MRFF-funded clinician investigators and clinical trials, and publishes regularly in the highest impact global publications.

The basic research activities of the Department are undertaken in collaboration with The Ritchie Centre, jointly managed with the Hudson Institute of Medical Research. The Centre has over 150 research staff and students, including fetal physiologists, immunologists, and stem cell biologists, as well as clinician scientists including neonatologists, paediatricians, and of course obstetricians.

Professor Beverley Vollenhoven is the Head of the Department of Obstetrics and Gynaecology. She is a specialist gynaecologist (and a Monash University medical graduate) with a subspecialty qualification in reproductive endocrinology and infertility. Professor Vollenhoven overseas Victoria’s largest gynaecology service at Monash Health.

Research groups

Cell Therapy and Regenerative Medicine View

Understanding of the innate capacity of the fetus to repair and regenerate tissues and the application of these processes is enabling development of novel organ and tissue regeneration models using stem cells. In particular, researchers in the Cell Therapy and Regenerative Medicine laboratory are investigating the therapeutic use of cells derived from reproductive tissues such as the placenta and uterus and adult mesenchymal stromal cells derived from bone marrow and adipose tissue.

In collaboration with Professor Euan Wallace and Professor Suzie Miller, the group is also pioneering stem cell use in the fetus and neonate for the treatment of respiratory distress and abnormal neurological development in infants who were growth restricted in utero, born prematurely or following birth asphyxia. The therapeutic use of multipotential stem cells in the treatment of intractable diseases such as cystic fibrosis, brain neurotrauma and spinal disk injury is also being investigated. Having recently completed a successful commercial preclinical trial for treatment of spinal disk injury, this study has now entered clinical trial phase.

Meet the team View

Research Projects

Current research in this area by scientists in The Ritchie Centre is focused on the wellbeing of mother and child, with a particular interest in pulmonary distress. Regenerative medicine is a relatively new field of medicine, which aims to help natural healing processes work faster, or use special materials to replace damaged tissue.
Recently, human amnion epithelial cells (hAEC) have attracted a lot of attention as a potential cell source for regenerative therapies. Amnion-derived cells have the considerable advantage in that they do not require the destruction of human embryos for isolation, as the amnion is usually discarded as medical waste along with the placenta following birth.
We have been investigating the potential therapeutic benefits of hAEC in reducing lung inflammation and fibrosis in models of adult respiratory diseases and in bronchopulmonary dysplasia (BPD) of the newborn. Bronchopulmonary dysplasia is a life-threatening chronic lung disease that affects many infants born preterm and, particularly, very preterm. Lung inflammation likely underlies the pathogenesis of BPD. The team is identifying the effect of hAECs on inflammatory responses of the preterm newborn and clinical trials on the use of hAECs in the treatment of lung injury in very premature babies are about to commence.
Cerebral palsy (CP) is the most common cause of childhood disability and there is currently no cure. The origins of CP are not fully understood but are likely to lie in the fetal developmental period when the fetal brain is most susceptible to injury. Damage to the brain during pregnancy or at birth is the major cause of cerebral palsy. Approximately 95 per cent of newborn brain damage originates during fetal life in utero, or at the time of birth, with term hypoxic-ischemic encephalopathy (HIE), preterm birth and low birth weight being the most important risk factors. There is also a strong association between intrauterine infection during pregnancy, a fetal inflammatory response, white matter damage and subsequent development of CP.
Scientists in The Ritchie Centre are investigating the potential of stem cells, derived from placental tissues and the umbilical cord to ameliorate fetal brain injury associated with cerebral palsy. They hypothesise that administration of human amnion epithelial cell (hAEC) or specific cells derived from cord blood will reduce inflammatory mediators and stimulate neuronal growth and development, thereby protecting the fetal brain against such injury as well as initiating neuroregeneration.
Bone marrow derived mesenchymal progenitor cells, endometrial mesenchymal stem/stromal cells (MSC) and amnion epithelial cells represent three stem cell types that are easily accessible and do not have the limitations and ethical concerns associated with embryonic stem cells, iPS cells and their derivatives.
The advent of tissue engineering in the last few decades, together with stem cell developments, has given researchers the potential ability to suitably engineer cellular constructs for replacement of damaged tissues. Scientists in The Ritchie Centre are investigating the potential application of stem cells, when combined with novel biomatrices, in models of spinal disc injury and osteochondral defects such as osteoarthritis and pelvic organ prolapse. They have demonstrated that allogeneic mesenchymal precursor cells (MPCs), obtained from adult bone marrow, are capable of differentiating into osteocytes and chondrocytes in biocompatible matrices as well as initiating repair and regeneration of damaged tissues. They have shown, for the first time, that anterior cervical implantation of allogeneic MPCs, in a matrix contained in a cervical interbody spacer, effectively facilitate new bone formation following discectomy. This led to a recently completed medical trial at the Monash Medical Centre.
The capacity for chondrogenic differentiation of stem cells is now being studied in this application in an attempt to produce appropriate bio-scaffolds to replace damage or degenerated osteochondral joints and spinal discs to provide a fibrous or cartilaginous joint.
Endometrial MSC, extracted from endometrial biopsy tissue using a novel marker, produces stromal connective tissue when transplanted into an animal model. Endometrial MSC can also be grown on novel scaffold materials being produced by our collaborators at CSIRO, which are currently being tested for their potential use in treating pelvic organ prolapse.
Cystic fibrosis (CF) remains a leading cause of childhood respiratory morbidity and premature mortality. The condition is a result of mutations in the gene that codes for an epithelial transmembrane chloride channel, called the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. Currently there is no cure for cystic fibrosis. The only treatment option that attempts to restore normal lung function to CF patients is lung transplantation. An alternative approach to a future cure could be the delivery of a cell-based therapy, involving the delivery of cells with functional CFTR that might integrate into the respiratory tract.
Scientists at The Ritchie Centre are investigating the ability of fetal and adult stem cells, including human amnion epithelial cells (hAECs) and induced pluripotent stem cells (iPSCs), to differentiate into lung epithelial cells in vitro, to express functional CFTR and to engraft in the respiratory airway. They have employed novel research tools, including the Australian Synchrotron and the Advanced Light Source in Berkley, California, to demonstrate that hAECs can be manipulated to express the CFTR gene and form 3-dimensional structures that expressed the CFTR protein in a polarized manner, similar to that observed in normal lung epithelial tissue.
In addition, they have demonstrated that the ion channels within the CFRT are functional and able to secrete chloride ions from within the cell. In collaboration with colleagues at RMIT, they are now investigating the application of novel “Surface Acoustic Wave” nebulization technologies to facilitate administration and engraftment of these cells into the respiratory tract. This research, which has been supported by a grant from the Australian Cystic Fibrosis Research Trust, suggests that hAECs may provide a platform for the development of a cellular therapy for cystic fibrosis.

