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Hcg 0 after hydatidiform mole pregnancy. Symptoms that accompany pathology. Causes of hydatidiform mole

Cystic drift is a benign tumor that develops in the uterine cavity as a result of fertilization of the egg, when numerous cysts appear in the uterus instead of a normal embryo and placenta. In medicine, cysts are called blisters with liquid, and it is with the growth of such blisters in the uterine cavity that the name of this disease is associated - cystic drift.

How common is hydatidiform mole?

A mole occurs in about 1 in 1,000 to 1,500 women with early pregnancy symptoms.

Why does blistering develop?

Several reasons for the development of hydatidiform mole are known, and all of them are associated with "failures" in the process of fertilization. So, a mole can develop if the egg was mistakenly fertilized by two sperm at once, or if the sperm fertilized a defective egg that does not contain genetic information.

Who is at increased risk of hydatidiform mole?

  • In women under 20 years of age and over 35 years of age
  • In women who have already had a hydatidiform mole
  • In women who have already had an early miscarriage
  • In women whose diet is poor in vitamin A

Partial and complete hydatidiform mole

There are two types of hydatidiform mole:

  • Partial hydatidiform mole occurs as a result of erroneous fertilization of the egg by two spermatozoa at once. At the same time, areas of normal placenta and tissue of the embryo, which, nevertheless, is deformed and not viable, can be found in the uterus.
  • Complete hydatidiform mole develops in the event that the genetic information from the maternal side is absent for some reason. At the same time, neither an embryo nor areas of a normal placenta are found in the uterus.

Symptoms and signs of hydatidiform mole

The insidiousness of the cystic drift lies in the fact that at first it manifests itself as a normal early pregnancy: positive, nausea and vomiting in the morning, etc.

However, soon the woman begins to notice alarming symptoms:

  • Bloody discharge from the vagina, similar to menstruation
  • Vaginal discharge containing blood clots and blister-like tissue
  • Severe nausea and vomiting (which are often mistaken for severe toxicosis)
  • Pain and discomfort in the abdomen
  • Increased sweating, cold hands and feet, palpitations, irritability

If the symptoms listed above appear, a woman should contact a gynecologist as soon as possible.

How dangerous is blistering?

In rare cases, a mole begins to behave like a malignant tumor: it grows into the tissues of the body and can metastasize. This condition is called invasive mole.

It is noted that complete hydatidiform mole often leads to this complication: in about 20% of cases. With partial hydatidiform mole, this complication develops in 5% of cases.

An invasive mole may contain cancer cells. In this case, they speak of chorionepithelioma or chorioncarcinoma.

Fortunately, chorionepithelioma can be successfully treated and almost always disappears after a course of chemotherapy.

Diagnosis of hydatidiform mole

Since the first symptoms of a mole are very similar to those of pregnancy, often a woman is unaware of the problem and goes to the doctor to register for pregnancy. And already during the first gynecological examination, the gynecologist may suspect this disease.

What will the gynecologist find?

The size of the uterus with cystic mole usually does not correspond to the delay in menstruation and exceeds the norm by several weeks. For example, a woman thinks she is pregnant and is 5 weeks pregnant and her uterus is 8-9 weeks pregnant. Another common finding of a gynecologist with cystic mole is an increase in the size of the ovaries due to the appearance of a large number of cysts in them.

What will the ultrasound show?

Ultrasound is the most reliable method for diagnosing hydatidiform mole. With the help of ultrasound, you can not only clarify the diagnosis, but also find out the type of disease (complete or partial mole). With a complete hydatidiform drift, ultrasound will not detect either an embryo or a placenta in the uterus. With partial hydatidiform drift on ultrasound, areas of the normal placenta and embryo are determined. The typical ultrasound picture of a hydatidiform mole is many small cysts (vesicles), which some doctors describe as a "blizzard". In addition, ultrasound revealed enlarged ovaries with a large number of cysts.

Often, transvaginal ultrasound (through the vagina) is used to detect hydatidiform drift in the early stages.

What will a blood test for hCG show?

