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Partial cystic drift of the consequences. Removal of cystic skid. Proliferating hydatidiform mole

Bubble drift is a very rare form of pathological development of the placenta during pregnancy (only 0.02 - 0.8% of cases). The violation is based on a chromosomal "breakdown" of the conception process, which causes degradation of cells, on the basis of which a child's place subsequently appears. Affected chorionic villi transform to bubbles with fluid inside. At the same time, the conditions for the growth of the embryo and its existence as a whole are absent, because the ovum acquires the structure of a grape bunch. Read more about the disease and methods of its treatment below.

Vesicular motility belongs to the group of trophoblastic tumors that are most often found in young women (average age 18 - 35 years) and are not malignant. The inner space of the uterus is filled with numerous small cysts, inside which there is a liquid substance. There are no clear boundaries at the time of the appearance of bubbles: pathology can be detected both at 7-8 weeks of gestation, and at later stages of its development. With cystic drift in early pregnancy, the fetus will not survive, since the mutilated placenta cannot provide it with sufficient oxygen and vital substances. Outside of the uterus, a vesicular neoplasm grows extremely rarely.

Causes of gallbladder drift during pregnancy

Most cases of cystic drift are recorded precisely during repeated pregnancy. Sometimes women who have celebrated their 40th birthday face such a problem. From what exactly this pathology develops, it is currently not known for certain. First of all, the suspicions of scientists relate to chromosomal breakdowns, when a sperm fertilizes an empty egg, which has no nucleus. Not finding the necessary cellular material from a woman, the chromosomes of a potential father double, while the mother's genetic heritage is completely lost. Bubble drift also occurs when a normal egg is fertilized by two sperm at the same time.

Among other alleged causes of the violation, we note diseases of viral and infectious etiology, as well as hormonal disruptions provoked by an insufficient amount of estrogen in a woman's body. All this contributes to the pathological transformation of the chorionic villi.

The likelihood of developing a serious pathology increases against the background of such disorders in the female body:

  • ectopic pregnancy. In this case, the cystic drift "occupies" the fallopian tube;
  • repeated abortions, as well as spontaneous miscarriages;
  • extremely weak immunity;
  • poor nutrition, as a result of which the body experiences an extreme deficiency of retinol and animal fats.

Another provoking factor of a dangerous disorder, scientists consider marriages between close relatives. Bubble drift is a really dangerous disorder, because if it happens more than once, a woman is likely to become sterile.

In medical practice, cases have been recorded when a cystic drift developed in the vicinity of a normally growing fetus. This is possible if the pregnancy is dizygotic, that is, when one ovum has grown from a full-fledged egg, and the second is affected by a complete cystic mole. If at the same time no more than a third of the uterus is affected, the woman has a chance to give birth to a healthy child.

Stages of cystic drift during pregnancy

According to the extent of the chorionic lesion, the cystic drift is classified into several types:

  • normal, or complete blistering skid. The entire chorion undergoes pathological deformation. In this case, the embryo is endowed exclusively with the paternal chromosomes. When it dies, the cysts continue to grow (some are the size of a match head, others look like large grapes), and the uterus grows in size. With this form of the disease, numerous cases of degeneration of neoplasms into a malignant tumor with the subsequent development of metastases are recorded;
  • partial cystic drift. Chorionic pathological changes are fragmented. An embryo that has received one female chromosome and two male chromosomes dies at about 8 to 10 weeks of intrauterine life;
  • simple cystic skid. Cysts fill exclusively the inner space of the uterus;
  • destroying cystic drift. With this form of pathology, the destructive process spreads to the tissue of the walls of the uterus, because of which they begin to collapse, causing internal bleeding.

In photo 1 and photo 2, complete and partial cystic drift during pregnancy, respectively:


Photo 1
Photo 2

Clinical symptoms of hydatidiform mole during pregnancy

The biggest danger with cystic drift in a short period of pregnancy is that the disease may not manifest itself in any way during the first two months. This significantly complicates its diagnosis.