Selected publications

Li J, Kobata K, Kamei Y, Okazaki Y, Nishihara M, Wada H, Tamai H, Funato M, Jenkin G (2013) Nucleated red blood cell counts: an early predictor of brain injury and 2-year outcome in neonates with hypoxic-ischemic encephalopathy in the era of cooling-based treatment (2013) Brain and Dev. ID P01577394: This clinical paper describes early predictors of brain injury and neurological outcomes in cooled and non-cooled asphyxiated neonates.

Castillo-Melendez M, Yawno T, Jenkin G, Miller SL (2013). Stem cell therapy to protect and repair the developing brain: a review of mechanisms of action of cord blood and amnion epithelial derived cells Frontiers Neurosci. Oct 24;7:194. ID PP01619295. An invited review that provides an overview of the work of our group on stem cell treatment of brain injury. It has received significant popular and peer review acclaim and interest.

Yawno T., Schuilwervel J., Moss T., Vosdoganes P., Westover A., Afandi E., Jenkin G., Wallace E., Miller S. (2013) Human amnion epithelial cells reduce fetal brain injury in response to intrauterine inflammation. Developmental Neuroscience: 35(2-3), 272-282. This paper describes the use of stem cells to protect the brain against injury caused by intrauterine infection, a major cause of cerebral palsy.

Oehme D, Ghosh P, Shimon S, Wu J, McDonald C, Troupis, J, Goldschlager T, Rosenfeld JV and Jenkin G (2013). Mesenchymal progenitor cells combined with pentosan polysulfate can mediate disc regeneration at the time of microdiscectomy. A preliminary study in an ovine model. Journal of Neurosurgery: Spine. SPINE13-760R1. An example of the clinical translation work being undertaken combining matrices and stem cells for spinal disk repair and regeneration.

Moodley, Y., Ilancheran, S., Samuel, C., Vaghjiani, V., Atienza, D., Williams, E., Jenkin, G., Wallace, E.M., Trounson, A.O., Manuelpillai, U.C., 2010, Human amnion epithelial cell transplantation abrogates lung fibrosis and augments repair, (2010), American Journal Of Respiratory And Critical Care Medicine, 182, 643-651 ID P10588284 A landmark paper describing the use of Amnion Epithelial Cells in BPD, which has resulted in a PCT patent and has now led to commencement of clinical trials.

Murphy, S.; Lim, R.; Heraud, H.; Cholewa, M.; Le Gros, M.; De Jonge, M.; Howard, D. L.; Paterson, D.; McDonald C.; Atala A.; Jenkin, G.; Wallace, E. M. (2012) Human Amnion Epithelial Cells Induced to Express Functional Cystic Fibrosis Transmembrane Conductance Regulator (CFTR). PloS ONE. 7(9):e46533. A landmark paper showing for the first time that stem cell therapy with amnion derived epithelial stem cells may be used in the treatment of cystic fibrosis.

Daniela Ulrich, Sharon L. Edwards, Kai Su,, Jacinta F. White, John A. M. Ramshaw, Graham Jenkin, Jan Deprest, Anna Rosamilia, Jerome A. Werkmeister, Caroline E. Gargett (2014) Influence of Reproductive Status on Tissue Composition and Biomechanical Properties of Ovine Vagina. PLOS1; DOI: 10.1371 Research that will form the background to preclinical studies on the use of novel matrices and endometrial stromal cells in the treatment pf pelvic floor prolapse.