A blood test for hCG in hydatidiform mole allows not only to clarify the diagnosis of hydatidiform mole, but is also used to diagnose malignant complications and to monitor the effectiveness of treatment. The level of hCG with a mole often exceeds 100,000 mIU / ml (mIU / ml). A too rapid increase in the level of hCG can indicate a dangerous complication of cystic drift - the development of chorionepithelioma.

What other tests and examinations may be needed?

When the diagnosis of hydatidiform mole is confirmed, additional tests may be prescribed to the woman: an analysis for thyroid hormones, a complete blood count, an x-ray of the lungs, computed tomography (CT), and others. All of these tests are aimed at identifying possible complications of a mole.

Treatment of hydatidiform mole

Treatment of cystic drift is reduced to the elimination of the tumor from the uterine cavity. Most often, this procedure is called or cleaning, although vacuum aspiration (“sucking out” of the contents of the uterine cavity with a special instrument is often used to remove the hydatidiform mole). Regardless of the method of removal of the hydatidiform drift, this procedure is performed under general anesthesia.

The material obtained as a result of curettage of the uterus is then sent for histological examination. Histology allows you to confirm the diagnosis of hydatidiform mole and clarify its type (complete or partial).

In some cases, the doctor is unable to eliminate the entire tumor, and then a second cleaning may be required. This is very important, because otherwise the tumor can grow into neighboring organs and even metastasize (in this case, they talk about invasive mole). Invasive hydatidiform mole may be indicated by the presence of spotting or bleeding during the first weeks and months after curettage.

In the case of the development of malignant complications of hydatidiform mole, treatment with anticancer drugs (chemotherapy) may be required.

How does the level of hCG change after curettage of a hydatidiform mole?

The level of hCG in the blood is an important indicator to make sure that the treatment of a mole has had an effect, and nothing else threatens your health.

Normally, after treatment of a hydatidiform mole, the level of hCG begins to decrease, reaching normal values ​​​​(characteristic of non-pregnant women) within 8-12 weeks.

If, after curettage, the level of hCG remains at the same level or continues to grow, the woman needs further diagnosis and treatment.

What happens after the treatment of hydatidiform mole?

Over the next few months after curettage, you will need to be closely monitored by your doctor. You will have to regularly take blood tests for hCG (at first once a week, then a little less often), undergo an ultrasound of the pelvic organs and visit a gynecologist for preventive examinations.

Planning for pregnancy after hydatidiform mole

Fortunately, a previous hydatidiform mole does not reduce the chances of a successful pregnancy and the birth of a healthy child in the future. However, after treating a mole, gynecologists recommend waiting a little while planning a pregnancy.

You can resume trying to conceive no earlier than 6 months after your hCG levels have returned to normal. If chemotherapy has been used to treat a mole, then pregnancy planning is recommended to be postponed for 12 months.

In order not to become pregnant during the recovery period of the body, it is recommended to use. Birth control pills also increase the risk of mole complications and are therefore not recommended.

- pathology of the fetal egg, characterized by the transformation of the villi of the outer germinal membrane (chorion) into cysts - fluid-containing vesicles, the growth of the epithelium of the villi, the death of the fetus. Bubble drift is manifested by early toxicosis, bleeding, an increase in the size of the uterus compared to the gestational age. A mole is detected using a vaginal examination, ultrasound, determination of the content of β-CHG, fetal PCG. Treatment consists of removing the mole by vacuum aspiration, curettage of the uterine cavity, and sometimes a hysterectomy.

Due to the rapid growth of drift bubbles, a relatively rapid increase in the uterus occurs, in which its size does not correspond to the expected gestational age. With cystic drift, toxicosis is often noted, accompanied by nausea, repeated vomiting, salivation, exhaustion, increasing liver failure, symptoms of preeclampsia, preeclampsia and eclampsia already in the first trimester.

Since the fetus, as a rule, dies in the early stages with cystic drift, there are no reliable signs of pregnancy - parts of the fetus are not determined by palpation and with the help of ultrasound, the heartbeat is not heard and is not recorded by hardware methods, there are no fetal movements. At the same time, biological and immunological pregnancy tests give a positive result.