We list the signs of pathology in the early stages of gestation:

  • large size of the uterus (due to the accumulation of cysts and blood);
  • overestimated indicators of human chorionic gonadotropin;
  • bleeding from the genital tract, which becomes more intense when the skid is driven out. Due to blood loss, anemia develops;
  • there are white bubbles in the blood that comes out of the vagina;
  • the formation of cysts in the ovaries;
  • high blood pressure;
  • pregnant urine contains protein;
  • a woman often suffers from nausea, vomiting, general weakness and fatigue;
  • there are no obvious signs of pregnancy (fetal heart rate, movements and tremors).

Most often, the uterus with a cystic drift looks excessively large for the period of pregnancy in which the woman is. However, in some cases, the size of the reproductive organ does not go beyond the normative framework, therefore, cystic drift is confirmed on the basis of some other symptom.

The fetus with such a pathology can be saved extremely rarely. It is a great success if a spontaneous miscarriage occurs without any complications, and the woman still has the opportunity to have children in the future. The unfavorable development of the pathological process entails serious consequences.

Consequences of cystic drift during pregnancy

On the basis of a cystic drift, a woman develops complications that greatly darken her future life:

  • regular interruptions or complete cessation of the menstrual cycle (more than 13% of cases);
  • about a third of their patients, after suffering a disease, doctors pronounce a verdict in the form of infertility;
  • there is a high probability that in the next pregnancy, the fetus is diagnosed with developmental abnormalities, and childbirth will be difficult;
  • the risk of developing malignant tumors increases several times;
  • the development of a malignant tumor of a trophoblastic nature - chorioncarcinoma. With untimely treatment or its absence, a woman is doomed to death.

Bubble drift during pregnancy: the specifics of the definition of pathology

The clinical picture of cystic drift is very diverse and largely depends on the form of the disease and the degree of its development.

It is quite difficult to diagnose a partial cystic mole during pregnancy, since the uterus often retains its natural volumes, and due to incomplete damage to the child's place, pregnancy continues to develop. Nevertheless, there is only one outcome: in one case, the fetus dies in the womb, in the other, a still child is born.

If the bladder drift has completely covered the uterus, the correct diagnosis will be determined in time. Everything is obvious: there are no symptoms of the development of the embryo in the uterus, but the size of the organ is much higher than the norm. The body of the uterus contains cystic cysts and villi with signs of edema.

Destructive cystic drift is detected due to pronounced internal bleeding. In this case, a woman is worried about a severe headache, bloating, heaviness in the lower abdomen, dull and pulling pain that spreads to the sacrum and lumbar region. This symptomatic picture is due to the painful germination of degrading villi into the body of the uterus.

Because cystic moles are rare, doctors do not always make the right diagnosis right away. Pathology can be mistaken for spontaneous abortion, polyhydramnios and uterine fibroids accompanying pregnancy. The main distinguishing feature of cystic drift is the bubbles that are released from the vagina along with blood, as well as the rapid growth of the uterus, combined with a modified consistency.

In the case of the development of a malignant tumor of chorionic carcinoma, the vagina, lungs and brain of a woman are affected by metastases, which is externally manifested by coughing, coughing up blood, nausea, dizziness and excruciating headaches.

To confirm that a pregnant woman has cystic drift, doctors use the following diagnostic methods:

  • Ultrasound to assess the size of the uterus;
  • fetal phonocardiography to check if the fetus is showing signs of life;
  • determination of the level of hCG;
  • examination of the uterine cavity and patency of the fallopian tubes;
  • CT and MRI;
  • biochemistry of liver tests;
  • x-rays of the lungs and brain.

The patient passes the analysis for hCG regularly - according to its indicators, the tendency of the cystic drift to degenerate into a malignant tumor is judged. If the elevated level of a specific hormone is steadily elevated, this may be evidence of the formation of metastases.