Endometrial Stem Cell Biology View

Following the group’s discovery of endometrial stem/progenitor cells in the highly regenerative lining of the uterus (endometrium), the Endometrial Stem Cell Biology research team has focused on characterising endometrial stem/progenitor cells and their role in gynaecological disease. The group also discovered markers of the epithelial progenitors and mesenchymal stem/stromal cells (MSC) found in human, ovine and mouse endometrium, enabling us to investigate:

Basic cellular and molecular biology of human and mouse endometrial stem/progenitor cells.
- The mouse model uses transgenic telomerase reporter mice (m-Tert-GFP) to identify and study the function of mouse endometrial stem/progenitor cells. A Cre version is used for lineage tracing.
- the use of 3D organoid cultures to investigate the properties and signalling pathways used by human and mouse endometrial epithelial progenitor cells.
The utility of endometrial MSC combined with novel scaffold materials developed with CSIRO collaborators as a cell-based therapy for treating Pelvic Organ Prolapse. This extremely common condition results from herniation of pelvic organs into the vagina due to childbirth injury. Our tissue engineering approach for vaginal surgical repair shows promise in a rat model and we are assessing their utility in a sheep vaginal surgery model for preclinical studies. This interdisciplinary research also includes the following
- the development of a secondary prevention strategy for treating women soon after childbirth with their own endometrial MSC and novel nanobiomaterials for local delivery of cells to prevent Pelvic Organ Prolapse occurring later in life.
- using small molecules to maintain stemness of endometrial MSC and produce a reproducible cell product for clinical use. Combined RNAseq and ATACseq is being used to discover mechanism and the research is being applied to placental, menstrual blood and bone marrow MSC
- The immunomodulatory properties of human endometrial MSC. Similar to bone marrow MSC, endometrial MSC show anti-inflammatory, immunomodulatory properties and promote wound healing in culture and in mouse and ovine models
- Development of a novel pressure sensor device using fibre optics technology by collaborators from Flinders University which is currently being trialled in women to more precisely diagnose areas of vaginal wall weakness.
- In collaboration with modellers, engineers and material scientists at CSIRO and Monash Institute of Medical Engineering, the team is undertaking the rational design of mesh materials for use in Pelvic Organ Prolapse surgery that better matches vaginal tissue biomechanical properties
Whether endometrial stem/progenitor cells shed in menstrual blood gain access to the pelvic cavity during retrograde menstruation, where they establish endometriosis. This serious chronic disease affects 10% of young women where endometrial tissue grows outside the uterus. It causes severe pain and infertility and current treatments are suboptimal.
- RNAseq on purified populations of endometrial stem/progenitor cells is being examined to identify differences between women with endometriosis that allow the stem/progenitor cells to implant and grow in the pelvis and normal women.
- using the mTert-GFP mouse, a model of endometriosis mimicking the attachment of menstrual debris to the peritoneum has been established to examine the role of stem cell signalling pathways in establishing lesions
- other studies are assessing whether neonatal uterine bleeding is a potential biomarker of adolescent endometriosis.
Endometrial-related infertility where the endometrium fails to support embryo implantation particularly in women with Recurrent Implantation Failure undergoing IVF procedures. The role of endometrial stem/ progenitor cells is under investigation.

Meet the team View

Research Projects

How does the endometrium regenerate? Role of the Wnt signalling pathway.
Testing the in vivo regenerative potential of human endometrial epithelial progenitor cells isolated using a new marker
Do human endometrial mesenchymal stem/stromal cells (MSC) have immunomodulatory properties that can be harnessed for treatment of human disease?
Developing protocols for cell production of autologous endometrial MSC in preparation for clinical use.
Role of endometrial stem/progenitor cells in endometriosis
Role of endometrial stem/progenitor cells in endometrial injury-induced doubling of pregnancy rates in women with Recurrent Implantation Failure undergoing IVF
Developing a large animal preclinical model of birth-induced injury to assess the efficacy of autologous endometrial MSC as a cell based therapy to prevent Pelvic Organ Prolapse
Nanotechnology and tissue engineering strategies to uncover causes and treat Pelvic Floor Disorders
Investigating the requirement for Notch and Hedgehog signalling in the endometrial stem/progenitor populations that cause endometriosis
Organoids from mouse and human endometrial stem/progenitor cell populations

Epidemiology and Clinical Trials View

Informed by the outcomes observed in the maternity services at Monash Health, our group provides research expertise and capability to Monash Health and the State of Victoria via the Consultative Council for Obstetric and Paediatric Mortality and Morbidity. Our group is also an integral part of the Monash University, Department of Obstetrics and Gynaecology. Our unique co-location within the hospital and Hudson Institute affords us the opportunity to undertake our own research and to support both scientists and clinicians in the translation of research findings from the laboratory bench to apply them at the hospital bedside.

We utilise epidemiological design principles, biostatistics and clinical trial expertise to improve the health of pregnant women and their babies/children. Current research areas include:

Ethnic differences in maternal and perinatal outcomes
Reducing perinatal mortality and morbidity in Victoria
Assessing the impacts of interventions and procedures related to pregnancy and labour care.
Randomised Controlled Trials to assess the efficacy of interventions in pregnancy and birth.
Breastfeeeding

In addition we offer study design, human ethics advice and statistical support to Monash Health staff and the wider Ritchie Centre. Through collaborations with other Hudson Institute researchers we are also able to combine biological samples with epidemiological data.