In 30-40% of cases, bilateral thecalutein cysts are detected in patients, which spontaneously regress after removal of the hydatidiform mole. The greatest danger of cystic drift is due to the possibility of the occurrence of malignant gestational trophoblastic tumors that metastasize to the walls of the vulva and vagina, lungs, brain, and abdominal organs.

Diagnosis of hydatidiform mole

When diagnosing, cystic drift is differentiated with multiple pregnancies, polyhydramnios, pregnancy against the background of uterine fibroids, spontaneous miscarriage. Distinguishing features include the presence of vesicles in the bloody discharge, usually observed before the expulsion of the hydatidiform mole. In a gynecological examination, the densely elastic consistency of the uterus is determined with areas of excessive softening, the excess of the size of the uterus over the gestational age.

Ultrasound reveals an increase in the uterus in the absence of a fetus in it, homogeneous small-cystic tissue (a symptom of a “snow storm”), the presence of tecalutein ovarian cysts with a diameter of more than 6 cm. During fetal phonocardiography, the heartbeat is not recorded. According to the indications for cystic drift, ultrasound, hysteroscopy, laparoscopic echography, diagnostic laparoscopy can be performed.

If you suspect the development of cystic drift, the content of chorionic gonadotropin (hCG) is necessarily examined; if necessary, biochemical tests of the liver, determination of creatinine and coagulograms are performed. To exclude metastatic screenings of hydatidiform mole, an x-ray of the chest, abdominal cavity, CT or MRI of the brain is performed. After removal of the cystic drift, a histological examination and determination of the karyotype are performed.

Treatment of hydatidiform mole

When a cystic drift is detected, the therapeutic tactic is to remove it. The cystic drift is removed by vacuum aspiration with control curettage after preliminary dilatation of the cervix. For better contraction of the uterus, oxytocin or pituitrin is prescribed. Sometimes there is an independent expulsion of cystic drift from the uterine cavity. With the development of threatening bleeding or the reproductive function performed, a hysterectomy is performed - removal of the uterus without appendages. The removed tissues are subject to mandatory histological examination.

After the evacuation of the hydatidiform mole over the next 2 months, the patient undergoes a weekly determination of hCG in the blood serum, ultrasound of the small pelvis once every 2 weeks, radiography of the lungs. In the absence of signs of developing chorionepithelioma, subsequent chemotherapy is not indicated. Dispensary observation of an oncogynecologist after a hydatidiform mole is carried out for 2 years. For this period, protection from pregnancy with oral contraception is recommended.

Complications of hydatidiform mole

A threatening complication of cystic drift can be the development of chorionepithelioma (chorioncarcinoma) - a malignant form of trophoblastic disease. Chorionepithelioma is characterized by invasive germination of the uterus, massive metastasis to the lungs, liver, brain, and can be fatal. Often, after cystic drift, intrauterine infections, metrothrombophlebitis, thrombosis, septicemia develop. In 30% of women after hydatidiform drift, infertility is noted, in 14% - amenorrhea.

Forecast and prevention of hydatidiform mole

Prophylactic chemotherapy is indicated if, after evacuation of the mole, there is no decrease in hCG titer, as well as in case of detection of metastases. In 80% of women who have had a hydatidiform mole, spontaneous remission occurs without the need for additional treatment. Systematic monitoring of hCG and observation by a gynecologist help to detect developing chorionic carcinoma in a timely manner and take active measures.

Adequate treatment of hydatidiform mole allows you to preserve the reproductive potential of a woman with the possibility of a subsequent normal pregnancy.

Bubble drift is a rare pathology of the fetal egg of a chromosomal nature. In most cases, it develops against the background of pregnancy, when an abnormal degeneration of the chorionic hairs into fluid-filled vesicles occurs. At the same time, the normal development of the embryo is impossible; in its appearance, the fetal egg resembles a bunch of grapes.

Pathology is rare in 0.02-0.8% of pregnancies. Instead of a normally developing embryo, cysts appear in the uterus, which are vesicles with liquid up to 25 mm in diameter. The period of formation of education can vary significantly: it can be diagnosed already in the second month, and sometimes only by the 20-30th week of pregnancy. With the development of cystic drift, the death of the fetus in the first months of gestation is inevitable, because due to the unformed placenta, it does not receive enough oxygen and nutrients necessary for development.

