János Gellén M.D.
Registered Specialist in Gynecology, Obstetrics and Prenatal Diagnostics
Moritschstrasse 2 / 3 - 9500 Villach (Altes Parkhotel)
T: +43 4242 / 29 707
Fax: +43 4242 / 29 7 07-4

Dialogue, Information, decision support

One of my priorities in the care for pregnant women is the steady dialogue and the provision of information. Patients are often accompanied by their partner or another confident that support them in these discussions. Already before starting the ultrasound examination, the patient should know the capability of ultrasound technique and its limits. There is always the possibility that inner conflicts and fears develop due to a suspicious finding in ultrasound examination. However, the patient ALWAYS has the right to say NO to the examination.

Since, with ultrasound, a disease can never be diagnosed but the performing specialist can only get clues of a possible problem, a lot will be said about probabilities and risks. For example the risk of a chromosomal abnormality of the child. Due to the fact that many genetic diseases show a very complex set of symptoms and findings, they are sometimes not easy to be explained or understood. That’s why I often use sketches or photo material to give the patient a better understanding of what I’m talking about.

If there is the question whether or not to perform further diagnostic procedures after a suspicious ultrasound examination, most of the time there is more than just one option with individual pros and cons. By talking a lot with the patient I want to give her (and her partner) enough time to think about every possible next step without feeling any time pressure. Only this way the parents can make well-founded decisions.

When talking to my patients it is very important to me to use simple language without the constant usage of medical terms. I don’t want the patient to be overloaded by information and she always has to have the possibility to say whether she wants further information on a specific topic or not.

First-Trimester Screening and Combined Test

The Combined Test is a combination of ultrasound examination in 11. - 14. weeks’ gestation and a blood sampling where two hormones are determined that are known to be distributed differently in the mother’s blood when she’s expecting a healthy child or a child with, for example, Down syndrome. The ultrasound scan is thought to detect or exclude abnormalities that could indicate a chromosomal abnormality.

A world-wide known and approved statistics program then uses the before-measured parameters as well as the hormone levels plus the patient’s age and calculates an individual risk of chromosomal abnormalities for the patient’s unborn child.

Read the fact sheet on First Trimester Screening and Combined Test to find out more.

The Ultrasound Examination

What’s important to know is: Even in experienced hands, ultrasound technique has its limits. An ultrasound examination can never prove that the child is “completely healthy”. However, by having a lot of experience and good visibility conditions (which depend, among other things, on the position of the fetus as well as the thickness of the mother’s abdominal wall) it is possible to see structural abnormalities of the fetus and to control blood flow patterns, the amount of amniotic fluid, the structure of the placenta… However, there’s always the eventuality that small structural abnormalities, like a small cleft lip, remain unseen. And, more importantly, there are problems that only develop over a longer period of time.

For further information, please read the fact sheet on Second Trimester Screening (Organ Screening).

In the office I always use one of the most recent ultrasound units. This helps me to scan the child ideally, sometimes also by using 3D-technique. The examination is structured according to the recommendations and guidelines of the Fetal Medicine Foundation (FMF) London and the Austrian Society of Ultrasound in Medicine (ÖGUM).

Invasive Diagnostics

There are cases where the Combined Test or the ultrasound scan alone show abnormalities that might require further investigation. To do this, there are field-tested, so-called “invasive”, methods. Only by using invasive diagnostics, a diagnosis can be made! However, it is always the patient who decides whether further investigation is needed/wanted or not.

  1. Chorionic villus sampling (CVS)

  2. This procedure can be made once the patient reaches 11+0 weeks’ gestation. Under sterile conditions and under constant ultrasound control, the abdominal wall and placenta are punctured with a thin long needle. Tissue samples, obtained via the needle, then get prepared and preserved in order to undergo genetic testing later. Preliminary results (for chromosomes 13, 18 and 21): after 1-2 business days; final results: after 1-2 weeks.
  3. Amniocentesis

  4. This procedure can be performed once the patient reaches 15+0 weeks’ gestation. Just like CVS under sterile conditions and under constant ultrasound control, the abdominal and uterine wall are punctured with a thin long needle and about 15ml amniotic fluid are taken from the uterine cavity. The reason why amniocentesis is only possible after 15+0 weeks’ gestation is that only now the fetus can “lack” some amniotic fluid without having negative consequences. Preliminary results (for chromosome 13, 18 and 21): after 1-2 business days; final results: after 2-3 weeks.

Both procedures can be performed in the office, in a quiet environment without any time pressure. It is very welcomed to bring either partner or any other confident of the patient’s choice.

Both procedures carry a certain risk of having a miscarriage. In rare cases, the puncture can lead to a rupture of membranes or to an infection that might cause contractions with consecutive child birth. The more experienced the doctor, the lower the risk of a miscarriage. However, the average risk of losing the child due to amniocentesis or CVS is around 1:200, meaning that in 200 procedures one child is lost, no matter whether this child is healthy or not. Both procedures carry the same risk.

Genetic testing takes place in Linz (Oberösterreich). For many years we have been in close collaboration with the Institute of Genetics at Kepler University Clinic Linz, led by Prim. Univ.-Doz. Dr. Hans-Christoph Duba.

For further information about the Institute of Genetics in Linz please click on the link to their official website.

Well-being of the child

By using ultrasound technique it is possible to assess the child’s well-being in utero. To do this, the growth of the fetus as well as his movements, the amount of amniotic fluid, the structure of the placenta and blood flow patterns in different arteries and veins in the fetus, as well as in uterine arteries, are controlled. Especially in the second half of the pregnancy this information can play an important role since many children with growth problems develop these problems only in this period. Additionally, some maternal diseases, like high blood pressure for example, may require regular controls. For further information on hypertensive diseases in pregnancy please read the fact sheet on preeclampsia.

Quality control

My main goal is to provide patients as well as assigning gynecologists with fast and detailed reports. Additionally I want to be a reliable and well-accessible partner in the discussion of issues regarding prenatal diagnostics and/or high-risk pregnancies.

To steadily control the quality of my care for pregnant women, there’s a short report form given to every patient that undergoes ultrasound examination in our office. We ask our patients to fill in the form after the child’s birth and to return it in whatever way they prefer.

The report form is important to us to

  1. find out about the pregnancy outcome and to
  2. give suggestions or critique regarding our patient care.

Usage of new methods and techniques as well as regular further training and study of new academic findings are a given to me.

Impressum