Meet the team View

Fetal and Neonatal Health View

The research in this theme in The Ritchie Centre seeks to understand the factors controlling normal fetal and newborn development, including how the fetus transitions to life after birth. Our research is focused on conditions and diseases that commonly affect newborns and children, including prematurity, intrauterine growth restriction, brain injury, and neonatal lung disease. We also aim to gain insights into how early life events may lead to life-long diseases such as multiple sclerosis, schizophrenia, chronic lung diseases, obesity, hypertension and diabetes.

Meet the team View

Research Projects

The development of the embryo and fetus occurs at a remarkable rate, progressing from a single fertilized oocyte, to a highly complex and functioning being capable of survival outside of the uterus by the time of birth. In humans this dramatic growth, maturation and attainment of organ function occurs during the 40 week period known as gestation but it occurs in only 19-21 days in mice! This extremely rapid rate of development requires highly co-ordinated and tightly regulated control of cell proliferation, cell lineage formation, cell migration, programmed cell death and cell maturation to ensure appropriate fetal organ and body growth and development. However, growth and development does not cease at birth, but continues beyond the newborn period.
In the vast majority of cases, fetal and neonatal development occurs with a remarkable degree of accuracy. However, this extremely rapid rate of development means that that the fetus and newborn are particularly vulnerable to even minor perturbations in the maternal, embryonic, fetal, or neonatal environment and these perturbations can have fatal, or dramatic and life-long consequences for the offspring.
Scientists in The Ritchie Centre are researching how the organs develop and function during fetal life, identifying factors that cause perturbations in organ development and identifying how those factors lead to perturbed development. It is critical to know how those processes occur so that we can develop new treatments to mimic or accelerate organ development in infants that are born preterm (before their organs have had sufficient time to develop), or when they are born with deficits in organ growth or function. Similarly, it is critical to understand how abnormal organ development occurs so that we can prevent, or reverse, abnormal development while promoting normal development. These studies have led, and will continue to lead to, groundbreaking advances in our understanding of fetal and neonatal development and underpin the development of new therapies and treatments for affected infants.
Specifically, scientists in The Ritchie Centre are investigating how the lungs, brain, cardiovascular system, nervous system, immune system, muscular system and gastrointestinal system develop and function before and after birth.
In Australia, about 300,000 babies are born each year. Unfortunately, not all of these pregnancies or births will go to plan – preterm birth, intrauterine infection, growth restriction and birth asphyxia remain enormous problems in our population, with babies and their families at risk of short and long-term disadvantage.
Depending on the underlying cause of the complication, the brain, lungs, kidney or cardiovascular system may be adversely affected, which can lead to complications in the newborn period and extend into lifelong disabilities, including cerebral palsy and respiratory disease.
Hudson Institute’s Ritchie Centre hosts Australia’s largest team of scientists and clinicians working together to better understand the developmental changes that take place in complicated pregnancies or birth, and they are using this knowledge to pursue new therapies and treatments that will reduce the incidence of perinatal morbidities and improve long-term health. For example, The Ritchie Centre team lead the world in understanding the transitional changes that occur in normal and preterm birth, and the effects of different resuscitation and ventilation strategies. This is now translating to new procedures and therapies utilised in the delivery room to enhance newborn wellbeing and decrease the incidence of short and long-term lung injury.
The Ritchie Centre also has a dedicated team of researchers pursuing new treatments to decrease the incidence and severity of the brain injury that underlies cerebral palsy. Cerebral palsy results from adverse growth and development of the brain, predominantly during pregnancy, and is linked to preterm birth, intrauterine infection or a lack of oxygen supply to the brain.
Researchers are now testing a handful of specific therapies, including stem cells, to determine their efficacy in decreasing the progression of brain injury, or to repair the brain once injured. Within the Ritchie Centre, scientists and clinicians work together to understand the basic science that causes adverse fetal and neonatal development, so that they can continue at the forefront of testing new therapies and treatments to improve babies’ health.
The transition from life within the womb to life after birth presents the greatest challenge of our lives. For example, at birth, the lungs must be rapidly cleared of the liquid that filled the airways and supported their growth before birth, so that newborns can immediately start using their lungs to breathe. The circulation of the blood must also be immediately redirected, when the umbilical cord is cut and the baby becomes detached from the placenta, so that supply of oxygen and nutrients can meet the changing metabolic demands of the infant’s organs and tissues. Finally, the newborn baby must become capable of feeding, regulating its own temperature, eliminating waste and performing other independent functions necessary for survival and wellbeing.
These monumental challenges faced at birth are sometimes compromised in human babies. Failure often occurs as a result of factors influencing development before birth and events during labour. Premature babies are particularly at risk of failing to transition to newborn life appropriately because of their immaturity and the influence of the events that led them to be born early. The Ritchie Centre team’s aim is to understand why some babies fail to transition effectively at birth and to identify the best ways to support or facilitate the transition in babies that struggle to cope.
Centre scientists are also currently investigating how infection or inflammation within the uterus during pregnancy alters the transition at birth and how common medical interventions aimed at improving survival of premature babies impact on the transition at birth. They are also investigating how to best provide breathing support for babies that struggle to breathe independently, reducing lung injury and achieving optimal oxygen delivery.
The birth of a healthy, full-term infant is the result of the successful orchestration of a multitude of individual developmental events and physiological processes. In many pregnancies a variety of environmental factors impact on the mother, embryo, fetus or newborn baby, resulting in abnormal development. Although these individual factors might have minor effects at the time, the longer-term consequences can be devastating.
Injury and abnormal development can occur in all babies but premature infants are particularly at risk. Over 8 percent of Australian babies are born premature (<37 weeks of gestation). Despite substantial effort, we do not understand why premature birth occurs, how to predict which pregnancies will be affected or how to stop preterm labour once it has begun. As a result of the events precipitating premature birth, and the medical management of women in preterm labour, premature babies are exposed to a variety of factors that result in abnormal development.
Infection
Infection or inflammation within the uterus during pregnancy is the principle contributor to the majority of premature births and increases the risk of brain damage and chronic lung disease in babies. Scientists in the Ritchie Centre are investigating the developmental processes that are altered by exposure to infection or inflammation before birth and their long term consequences (on the brain and behaviour, the lungs, heart and blood vessels and immune system). They are also investigating new treatments to try and prevent the adverse effects.
Antenatal corticosteroids
Women at risk of premature birth are routinely given injections of steroid drugs to try and accelerate development of their babies, to better prepare them for early birth. These treatments are life-saving but they do not always work and there are potential adverse side effects, to which growth restricted babies are particularly vulnerable. We are identifying how growth restricted babies respond to these steroid treatments before birth. We are also investigating alternative ways to prepare babies for preterm birth.
Lung damage
More than 7 percent of all Australian babies require some assistance to start breathing after they are born. Unfortunately, the support that is required can cause inadvertent damage to the delicate newborn lungs. High pressures and volumes delivered to infants’ lungs, and high oxygen levels, can cause lung injury and inflammation. With time, this injury can develop into life-threatening chronic respiratory disease; survivors commonly suffer respiratory problems for the rest of their lives, particularly if they also smoke cigarettes. The best way to provide breathing support to newborns, so as to avoid inflammation and lung injury, is not known. Ritchie Centre researchers are working to identify the optimal way in which to support breathing in newborn babies, and are trialling new treatments to prevent lung damage and subsequent disease.
Brain injury
Damage to the developing brain can have devastating consequences, resulting in long-term severe disability or even death. Developmental brain injury results in a spectrum of postnatal disabilities, of which one of the most severe is cerebral palsy, which affects ~35,000 Australians. Schizophrenia and autism may also originate from abnormal development or injury of the fetal or newborn brain. We are investigating the origins of developmental brain injury in a broad range of experiments targeting the various factors known to increase the risk of brain injury in babies (for example a lack of oxygen during birth and infection during pregnancy). We are also working on the development of new treatments to prevent this devastating consequence of abnormal development.

