Is there anything as wonderful as bringing a new life to the world? Pregnancy nonetheless comes with plenty of questions. We are happy to answer them based on our many years of experience, so you can feel the comfort and security you need to enjoy your pregnancy. Our goal is to make this time as unique and carefree as possible.

We provide you with complete care before, during, and after your pregnancy, in cooperation with specialized practices and clinics if needed:

• Best possible preparation for pregnancy
• Prenatal care, including high-risk pregnancies
• Invasive and non-invasive prenatal examinations (First Trimester Screening/Aneuploidy Screening, DNA-based blood screening test, Genetic Ultrasound, Flowmetry (called Doppler), Amniocentesis)
• Infection screenings (Cytomegalovirus, Toxoplasmosis, Beta-Streptococcus etc.)

We are looking forward to helping you throughout this exciting journey.

Pre-conception counseling

It is important to have a consultation before becoming pregnant. We can help you ensure that your pregnancy gets off to the best possible start.

• Nutritional advice, blood work, and testing for vitamin and nutrients levels
• Vaccinations, including any you have missed
• Menstral cycle monitoring, inlcuding vaginal ultrasounds
• Pap Smear test for Chlamydia and other STD´s

If you are having difficulty getting pregnant, you are not alone. Approximately 10-15 percent of couples suffer from infertility from a variety of conditions.

The first step is to identify the causes of infertility. The diagnostic evaluation includes:

• Hormone analysis
• Assessment of ovarian reserve (Anti-Müller-Hormone)
• Ultrasound scan of pelvic organs
• Blood test for infection testing
• Spermogram (semen analysis)
• Laparoscopy to check for defects of the uterus, ovaries or fallopian tubes

After diagnostic evaluation and counseling, we guide you through the fertility process and help you determine the best treatment options, in cooperation with infertility centres in Regensburg. Treatment steps may include:

• Menstral period monitoring
• Ovulation induction
• Insemination
• In-vitro fertilization (IVF)
• Referral to genetic counseling if appropriate

Today there are more options than ever to enable you to take control of your life. Each type of birth control offers different types of advantages and disadvantages.

Contraception is a very personal decision You might need birth control for the very first time, you might look for a suitable option for the lactation period or you would like to just try another contraceptive. We will help you choose the form of birth control that works best for your needs and offers the most comfortable and most convenient solution based on your lifestyle, your sexual activity and your own personal preferences.

Taking your personal and family health history and a proper examination is very important before discussing your contraception needs.

We offer you the following birth control methods:

• Oral contraceptive pills
• Morning-After Pill (Emergency Contraception)
• Contraceptive vaginal ring, contraceptive patch
• Birth control implant
• Birth control shot
• IUD (copper)
• Hormonal IUD
• Diaphragm
• Natural family planning (Fertility Awareness-Based Methods)

The first trimester screening (nuchal translucency screening), one of the most important ultrasound scan during pregnancy is performed between 11 and 13 weeks of pregnancy.

In the first part of the scan we calculate the risk of the fetus having extra chromosomes, called trisomies. This test uses a combination of the mother´s age, hormones that come from the placenta and a sonogram measuring the pocket of fluid at baby´s neck. The screening test has a 90-93 % detection rate of Down-syndrome (Trisomy 21) and a 5 % false positive rate.
In the second part follows the evaluation of the whole fetus´s anatomy as far as possible in this early week of gestation. Most of the major anomalies can be already detected at this stage, but the main goal of the scan is to confirm normal development and reassure parents.
Thirdly the screening can be completed with a risk estimation for developing a preeclamspia after 20 weeks.

The screening can only be performed by physicians who are yearly certified. Dr. Jánky is certified for First Trimester Screening through the Fetal Medicine Foundation (FMF) in London.

With a DNA-based blood screening test you can detect chromosomal anomalies, as well as detect the gender. The test can exlude following conditions: Trisomies 13, 18 and 21, Turner-Syndrome, Klinefelter-Syndrome, Triple-X-Syndrome and XYY-Syndrome.

The test can be performed as early as 9th week of pregnancy. It has a very high detection rate for chromosomal anomalies (99,8 % for Down-Syndrome) but gives no hint at all about structural malformations of the fetus.

Thus, according to current recommendations, the NIPT is usually performed together with the first trimester screening.

At this scan between 20 and 22 weeks of pregnancy we check baby´s anatomy again, ideally as the second „full“ ultrasound scan after the first trimester screening. All the organs of the fetus are examined systematically, from brain and face down to the heart and extremities.
Furthermore we check the amount of amniotic fluid, the placenta as well as the blood flow in some arteries.

With a heart scan we check the baby´s heart in detail with a high resolution ultrasound maschine. In the vast majority of cases we rule out a heart condition. However in a few cases we diagnose a heart failure. The accurate diagnose allows an early consultation with pediatric cardiologists and pediatric heart surgeons, to provide optimum care before and after birth. In most of these cases we plan the delivery in a pediatric heart center with appropriate specialists.

When is the scan performed?
In principle, fetal heart can be checked beyond 12-13 weeks of pregnancy. About 50-60 % of heart conditions can be then detected. However the reliability of the scan at this early stage of pregnancy is limited due to small size of the heart, so that we recommend another scan later in pregnancy. The most favourable time for the heart scan is between 20-22 weeks, where specialists can detect up to 80 % of all heart conditions.

Of course a fetal heart scan can be performed at any stage of pregnancy by suspicion of a heart failure, cardiac arrhythmia or in existence of other malformations.

The Doppler scan is a special ultrasound technique to measure blood flow velocitiy and resistance in the vessels of the uterus as well as in baby´s vessels and organs. From the obtained data conclusions can be drawn about the adequate supply of the child with nutrients and oxygen, as well as on cardiac and circulatory function.

Most commonly we measure the blood flow in the umbilical cord and brain arteries of the baby and in the uterine arteries of the mother.

The senology deals with the clarification and treatment of diseases of the breast.

Pain or nodes in breast lead to concern and anxiety. Using high-resolution breast ultrasound, both breasts and the lymph nodes can be examined without pain and radiation.

Dr. Jánky has long years of senological experience. She has been treating breast-cancer patients for many years at the Breast Center in Amberg. She also holds the DEGUM II qualification for breast ultrasound (mammasonography) and participates in regular training and congresses.

• Breast ultrasound in women without symptoms as extended cancer care
• Clear up suspect palpation findings or pain in the breast
• Biopsy of breast or lymph node tissue (core biopsy, fine needle aspiration)
• Genetic counseling
• Breast cancer aftercare
• Intensive breast cancer screening in women with high frequency of breast cancer in the family

Core biopsy, fine needle aspiration

In the case of unclear findings, which are noticed during the examination, ultrasound scan or mammography, we can usually immediately take a tissue sample in local anesthesia under ultrasound control with a thin needle, which can be studied in the lab to see if cancer cells are present. The biopsy takes about 5-10 minutes and then you can follow your everyday activities without restriction.

Discussion

Usually it takes 1-2 days to get the result of the biopsy, so you get a diagnosis in a very short time. Fortunately most biopsy result are not a cancer. But sometimes you may need another biopsy or a surgery to get a definitive diagnosis.

The care of our patients with breast cancer is based on national and international guidelines in cooperation with certified breast care centers.