Etiology and clinical picture

The exact cause of the pathology has not been established, but most physicians are inclined to the version of a failure in the chromosome set. As a rule, the presence of the disease during pregnancy is stated, but often it can be the result of an abortion, miscarriage, or occur after childbirth.

With cystic drift, the fetus has a double set of paternal chromosomes with an incomplete or absolute absence of maternal chromosomes. The loss of maternal cells occurs during the fertilization of an “empty” ovum that does not carry genetic information or when it is fertilized by two spermatozoa. It is possible to develop a complete and partial hydatidiform mole.

  • A complete hydatidiform mole occurs when the embryo has exclusively chromosomes received from the father. In the future, the fetus dies, but the cystic drift continues to grow, and the size of the uterus increases. For this form of the disease, a high risk (up to 20%) of malignant degeneration and the development of metastases is noted.
  • Partial hydatidiform drift is characterized by the presence of one female chromosome and two belonging to the father. Fetal death occurs approximately 8-10 weeks after conception.

Also distinguish between a simple form and invasive (destructive) hydatidiform mole. In the second case, the skid passes into the walls of the uterus, which leads to their destruction. Destructive cystic drift is dangerous with the risk of developing internal bleeding.

Among the provoking factors should be highlighted:

  • frequent abortions;
  • early (up to 18 years) or late (after 40 years) age of the expectant mother;
  • close genetic relationship of the spouses;
  • malfunctions of the immune system;
  • nutritional errors associated with insufficient amounts of vitamin A and animal fats in food.

Symptoms

The following symptoms of pathology in early pregnancy are distinguished:

  • a significant increase in the size of the uterus, caused by the accumulation of blood, villi and vesicles;
  • high levels of hCG, exceeding the usual rate of pregnant women;
  • bloody discharge from the vagina, increasing by the time the mole is expelled (opened bleeding during cystic drift leads to the development of anemia);
  • appearance;
  • the absence of other signs of the development of pregnancy: the fetal heartbeat, its movements or tremors;
  • elevated blood pressure;
  • the release of characteristic white vesicles along with the blood;
  • the presence of protein in the urine in the first trimester of pregnancy;
  • nausea, severe vomiting, increased fatigue and weakness.

The size of the uterus with cystic drift is usually larger than they should be at a certain stage, at 3-4 weeks. However, in some cases, this symptom is not confirmed and the size of the organ is normal.

Since the preservation of the fetus is very rare, a favorable outcome of the disease is its spontaneous expulsion, which is not accompanied by complications and while maintaining the woman's ability to further conceive. With an unfavorable outcome, a miscarriage further leads to pathologies of varying severity.

Consequences

In some patients, a past hydatidiform mole can cause complications. Almost a third of women develop, in 14% the menstrual cycle is disrupted or even stops completely, and the risk of malignant neoplasms increases.

There are certain risks of developing fetal pathologies in subsequent pregnancies and complications during childbirth.

But the most dangerous consequence is the development of choriocarcinoma - a malignant trophoblastic tumor. If left untreated, it can lead to the death of the patient.

Diagnostics

Clinical signs of hydatidiform drift may differ and depend on the form of development of the disease and the degree of damage.

With a partial form of the development of the disease, diagnosis can be difficult, since the uterus can retain its usual dimensions for a certain period. Pregnancy can continue to develop if the placenta of the fetus is only partially disturbed, but sooner or later ends with the death of the fetus or the birth of a dead child.

With a complete form, it is much easier to identify pathology. The uterus completely lacks any signs of the development of the embryo, while its size exceeds the usual several times. The body of the uterus is filled with vesicles and edematous villi. With an invasive form of skidding, the main symptom is pronounced internal bleeding. A woman may complain of headaches, bloating, a feeling of heaviness inside, dull and aching pains that radiate to the sacrum and lower back. This is due to the aggressive germination of the villi into the body of the uterus. Approximately 7% of patients complain of palpitations, tremors of the limbs, an increase in the size of the thyroid gland.