Infections in Pregnancy View

The Infections in Pregnancy team is a research group in the Department of Obstetrics and Gynaecology, Monash University, based at the Monash Children’s Hospital, and the Monash Centre for Health Care Research and Implementation (MCHRI).

Our mission is to reduce infections and antibiotic use in children through prevention strategies in hospitals and the community. A key focus area is improving our use of new and existing vaccines in Australia and internationally.

Meet the team View

Research streams

We conduct surveillance for vaccine preventable infections in children in hospital and the community, and research the impact of potentially vaccine preventable infections upon children and families. We perform vaccine trials in children and during pregnancy and study immunity to infections.
We conduct vaccine safety surveillance for all Victorian’s and develop better ways of detecting vaccine safety concerns as fast as possible. We host (through MCHRI) the WHO Global Vaccine Safety Observatory, a resource for WHO member countries to track their progress and access resources to improve their vaccine safety capacity. We investigate the genetics of adverse events following immunisation (adversomics) to provide advice to families.
We study how antibiotics are used in Australia and internationally and how to use them more effectively and less frequently.
We conduct research into infections in preterm babies as part of the international NeoNIN network, and in children hospitalised with serious infections.

Funding

We are funded through the NHMRC, DHHS Victoria, Department of Health and Ageing, the National Institutes of Health, GAVI, and various philanthropic organisations.

Collaborators

We collaborate nationally and internationally.

In Victoria we collaborate with a range of different groups including those from:
Nationally we collaborate with:
Internationally our collaborators include:
- World Health Organization
- Global Vaccine Data Network
- Brighton Collaboration
- Cincinati Children’s Hospital
- Shenzhen Children’s Hospital
- St George’s Hospital, London
- Oxford University

Lung Development View

Maternal and Perinatal Medicine View

Professor Wallace established the Maternal-Fetal Medicine Group (now Maternal and Perinatal Medicine) in 1996 after joining Monash University’s Department of Obstetrics and Gynaecology. The group’s original research focus on pregnancy and the fetus has expanded to include life after birth, leading to the inclusion of perinatal in its name. Improvement of maternal, fetal, and neonatal health remains the focus of the group’s work. As leaders in their field, the team continues to combine fundamental and clinical research to shape best clinical practice and improve patient care. Their impressive record for delivery of translational outcomes includes several world firsts.

