Honorary Fellow Professor Kyprianos Herodotus NICOLAIDES (2020)

Professor Kyprianos “Kypros?Herodotus Nicolaides was born to one of the very first doctors in Cyprus in 1953. He studied medicine at King’s College School of Medicine and Dentistry in London and graduated in 1978. While he was a house officer at King’s College Hospital, he was inspired by Professor Stuart Campbell and decided to pursue a career in fetal medicine. He is a visionary and a pioneer of fetal medicine and the “father?of prenatal screening. His discoveries have revolutionised the practice in fetal medicine, including prenatal screening and diagnosis and fetal therapy. He is a prolific scholar with over 1400 indexed publications, with an H-index of 165.

Through his keen eyes, he has discovered novel ultrasound phenotypes or markers for fetal diagnosis. In the 1980s, he described the lemon and banana signs that are indicative of spina bifida. In the 1990s, he reported that increased fetal nuchal translucency and absent nasal bone are markers of Down syndrome. These markers are now part of routine ultrasound assessment. With regard to Down syndrome screening, he developed the first trimester combined screening algorithm with a combination of ultrasound and biochemical markers in the year 2000. This method of screening, which can achieve a detection rate of 90% for Down syndrome, at a false positive rate of 5%, was the most accurate screening method until the era of cell-free DNA in early 2010. Though the cell-free DNA test is highly sensitive, the first trimester combined screening algorithm continues to play an important role as the first line test in Down syndrome screening, whilst the cell-free DNA test is offered contingent on the results of the first line test. This is the screening strategy that has been adopted in several regions and countries, including Hong Kong. He has also pioneered fetoscopic laser coagulation for treating twin-twin transfusion syndrome. This fetal therapy has since been proven as an effective treatment for twin-twin transfusion syndrome in a large randomised controlled trial, and it has become the first line treatment for the complication.

In early 2000, he had the vision to implement the fetal medicine approach in maternal medicine. Together with Professor Liona Poon, they were the first researchers to develop an effective method of screening for preeclampsia in the first trimester pregnancy, utilising a combination of maternal characteristics and medical history, measurement of mean arterial pressure, uterine artery Doppler and serum placental growth factor. They have subsequently demonstrated in a prospective multicentre randomised controlled trial that aspirin prophylaxis, at 150 mg daily, given to high risk women identified by the first trimester combined test could reduce the rate of early and preterm preeclampsia by 80% and 60%, respectively; with subsequent benefits in reducing its related maternal and perinatal complications and costs of treatments. Through his remarkable journey in developing several prenatal screening strategies, he has challenged the current paradigm of antenatal care, which emphasises the need for frequent visits at late gestation, without objective guidance on the nature and content of each clinical visit. Instead, he has proposed a new model of antenatal care that focuses on comprehensive risk assessment of a series of major obstetric complications in the first trimester of pregnancy, thereby triaging pregnant women into different risk categories and therefore care pathways. This concept is known as “Turning the Pyramid of prenatal Care".

He has held the position of Professor of Fetal Medicine at King’s College London since 1992. He is the director of the Harris Birthright Centre, which was the first fetal medicine unit in the United Kingdom. In 2016, the Harris Birthright Centre was moved to the Fetal Medicine Research Institute, which was purposely designed and built, under his vision and guidance, as a centre of excellence for maternal fetal medicine. This is where pregnant women and their family can receive the best possible care in a serene environment; whilst the attending clinicians can deliver health services to their full potential and undertake ground-breaking research. His programme of research and teaching is one of its kind and has attracted thousands of visiting clinicians from all over the world. He has nurtured hundreds of PhD or MD students from more than 50 countries, and many of them now have dominant roles in the field of maternal fetal medicine in their own countries.

Alongside his clinical and academic commitments at King’s College Hospital, he established a charitable organization ‘The Fetal Medicine Foundation?in 1996. This foundation provides free on-line training courses for maternal fetal medicine doctors, with an accreditation process to ensure quality of ultrasound scanning, including the measurement of fetal nuchal translucency thickness, uterine artery Doppler and cervical length. This accreditation process continues to serve as standards in assessing the competence of many ultrasound providers worldwide.

Professor Nicolaides has been a great friend and supporter of Hong Kong throughout his extraordinary career, at postgraduate and professional level. He is a beacon and a true inspiration in our profession. We are honoured that he has accepted the Honorary Fellowship of our College. Mr President, I present Professor Kypros Nicolaides, for the Honorary Fellowship of The Hong Kong College of Obstetricians and Gynaecologists.

Dr LEUNG Tse Ngong
at the conferment ceremony in 2020