Bubble drift belongs to rare pathologies, therefore, when making a diagnosis, it can be mistaken for a normal miscarriage, the presence, a pregnancy that develops against the background of uterine fibromyoma.

The main features of the disease are the release of vesicles, usually preceding the expulsion of the skid, and the excess of the size of the uterus with a simultaneous change in its consistency.

In the case of malignant degeneration, metastases may occur in the vagina, lungs, and brain. This causes coughing and hemoptysis, severe headaches, nausea, dizziness.

If a cystic drift is suspected, the woman is prescribed the following diagnostic measures:

  • to accurately determine the size of the uterus;
  • conducting phonocardiography of the fetus, which allows you to establish the absence of its viability;
  • study of the content of chorionic gonadotropin;
  • examination of the state of the uterine cavity and tubal patency;
  • computed tomography and;
  • biochemistry of liver samples.

In addition to ascertaining an increase in the uterus, ultrasound reveals the presence of ovarian cysts, filling the body of the uterus with a fine-grained mass.

After treatment, a histological examination of tissues, radiography of the lungs and brain is performed. Also, a regular analysis for hCG should become a mandatory procedure. Such diagnostic measures are needed in order to make sure that the pathology does not escalate. Elevated levels of hCG in a mole that does not show a gradual decrease may be a signal that the tumor has spread to other organs.

Treatment

Modern medicine uses various methods of treatment of hydatidiform mole. With a benign form of tumor development, the egg is removed using vacuum aspiration. This method, first of all, is relevant for women who plan to have a child in the future.

Surgical removal

Often, with a disease, spontaneous expulsion of a skid from the uterus occurs. But in this case, vacuum aspiration is carried out to completely cleanse its cavity. It is impossible to remove the tumor without surgery. In rare cases, curettage may be incomplete. The fact that pathological growths remained in the uterus will be indicated by the results of an analysis of the level of hCG, which will continue to remain high. In this case, it is repeated.

Before the vacuum aspiration, the woman is given Oxytocin, which improves uterine contractions. It is necessary to scrape the body of the organ to completely remove the bubbles with liquid. It is produced through the expansion of the cervical canal. The extracted material is sent for examination to exclude the possibility of malignant cell transformation.

Vacuum aspiration is a more gentle method of removing the ovum than traditional abortion. The risks of damage to the walls of the organ, infection or bleeding are minimal.

There is no special need for excision of cysts on the ovaries, since after removal of the cystic mole, they resolve on their own. For several days, the patient is prescribed drugs to enhance uterine contraction, antibiotics, cold on the lower abdomen. Rh-negative women, especially those with partial mole, are given immunoglobulin.

Treatment after curettage should be aimed at eliminating the symptoms associated with the disease, which pose a danger to well-being. These are malfunctions of the thyroid gland, anemia, preeclampsia.

How likely is a hydatidiform mole to recur?

With proper treatment, the risk of recurrence of the pathology is very low and amounts to no more than 1%.

If the disease is accompanied by profuse uterine bleeding, an increase in the uterus to the size of a 20-week pregnancy, a woman may be recommended a laparotomy with. The ovaries are preserved.

Treatment after removal

After the mole is removed, the second stage of therapy begins, the main task of which is to monitor the woman's hCG levels. Previously, it was believed that all patients who underwent this pathology must undergo chemotherapy without fail. Today, the latter is performed in cases where the patient remains at a high risk of developing choriocarcinoma.

Approximately four weeks after curettage, menstruation should pass (provided that the menstrual cycle is 28 days). In most cases, they are no different from normal menstruation.

If there is no period after cleansing for more than seven weeks, the woman should seek medical attention. The absence of menstruation indicates a disorder in the body and should not be ignored. It can be inflammatory processes, various infectious diseases, hormonal imbalances.

Bubble drift is a pathological condition in which, instead of a long-awaited pregnancy, a trophoblast (a temporary organ necessary for attaching a fetal egg to the walls) degenerates into a huge number of small bubbles in a woman's uterus. With such a pathology, the appearance of the fetal egg resembles bunches of grapes. The embryo with such a pathology dies in the early stages of pregnancy.