Despite embracing fetal and neonatal research, the team’s central focus on the pregnant woman continues to align them with the Ritchie Centre’s Women’s Health Theme. With several other research groups evolving from the Maternal and Perinatal Medicine Research Group, they remain tightly embedded in the Centre’s broader research portfolios. These established independent groups have maintained active collaborations within the Centre.

Researchers

Research groups

Fetal growth restriction View

Preeclampsia View

Amnion cell therapies View

Maternal and perinatal medicine translational research View

Project Leaders

Dr Kirsten Palmer, a Monash University practitioner fellow within the School of Clinical Sciences, leads the maternal and perinatal medicine translational research group. Our research seeks to translate promising new therapeutics into the clinical setting with a particular interest in the disorders of placentation, such as pre-eclampsia and fetal growth restriction. We have developed a collaborative network both nationally and internationally, through which we conduct research that extends from exploring the pathophysiology of these disorders to better inform new clinical advances, through to clinical trials research to assess the true potential for improving clinical outcomes. We are currently conducting trials to improve postpartum haemorrhage prevention and optimise outcomes for babies affected by fetal growth restriction. This is in addition to studies aimed at identifying new predictive or diagnostic biomarkers for pre-eclampsia, as well as predicting those women at greatest risk of future cardiovascular morbidity or mortality following a pregnancy complicated by pre-eclampsia.

Staff and students

Research Midwives

Stefanie Di Benedetto
Harriet Dinning

PhD student

Dr Jennifer Yo

Key collaborations

Annie Cox - co-supervise with Prof Euan Wallace and Dr Sarah Marshall in research assessing a potential new pre-eclamptic therapeutic, sulforaphane.
Deborah DeGuingand - co-supervise with Dr Stacey Ellery in research assessing the use of creatine supplementation in pregnancy
Mary Mansilla - co-supervise with Prof Guiying Nie in research exploring molecular mechanisms that underpin placental development and how these may lead to the subsequent development of pre-eclampsia.
Mark Beaves - co-supervise with Prof Euan Wallace in assessing the delivery and effectiveness of an educational program for cardiotocographs in improving neonatal outcomes.
GlaxoSmithKline
Monash Institute of Pharmaceutical Science: Inhaled oxytocin for post-partum haemorrhage prevention

Current projects

Inhaled oxytocin for post-partum haemorrhage prevention: Phase 1 pharmacokinetic trial
PROTECT- Me trial: Assessing antenatal maternal melatonin supplementation to improve neurodevelopmental outcomes in early onset fetal growth restriction
PreDIP study: Assessing new biomarkers to enhance the prediction and diagnosis of pre-eclampsia
PREACH study: Assessing antenatal and postpartum maternal cardiac indices to improve the prediction of women at greatest risk of future cardiovascular events following a pregnancy complicated by pre-eclampsia.

Selected publications

Miller SM, Yawno T, Alers NO, Castillo-Melendez M, Supramaniam VG, Van Zyl N, Sabaretnam T, Loose JM, Drummond GR, Walker DW, Jenkin G, Wallace EM. Antenatal antioxidant treatment with melatonin to decrease newborn neurodevelopmental deficits and brain injury caused by fetal growth restriction. J Pineal Research 2014;56: 282-94.

Ilancheran S, Michalska A, Peh G, Wallace EM, Pera M, Manuelpillai U. Stem cells derived from human fetal membranes display multilineage differentiation potential. Biology of Reproduction 2007; 77 (3): 577-588.

Edwards E, Megens A, Peek M, Wallace EM. Sexual origins of placental dysfunction. Lancet 2000; 355: 203-4.

Wallace EM, Baker LS. Effect of antenatal betamethasone administration on placental vascular resistance. Lancet 1999; 353: 1404-7.

Aitken DA, Wallace EM, Crossley JA, Swanston IA, van Parenen Y, van Maarle M, Groome NP, Macri JN, Connor JM. Dimeric inhibin-A as a marker for Down’s syndrome in early pregnancy. N Engl J Med 1996; 334: 1321-6.

Neuro development and Neuroprotection View

The Neurodevelopment and Neuroprotection research group is embedded within the Fetal and Neonatal Health Neurodevelopment and Brain Injury Theme of The Ritchie Centre, and is closely affiliated with the Cell Therapy and Regenerative Medicine Theme led by Professor Graham Jenkin. The group provides a focus for experimental and clinical studies directed towards understanding, and inhibiting, the mechanisms that contribute to perinatal brain injury and functional deficits associated with cerebral palsy. We strive towards the implementation of treatments to decrease neonatal brain injury and that can be effectively administered either during pregnancy or in the neonatal period. Such treatments include antioxidants, anti-inflammatory agents, and stem cells obtained from the cord blood and placenta.

Professor Suzie Miller’s group comprises more than 20 members with experts in fetal physiology, neuroscience, stem cells, cardiovascular physiology, clinical obstetrics, neonatology and paediatrics. This group provides a highly-regarded training platform for biomedical and clinical students.

