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Paphos-born, Greek-Cypriot maternal and fetal medicine expert, Professor Kypros Nicolaides is recognised worldwide for fetal diagnostic, intervention and surgery developments. He was one of the world´s pioneers on fetal medicine
Over the past years we have seen that new technologies, such as artificial intelligence and machine learning, are developing certain research fields even further. How do you think they will affect fetal medicine and the diagnosis of various syndromes and diseases?
“A very good question. Certainly, it will have an impact, in the sense that today with AI there is rapid growth in science specifically. In fetal medicine, we rely to a large extent on diagnosis with ultrasound to detect any anomalies in the embryo. That is the first stage that will make a patient come to us. The main problem is, however, to what degree the knowledge can spread, so that all medical centres, all doctors, can be in a position to make an accurate diagnosis and forward it to a research centre like ours.
And I think that very soon, in the next three to five years at most, all companies that carry out ultrasound will incorporate AI in their systems, so that the system itself will guide the individual in making a diagnosis. With some straightforward moves, one will be able to take ultrasound images of the embryo, and the machine itself will detect which images show some anomaly. That is the first stage. I regularly communicate with the large companies, which manufacture ultrasound machines, and all of them are focusing precisely on this aspect – how to improve diagnosis.”
Who imparted to you the love for medicine, and how did you suddenly find yourself studying in England?
“My father was a doctor, one of the first in Paphos. He had studied medicine in Athens in the 1930s. So, when he came to Paphos he was one of a handful of doctors that would visit the villages regularly, make calls on patients, and apply, what is commonly referred to today as holistic medicine.
I would often accompany my father on his rounds when visiting the villages. He would walk into a coffee shop, and people would often discuss the problems they faced as farmers. I recall them talking about their crops, complaining about the drought, or how too much rainfall had ruined their grapes. However, they also came to the coffee shop to talk about their health issues. Often the problems were psychosomatic. For instance, when their harvest did not go well, they suffered from headaches, or back pain. From a young age I learned that we have to look at a person holistically, not as an individual merely suffering from any given disease. This helped me over the years, in England, where the philosophy of holistic medicine became fashionable.”
How do you think research can be promoted in a small island such as Cyprus, and how did England utilise you in the designing of scientific and research policies?
“Can a small country conduct research? Sure. There are many types of research. In my own research, for example such as predicting preterm labour, or complications during pregnancy, you need samples from tens of thousands of patients. In Cyprus, we have only about 10,000 births a year. So, in this type of research, Cyprus will not fare well. But there is other research requiring far smaller sample sizes, studies that go to great depths to discover certain correlations, for example using molecular biology in detecting certain mechanisms of any given disease. And here Cyprus can carry out excellent research. We have very good scientists who have trained abroad and are qualified to do this.
“Cyprus has excellent universities. For instance, the Institute of Genetics, which carries out highly specialised research at a high level, publishes its results in international periodicals. In England, I oversee a large research centre, which promotes research by training people, participation in various research programmes, and we also publish our results. In 1992, I noticed a relationship between cervical transparency – concentration of fluid in the embryo’s neck in the 12th week of gestation – and Down’s Syndrome. After 14 years of research by my team, this was applied clinically in all hospitals. I have trained Cypriot doctors, who have come to London on scholarships, thereafter returning to Cyprus and providing their services in all the cities.”
What role do you think your teachers and professors played in the first stages of your learning?
“A very positive role. From primary school through to university, I often took a liking to certain teachers who were my source of inspiration. In my case, however, my father encouraged me to become a doctor. I had not thought about it much; I jumped on the plane and came to England to study. However, during my studies in the 1970s, many things occurred in the world – in Cyprus we had the coup and the Turkish invasion – which affected me more than my university studies. Suddenly a new professor showed up at our university, of obstetrics and gynaecology, who was among the pioneers in using ultrasound. In a lecture he gave, lasting half an hour, he inspired me so much, ultimately guiding me through my life over the next 40 years.”
While performing medicine there are both challenging and sad moments. How do these affect you as a person and a doctor?
“There are some very difficult moments that raise serious moral dilemmas. For example, a woman comes, she is diagnosed with a particular anomaly, and you need to convey in some way to the woman what you have seen, and what the consequences are. Sometimes we can intervene to make things better, through surgery which can prolong one’s life.
These in a sense are the easier problems, as they do not pose a moral dilemma. But when for example you diagnose Down’s Syndrome in an embryo, and you are dealing with two types of parents, that is extremely challenging. That is the kind of thing I deal with daily – how couples cope with the same information based on their personal values. Sometimes when you manage to save a baby, the parents treat you as if you are God. There are other moments, however, when, despite your best efforts, the baby dies; many parents will thank you for trying, but there will be others who pass the blame on the doctor for the baby’s death.”
You are considered the ‘father’ of cervical transparency that detects Down’s Syndrome in the 12th week of gestation, and of laser endoscopy. Please explain how you arrived at these amazing achievements.
“The discovery of cervical transparency was something that happened by chance. One day I saw a woman who had come for an ultrasound in her 12th week. I noticed that the embryo had a great deal of fluid in its neck. The thought occurred to me that this baby would have a serious case of anaemia. During this period, I was doing some other research combining amniocentesis with trophoblast biopsy in week 12. Over the next 48 hours, in this case, the result came out that the baby had Down’s Syndrome. So, something clicked in my head that perhaps increased cervical transparency had some connection to Down’s Syndrome. The first time I noticed a possible link was in 1991, and then the research that led to examining 100,000 women happened in 1998. It took seven years of research to prove the link.
As far as laser endoscopy goes, there are cases of identical embryos, where one embryo bled through shared blood vessels into the other, resulting in the death of both babies, one due to blood loss, and the other baby from having too much blood and heart failure. I used to see such patients in the 1980s, observing how the pregnancy progressed, and often saw these babies die. I remember one evening thinking that since the blood vessels were shared, perhaps the only way to solve the problem was to sever these blood vessels. Speaking with other doctors, we agreed that we should perform laser endoscopy in the uterus. I had no idea whether this would work. The Netflix series, The Surgeon’s Cut, dedicated to four doctors from around the world, features me in the first episode where I describe how we performed the surgery with laser.”
What are the basic traits one needs to have to succeed in your profession?
“It is the same traits that apply for all professions. You need to love what you do. You must be glad to get out of bed in the morning. However, if you are not motivated to go to work, you should find the drive to get there.”
Watch the interview on Cyprus Mail’s YouTube Channel: https://youtu.be/6omSZKZvlqM