Treatment of a hydatidiform mole during pregnancy

Given the versatility of modern medicine, the treatment of cystic drift can be done in several ways. With a benign nature of the cysts, the ovum is eliminated by means of an aspiration vacuum. The sparing operation does not threaten a woman's reproductive health.

Most often, with this disease, a spontaneous miscarriage occurs, along with which the skid is eliminated from the uterus. However, even in this case, vacuum aspiration is shown - for thorough cleansing of the organ cavity from fragments of pathological formation. It is not possible to expel them from the uterus without surgery. After that, the woman must donate blood for an analysis of the hCG level. Increased hormone levels indicate incomplete curettage. This means that disease-causing growths are still present in the uterus. In this case, the patient is sent for a second cleaning.

The biological material extracted during vacuum aspiration is examined for the presence of malignant cells.

For 3 - 7 days after the operation, the treatment continues: the woman is prescribed stimulants for the rapid contraction of the uterus, antibacterial drugs, it is recommended to apply cold to the lower abdomen. Immunoglobulin is prescribed to patients with Rh negative blood, especially after incomplete cystic drift during pregnancy.

The prognosis of treatment in most cases is favorable - relapses of cystic drift occur in isolated cases.

If, as a result of the pathology, a woman begins to bleed massively and the uterus is enlarged to volumes characteristic of the 20th week of pregnancy, specialists will most likely decide on a laparotomy with resection of the uterus and preservation of the ovaries.

After the operation, the second, rehabilitation, stage of therapy begins. During this period, doctors closely monitor the level of hCG in the patient's blood. If the risk of developing chorionic carcinoma is still high, the woman is recommended to undergo chemotherapy in order to prevent cancer.

Provided that the healing process is going according to plan, menstruation resumes on average 1 month after cleaning. The quantitative and qualitative characteristics of these periods are no different from the menstruation that a woman had before conception. If, within 7 - 8 weeks after elimination of the cystic drift, menstruation does not occur, you should make an appointment with a gynecologist. The reason for the absence of a menstrual cycle can be internal inflammation, infection, or hormonal imbalances. You should also seek medical help if your period is too heavy with an unpleasant odor, during which there is weakness throughout the body, dizziness and abdominal pain.

Treatment of a malignant tumor with cystic drift

When the high concentration of hCG does not decrease after surgical expulsion of the cystic drift, the patient is examined for neoplasms and metastases in the uterus. If the doctors' fears are confirmed, the treatment is continued: the woman is prescribed chemotherapy.

Diagnosis of malignant degeneration of cystic drift requires an integrated approach:

  • strict control of hCG indicators;
  • ultrasound examination of the pelvic organs with a frequency of 1 time in 10 - 14 days;
  • X-ray of the lungs.

At the stage of diagnosing the pathology, the patient is immediately prescribed hormonal contraceptives, since a new pregnancy during this period is extremely undesirable.

The doctor selects the procedure for the implementation of chemotherapy and medications based on the general indicators of the patient's health and the specifics of her disease. The choice of specialists most often falls on pharmaceuticals such as Dactinomycin or Methotrexate. The course of treatment lasts until the level of chorionic gonadotropin in the blood returns to normal and the normal monthly cycle resumes.

The following indicators contribute to a favorable prognosis for the treatment of trophoblastic neoplasms:

  • low levels of beta-hCG;
  • brain and liver without metastases;
  • the terms of the last pregnancy do not exceed 4 months.

An unfavorable prognosis of treatment is considered in the following case:

  • increased levels of beta-hCG;
  • the presence of metastases outside the uterus;
  • lack of positive dynamics after chemotherapy;
  • the appearance of a neoplasm after a normal pregnancy.

Pregnancy after cystic drift

After getting rid of the tumor, doctors recommend that the patient be registered with the ZhK for about 12-18 months. According to gynecologists, pregnancy after a cystic drift, eliminated without complications, is possible in 70% of women after a few months. Nevertheless, it is better to postpone thoughts of conception for a while, since, unfortunately, there is no guarantee that a new hormonal surge will not trigger a relapse of the pathology.