Meet the team View

Research Projects

Stem cells to reduce perinatal brain injury – fact or fiction?
Protecting the intrauterine growth restricted (IUGR) fetal brain with natural neurosteroids.
Treating neonatal seizures with ganaxolone
Can we modify neurovascular development in the IUGR brain with endothelial progenitor stem cells derived from cord blood?
Umbilical cord blood stem cells to improve brain structure and function after severe birth asphyxia, when to administer and how many?
Improving newborn wellbeing in a rural Indian community with a simple transdermal patch.

Perinatal Inflammation and Neurophysiology View

Too much inflammation during pregnancy or shortly after birth is a fundamental process that contributes to impaired newborn brain development and function and can result in life-long disorders in movement, cognition, hearing and vision. Our team focuses on discovering the cellular and physiological pathways that underpin how inflammation impairs brain cell development and function, and studies how existing and new anti-inflammatory interventions could help restore healthy brain development. To achieve this, we use a highly integrated and multidisciplinary approach that includes preclinical models of developmental brain injury, fundamental neuroscience, electrophysiology, medical imaging and assessment of clinical samples. Through collaborative partnerships with clinical experts, academia and industry, we are developing new and improved compounds for the treatment of newborn brain injury; and developing physiological biomarkers and brain imaging technology to improve the sensitivity and specificity of brain injury detection for improved treatment outcomes.

We are accepting graduate student applications (Honours / Masters / PhD). For enquiries, please contact Dr Robert Galinsky on Robert.Galinsky@monash.edu

Meet the team View

Perinatal Transition View

This group undertakes research focusing on how events prior to, during, and after birth can adversely alter respiratory, cardiovascular and neurological outcomes, with specific focus on the transition from a fetus to a newborn. The unique strength of the group is the close collaboration between scientists and clinicians, incorporating respiratory and cardiovascular physiologists, neurologists, obstetricians and neonatologists, which focus the research on major clinical issues with rapid translation into improving the health and wellbeing of infants. We aim to understand how events around the time of birth can lead to lung, heart and brain inflammation, and injury leading to life-long consequences such as bronchopulmonary dysplasia pulmonary and systemic hypertension and cerebral palsy. With a focus on infants born preterm, with an increased risk of morbidity and mortality, we are investigating the impacts of events in three key periods around the time of birth, which increases susceptibility to organ injury:

The preterm fetus is commonly exposed to a number of insults while in the womb, including inflammation/infection, antenatal corticosteroids and growth restriction. All of these may have adverse or beneficial effect on the developing lung, heart and brain.
The period around the time of birth is a time of significant instability within the cardiopulmonary-cerebral circulation, and as such, is a critical period for the development of acute inflammation and injury. Our research focuses on improving the haemodynamic transition by investigating the influence of delayed cord clamping, physiological cord clamping and he influence of obstetric management on the circulatory transition at birth.
Preterm infants often require respiratory support in the form of mechanical ventilation at birth. While life saving, our research has shown that it increases the risk of respiratory, cardiovascular and cerebral inflammation and injury. Our research focuses on improving respiratory support for preterm infants, which reduces lung and brain inflammation and injury, while improving the circulatory transition at birth. We utilise state of the art imaging techniques, including MRI, for early detection of injury, and test new therapies including Stem Cells and Erythropoietin, to protect the preterm brain.

Meet the team View

Research Projects

Effect of intrauterine inflammation on preterm lung, heart and brain injury
Effect of intrauterine growth restriction on preterm lung, heart and brain injury
Physiological based cord clamping for improving the cardiopulmonary-cerebral circulation at birth.
Erythropoietin for protection of preterm lung and brain injury
Human amnion epithelial cells for protection of preterm lung and brain injury
Early detection of ventilation induced brain injury
Influence of resuscitation strategy on preterm lung, heart and brain injury
Long-term cardiovascular consequences of preterm birth

Translational Tissue Engineering View

This innovative new group led by Dr Mukherjee focuses on Women’s health, specifically in addressing the inadequacies in biomaterials for reconstructive surgery for disorders such as pelvic organ prolapse (POP). Arising primarily from vaginal birth injury, pelvic floor disorders affect millions of women worldwide, yet lack an effective treatment. In partnership with scientists, engineers and clinicians, the team has a keen interest in regenerative tissue engineering and translating new strategies to address the limitations in pelvic reconstructive surgery and alleviation of birth trauma.

The team undertakes a multi-disciplinary approach to repair tissues that have been damaged through childbirth incorporating material science, nanotechnology, stem cell biology and immunology. Current research centres on using solution electrospinning, 3D Printing, Melt electro writing and hydrogel formulations in the construction of degradable tissue-engineered surgical constructs. To this end, we utilise small and large pre-clinical model to determine host foreign body response and understand critical pathways that determine fate of implants. Furthermore, the group is investigating how maternal birth injury leads to POP, often decades after the initial trauma and employs injectable hydrogels for prevention of chronic pelvic floor disorder following traumatic birth injuries.