Classification

In medical practice, there are several types of pathology such as cystic drift. The primary classification divides this disease into two forms: simple and invasive. When it comes to a simple form, we mean the formation of a cystic drift in the uterine cavity, which has a certain localization and does not affect the tissues of the organ located nearby. In the invasive form, the cystic drift grows into the walls of the uterus, which leads to tissue destruction and possible perforation, with the development of massive intra-abdominal bleeding.

Another classification divides this pathology into two forms: partial and complete. Most often, a complete mole occurs, in which it contains a diploid set of chromosomes, both of which belong to the father. If we talk about partial cystic drift, then it occurs when the transformation does not affect all the villous layers of the chorion. Sometimes with this form of the disease, a triploid set of chromosomes can occur, of which one chromosome is maternal and two are paternal.

The diploid set of chromosomes in complete hydatidiform mole is noted mainly in those cases when it was formed in the early stages of pregnancy. Triploids occur if a partial mole develops between 9 and 30 gestational weeks of gestation. In this case, in both cases, the fetus dies in the mother's womb, but if a complete cystic mole occurs at an early stage, the embryo in the fertilized egg is not detected at all. With such a violation as a partial hydatidiform mole, unchanged particles of the fetus and placenta can be found in the fetal egg, while with a complete one they are completely absent.

There is also a classification of such a pathology as hydatidiform drift, in accordance with the gestotype, that is, depending on which trophoblast cells undergo degeneration. According to this classification, three types of pathology are distinguished: cytotrophoblastic, syncytial and mixed.

Reasons for development

Since hydatidiform mole is a chromosomal pathology that occurs during gestation, it is impossible to determine exactly what leads to the development of such disorders. At the same time, the causes of hydatidiform mole lie in the fact that maternal genes are lost in the process of fertilization, and paternal genes, replacing them, are duplicated.

In addition, pathology can occur if an egg that does not have a nucleus is fertilized by two sperm.

If we talk about risk factors, then this disease occurs several times more often in women who are either not ripe for pregnancy (14–15 years old) or are already older than 40 years old. Multiple births, abortions, lack of certain trace elements and vitamins in the diet, immunodeficiency, as well as the creation of families between close relatives - all these factors can cause the development of this serious pathology in a woman during pregnancy. Fortunately, this phenomenon is quite rare - on average, it occurs in 1 pregnant woman out of 1000, although these figures are relative.

Clinical manifestations

The symptoms of this pathology are ambiguous - in different women they can manifest themselves in different ways. Since drift is formed at different stages of pregnancy and can be of different forms, this is the determining criterion for the clinical picture.

However, the main symptoms that may bother a woman with this disorder are:

  • after a long period of delayed menstruation, she has uterine bleeding with dark blood, which can be from slight to profuse;
  • , which many women mistake for pregnancy symptoms are nausea and vomiting, lack of appetite and exhaustion, salivation and dizziness.

In severe cases, when the cystic drift grows into the walls of the uterus, causing their destruction, intraperitoneal bleeding may occur, and if the woman is not treated urgently, the likelihood of death is very high. Also, one of the indicative symptoms of a complete hydatidiform mole is the discrepancy between the size of the uterus and the gestational age of pregnancy, which is confirmed by both visual examination and ultrasound.

Another characteristic symptom of this pathological condition is the presence of bilateral fluid ovarian cysts, which can reach 10 cm or more in size. They are easy to detect on ultrasound, but not all women with a hydatidiform mole develop them. Treatment of such cysts is not carried out, since they disappear on their own after the cleaning of the uterine cavity from cystic drift.

Separately, it should be said about hCG with cystic drift - its level is several times higher than the norm. Therefore, during treatment, it is mandatory to check it until the period when it does not return to normal. At the same time, after treatment, when the hCG level returns to normal, the woman will still have to take this test regularly for six months for a preventive purpose. Signs of partial hydatidiform drift can mimic its signs in early pregnancy, so diagnosing a violation during this period is problematic.