During this period, a woman should turn to protection with hormonal drugs, the selection of which is best entrusted to a competent specialist. Oral contraceptives not only protect against unnecessary pregnancy now, but also have a beneficial effect on the activity of the ovaries, balance the state of the hormonal background, which will further contribute to the birth of a healthy baby.

Ideally, pregnancy after cystic drift can only be planned 2 years after completion of therapy. If conception occurs earlier, there is a high risk of developing intrauterine fetal anomalies and difficult labor. This is especially true for women who have undergone treatment for a malignant tumor.

After the onset of pregnancy, the expectant mother should enlist the reliable support of specialists, which is expressed in the following:

  • regular medical supervision;
  • Ultrasound of the uterus 1 time in 3 months;
  • histology of the ovum or placenta (depending on how the pregnancy ends).

The likelihood of developing cystic drift with IVF

A complete cystic mole develops on the basis of a “defective” egg cell, in which there are no chromosomes, which, of course, the embryologist cannot correct. But the development of incomplete vesicular drift during IVF is excluded, since during the procedure the doctor will make sure that the female cell is fertilized with strictly one sperm. The likelihood of developing cystic drift with IVF is generally small and does not exceed the risks of natural pregnancy.

Prevention of gallbladder drift during pregnancy

Unfortunately, there are no special preventive measures, since cystic drift is not common, therefore, it is little studied by representatives of medicine. The main prevention for women who have had this disease earlier is abstinence from pregnancy for 2 years after treatment of the pathology.

Otherwise, you need to plan motherhood prudently and follow general preventive measures:

  • visit a gynecologist twice a year (even if nothing bothers you);
  • regularly donate blood for analysis in order to eliminate the risk of anemia in time;
  • consult a doctor on time and responsibly treat diseases of infectious and viral etiology;
  • do not have abortions;
  • "Be friends" with sports;
  • eat properly;
  • lead an emotionally stable lifestyle.

Bubble drift is one of the most unpredictable diseases in terms of complications. In order to detect the problem in time, a pregnant woman should register on time, take all the necessary tests on time and consult a doctor for any, even the most insignificant, ailment.

Every woman planning a desired pregnancy, with all her heart, wants a safe gestation and development of the fetus and is afraid of any deviations in this process. Unfortunately, this happens, although not so often. One of the serious diseases occurring during pregnancy is cystic drift.

This pathology is rare - less than 1% of women who are preparing to become mothers. It is associated with violations at the stage of fertilization, it can have serious consequences, it needs quick diagnosis and treatment.

What is the disease?

Vesicular drift is an irreversible change in the chorionic tissue - the temporary shell of the embryo. Attaching to the wall of the uterus, its villi mutate, begin to grow into a special tissue that resembles bunches with bubbles filled with yellowish liquid. Bubble drift can be in a certain area, it can fill the entire uterus, or even penetrate into other organs (in particular, the lungs).

The mechanism of the onset of pathology

In order to better understand and understand the nature of this disease, it is worth remembering how the embryo appears and what happens to it at the beginning of its existence.

During fertilization, the sperm is combined with the egg. The mother and father cells endow the product of their fusion with 23 chromosomes each. That is, the embryo receives 46 chromosomes, but normally it has 23. The ratio of male and female and determines what the sex of the future person will be.

The cell, which appeared as a result of fertilization, begins to actively divide and move along the fallopian tube to the uterus. There she must attach to her wall, receive nutrition, develop and grow for 9 months, gradually preparing to enter the big world.

The embryo needs nutrition, moreover, it is important for it to attach securely. Therefore, its outer shell - the chorion - is equipped with special villi, which, like the branchy roots of a tree, plunge into the mucous membrane of the uterus, attach to its blood vessels and begin to form the placenta. The remainder of the chorion is transformed - it becomes the umbilical cord and membranes.

Bubble drift is characterized by the fact that the chorionic villi begin to mutate, turning into tissue similar to vesicles. They grow, causing swelling of the surface of the uterus, and resemble clusters. Inside each bubble is a liquid that contains the pregnancy hormone hCG.