Meet the team View

Research Projects

DESIGN optimisation and engineering of polymer meshes, hydrogels, bioinks and coatings
TISSUE engineering with adult stem cells and biomaterials to determine biocompatibility and foreign body response
TREATMENT of Chronic POP using degradable cell-based nanofiber and 3D printed Meshes in pre-clinical models
PREVENTION of POP by applying hydrogels as a therapeutic for traumatic birth injury to prevent prolapse of the pelvic floor
UNDERSTAND the changes that occur within the pelvic floor after traumatic birth injury using biospectroscopy

Uterine Biology and Gynaecological Disease View

Education Program in Reproduction & Development (EPRD) View

EPRD focuses its research effort in areas of embryology, andrology, cryopreservation, idiopathic infertility, reproductive genetics and novel technologies IVF. Most of EPRDs research is based on the small research projects in-built within the two coursework degrees: GradDipRepSi and MClinEmb. However EPRD staff also take on a limited number of honours, MRepSc and PhD students in the following areas:

Idiopathic infertility
Sperm DNA damage analysis
Oocyte and embryo vitrification
Fertility preservation
Vitrification of ovarian tissue and follicles
In vitro oocyte maturation and In vitro and in vivo growth of follicles
Novel technologies for improving embryo culture and embryo selection
Reproductive genetics
Artificial intelligence in IVF

EPRD is currently involved with the following organisations in relation to product testing, research development and commercialisation:
- Peranta Biosciences
- Melbourne Aquarium
- Melbourne Institute of Plastic Surgery
- APSEF (Advanced Plastic Surgery Education Foundation)
- IVF supply companies - Cook, Origio, LifeGlobal, Sage, Gytec, Kitazato, Tek-event
- ESCO Global
- Ferring pharmaceuticals
- Monash IVF
- 23strands
We are currently developing the following projects
- Ferring Australia grant for the study “Oocyte DNA repair capacity in infertile couples”. Chief investigator: Dr Fabrizzio Horta, Dr Sally Catt, A/Prof Peter Temple-Smith and Prof Beverley Vollenhoven. Total funding: for 23,000 AUD
- Monash IVF grant for the study “Which factors are associated with recurrent implantation failure?”. Chief investigator: Dr Fabrizzio Horta, Prof Ben W Mol, Dr Sally Catt, A/Prof Peter Temple-Smith and Prof Beverley Vollenhoven. Total funding: 35,000 AUD
- Monash IVF grant for the study “Novel methods of cryopreservation of ovarian tissue”. Chief investigator: Dr Sally Catt, Dr Fabrizzio Horta, Dr Kiri Bielby, A/Prof Peter Temple-Smith and Prof Beverley Vollenhoven. Total funding: 25,000 AUD
- International Ferring COVID-19 investigational grant in reproductive medicine and maternal health for the study “Incidence of natural conception in infertile couples schedule for ART treatment during fertility clinic COVID-19 in Australia/New Zealand”. Chief investigator: Dr Fabrizzio Horta, Elizabeth Cutting, Prof Ben W Mol. Total funding: 8,500 AUD
- Reappraisal of the mechanisms underlying implantation success or failure. Salamonsen, L., Greening, D. W., Evans, J., Simpson, R., Catt, S., Vollenhoven, B. National Health and Medica Research Council (NHMRC). Total funding: 750,754 AUD.
- The central role of accelerated trophoblast syncytialization and aging in preeclampsia. Nie, G. and Catt, S. National Health and Medica Research Council (NHMRC). Total funding: 856,540 AUD.
Other projects
- Non-invasive metabolic imaging of oocytes and early embryo development. Chief investigators: Dr Fabrizzio Horta, Dr Sally Catt, Prof Beverley Vollenhoven, Prof Adrian Neild, Dr Reza Nosrati, Dr Victor Cadarso.
- Development of embryo culture media to improve DNA repair capacity in aged females. Chief investigators: Dr Fabrizzio Horta, Dr Sally Catt, A/Prof Peter Temple-Smith, Prof Beverley Vollenhoven.
- Machine learning for Clinical Decision support in in-vitro fertilisation. Chief investigators: Dr Fabrizzio Horta, Dr Hamid Rezatofighi, Dr Sally Catt, Prof JianFei Cai, Prof Beverley Vollenhoven.
- Post-thaw Viability and Function of Ovarian Tissue Cryopreserved by Slow-freezing or Vitrification

Women's Health Research

Maternal Vaccine Uptake Still Lagging. New National Project Aims to Change That

Research groups

Cell Therapy and Regenerative Medicine View

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Other staff and students

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Selected publications

Endometrial Stem Cell Biology View

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Epidemiology and Clinical Trials View

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Fetal and Neonatal Health View

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Infections in Pregnancy View

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Lung Development View

Research Projects

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Maternal and Perinatal Medicine View

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Research groups

Fetal growth restriction View

Preeclampsia View

Amnion cell therapies View

Maternal and perinatal medicine translational research View

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Key collaborations

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Neuro development and Neuroprotection View

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Perinatal Inflammation and Neurophysiology View

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Perinatal Transition View

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Researchers

Students

Research Projects

Translational Tissue Engineering View

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Researcher

Other staff and students

Research Projects

Uterine Biology and Gynaecological Disease View

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Researcher

Honours Students

Summer Students

Education Program in Reproduction & Development (EPRD) View