Separately, it should be said about the most severe complication caused by cystic drift - its transition to a malignant form, due to the spread of bubbles to various organs, mainly to the lungs. Very often, women with this pathology are faced with the development of chorionepithelioma (choriocarcinoma) after removal of the hydatidiform mole. The prognosis of the course of the disease in this case is extremely unfavorable - in most cases, a fatal outcome occurs. Therefore, the earlier the pathology is detected and its treatment is started, the higher the likelihood that the process will regress irrevocably, and the woman's health will suffer minimally.

Other complications of pathology are:

  • septicemia;
  • intrauterine infection.

Diagnosis and treatment

Diagnosis of the disease is based on a gynecological examination of the patient and palpation of her uterus, with the determination of the size, consistency and density of the organ. An ultrasound is also mandatory. Moreover, it is ultrasound that is the most informative method that allows you to see a cystic skid.

Ultrasound can be both external and vaginal. During ultrasound, bilateral fluid ovarian cysts can be detected, and, in addition, the absence of a fetus in the uterus can be seen. Phonocardiography shows the absence of a heartbeat in the fetus, which is also a diagnostic sign. Also, for the differential diagnosis of this pathology with others, hysteroscopy, CT and MRI may be required.

Laboratory tests are mandatory - the level of hCG is determined, biochemical samples of the liver are taken and a coagulogram is prescribed.

As for the treatment, it is exclusively operational. For this purpose, vacuum aspiration devices are used, followed by cleaning of the uterine cavity using curettage. With such a pathology as a simple cystic drift, sometimes it is spontaneously removed from the uterus. In this case, vacuum aspiration is still performed to make sure that nothing remains in the uterus. And the material extracted from the uterus is sent for research to confirm or refute the malignant degeneration of cells. With an invasive form, there is a high risk of bleeding, and having found this form on ultrasound, the doctor should urgently hospitalize the woman in a hospital and prescribe her surgical treatment with removal of the uterus and preservation of the ovaries (if possible).

In cases where the disease has a malignant course, chemotherapy is indicated, the scheme and drugs for which are selected individually for each patient. After treatment, patients are also shown a diagnostic ultrasound to examine the uterine cavity.

Many of the fair sex are interested in whether pregnancy is possible after a cystic mole. There is no single answer to this question, since much depends on the age of the woman, her state of health and complications caused by the pathology. According to studies, 30% of women after this pathology suffer from infertility, but if it was detected in a timely manner and the treatment was carried out with high quality, then the woman's chances of becoming a mother are not bad.

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Answer only if you have proven medical knowledge

Diseases with similar symptoms:

It is no secret that microorganisms are involved in various processes in the body of each person, including the digestion of food. Dysbacteriosis is a disease in which the ratio and composition of the microorganisms inhabiting the intestines are disturbed. This can lead to serious disorders of the stomach and intestines.

This serious complication of pregnancy, doctors of the Soviet school knew little, since the frequency of this disease was low. However, with the development of medicine, it turned out that many cases of trophoblastic disease were not diagnosed in time, as some aggressive types of this disease progressed rapidly, and women died after childbirth within a very short period.

Trophoblastic disease is often called gestational trophoblastic disease(GTB), emphasizing the relationship of this type of disease with pregnancy (gestation). There is benign GTB and malignant GTB, although diseases that are included in the concept of GTB are now more often divided into non-invasive and invasive (spreading beyond the uterus). The GTB group includes: simple hydatidiform mole, destructive hydatidiform mole (chorioadenomadestruens), choriocarcinoma (chorioepithelioma), and trophoblastic tumor of the placental uterine region. Invasive diseases of HBG, which include all diseases except simple hydatidiform mole, are also called gestational trophoblastic neoplasia, emphasizing their association with tumor-like malignant processes (cancer). A molar mole is also called a molar pregnancy because it occurs most often during pregnancy, and it can be partial or complete.

Trophoblastic disease arises from the cells of the placenta (trophoblast), causing them to swell and overgrow. If the fetus is alive and the growth of the tumor is partial, this type of cystic mole is called partial or simple. It turns into a malignant process in only 2% of cases. With a complete cystic drift, the fetus dies, and the overgrown edematous trophoblast (similar to grapes) fills the entire uterine cavity. This type of mole can also grow into the wall of the uterus and spread to neighboring organs. In many cases, the disease progresses to choriocarcinoma (about 20% of cases), one of the most malignant tumors. This tumor metastasizes (spreads) to the lungs, liver, brain and other organs in a matter of weeks.

The incidence of hydatidiform mole, especially in European countries, including Ukraine and Russia, has increased significantly over the past 10-15 years. Vesical mole occurs in 1 in 120-200 pregnancies and births(compared to 1 in 4000-5000 pregnancies two decades ago), that is, more often than an ectopic pregnancy! Half of cases of chorionic carcinoma occur after hydatidiform mole, 25% of cases - after an abortion, and 25% - after childbirth. There has been much speculation in the past that hydatidiform mole may be caused by environmental factors. With the development of genetics, scientists came to the conclusion that this disease is associated with a defective set of chromosomes in the fetal egg. With complete cystic drift, the chromosome set (karyotype) of the trophoblast (and fetus) is 46, XX or 46, XY (10-15% of cases), when a defective egg that does not have a woman’s chromosome set is fertilized immediately by two normal male spermatozoa. With incomplete hydatidiform drift, the karyotype is 69, XXY as a result of the fusion of defective eggs and spermatozoa.

If the woman is pregnant, then often spotting and bleeding is the only sign of GTD. Doctors usually pose a threat of termination of pregnancy and, without prior examination, prescribe a huge amount of drugs, trying to "save" the pregnancy. Sometimes such pregnant women may experience nausea, high blood pressure. The size of the uterus is either slightly ahead of schedule, or is normal. In non-pregnant women, GTB may be latent.
The development of a malignant (cancerous) tumor occurs during pregnancy, after abortions and childbirth, but also after a long period after them. Sometimes women complain about the discharge of "strange bubbles" with blood from the vagina. The pregnancy test in this case will be positive, but there is no fetus in the uterine cavity. Doctors suspect an ectopic pregnancy in this case and suggest that the woman undergo a laparoscopy, which is very unreasonable. The ovaries are often enlarged and ovarian cysts can be found in 20% of cases (luteal cysts).

If GTB is suspected, measure the level of human chorionic gonadotropin (hCG) in the blood serum and diluted urine, since this hormone is produced by the placental tissue. If the woman is pregnant, these levels will be above acceptable levels (usually above 100,000 mU/mL). After the termination of a normal pregnancy (abortion) and childbirth, the level of hCG drops to normal within 8-10 days (it is almost impossible to determine it in the urine). If the level of hCG rises after a decrease or does not decrease, remaining the same (plateau), an additional examination is necessary to exclude GTB. There are also a number of other methods for diagnosing trophoblastic disease.

As early as 25 years ago, due to GTB, especially its malignant forms, women died very quickly (practically “burned out” in a matter of weeks). Today this disease is curable. If a hydatidiform mole is found in a woman, it is necessary to remove trophoblastic tissue and conception products from the uterine cavity as soon as possible by scraping. The contents of the uterus are sent for tissue testing to determine if the process is benign or malignant. At the same time, the level of hCG in the blood serum is measured. After removal of a simple mole, hCG levels quickly return to normal, usually within 8-12 weeks, in 80% of women. In 20%, the level of hCG will remain unchanged or increase, so chemotherapy is recommended for such women. Thanks to chemotherapy with methotrexate, GTB is curable in almost 100% of cases, even in the presence of widespread metastases. Most often, after a mole, women whose hCG has returned to normal within 8-12 weeks do not need treatment with methotrexate. However, they should be observed by an oncologist, constantly measuring the level of hCG, and protected from pregnancy for at least 6-12 months. 80% of women after treatment with methotrexate may have children in the future. Other types of chemotherapy lower the fertility rate by up to 45-50%. Recurrent hydatidiform mole occurs in subsequent pregnancies in 1-2% of cases.

So, the appearance of spotting during pregnancy is not always dangerous with an ectopic pregnancy or abortion. It is important in such cases to exclude an equally serious complication - trophoblastic disease.