The tissue affected by the pathology increases in size. By the nature of its growth, it resembles a tumor. In the most severe cases, a malignant neoplasm does appear, and sometimes the vesicles metastasize into the vagina or up into the lungs.

Is pregnancy compatible with this pathology?

Unfortunately no. The fetus needs nourishment that the modified tissue cannot provide it. The placenta does not form, there is a lack of necessary substances, and the embryo dies. With an incomplete form of the disease, the fetus may develop for some time, but, in the end, it will still die. There were no precedents for the birth of a living child with the disease "cystic drift".

What are the causes of the pathology?

  • No female X chromosomes at all, or a doubling of the number of male Y chromosomes. That is, if normally the embryo receives 46 chromosomes - equally from the mother and father, then this disease involves 46 paternal cells or 69 in general (23 maternal and 46 paternal).
  • One of the reasons, according to the group of scientists, is estrogen deficiency, which is caused by general hormonal dysfunction. The predominance of the male hormone in the early stages of pregnancy causes various problems, including hydatidiform mole.
  • Infectious diseases, especially those transferred at the time of conception.

Signs and symptoms

Early diagnosis is usually difficult. Pathology mimics the symptoms of pregnancy, so it is sometimes detected at a serious time - from 25 to 34 weeks. Signs by which you can determine the problem and sometimes its causes, boil down to the following:

  • An enlargement of the uterus that does not correspond to the gestational age. This is one of the most important signs that characterize a complete cystic skid, in which all chromosomes are male. The expanding chorionic tissue stretches the walls of the organ, which a specialist can establish during a manual examination. However, an incomplete form of the disease may not have this symptom for a long time.
  • Signs of cystic drift are usually clearly visible during an ultrasound scan. The overgrown non-viable tissue with clusters of vesicles can be easily distinguished from the normal course of pregnancy. Ultrasound allows you to identify the nature of the pathology - partial damage to the uterus, complete or destructive (invasive), when the mutating tissue grows into the organ. In this case, we can talk about a malignant tumor formation.
  • Bleeding. This is a formidable sign in any, including normal pregnancy.
  • A distinctive feature that characterizes cystic drift is vaginal discharge with vesicles - particles of the affected tissue.
  • Toxicosis, characterized by severe vomiting, weakness and general malaise.
  • The absence of a fetus or its death. More often than not, it does not even begin to form. With a partial drift, lack of nutrition leads to the absence of signs of life of the embryo. An ultrasound specialist can determine this during the diagnosis (no heartbeat is heard, no fetus is visible), the woman herself does not feel the movements of the child.
  • The volume of the hCG hormone exceeding the norm by dozens of times, which does not decrease with the course of pregnancy.

Diagnostics

Bubble drift, the symptoms of which not every doctor can determine (since the disease is poorly understood), is diagnosed based on the results of a combination of factors. The clinical picture is often similar to other conditions. For example, an enlargement of the uterus in the early stages may indicate that a woman is carrying a multiple pregnancy, and bleeding is due to placental abruption and spontaneous miscarriage.

The surest sign by which you can determine chorionadenoma is the presence of bubbles in vaginal discharge. External examination does not reveal palpitations, the uterus is softened in places.

Ultrasound examination allows you to make a diagnosis if the following clinical picture is visible:

  • enlarged uterus;
  • there is no ovum or fetus, sometimes parts of it are visualized;
  • the presence in the uterus of a characteristic type of tissue with many bubbles;
  • 50% of pregnant women with a diagnosis of "cystic drift" have large symmetrical luteal cysts in both ovaries at the same time.

Treatment

By and large, therapy consists of expelling diseased tissue from the uterus. With an incomplete form of skidding, special preparations can be used to provoke spontaneous cleansing of the cavity. In other cases, this is a surgical intervention: vacuum aspiration and subsequent curettage, that is, cleaning the organ with a special instrument. This is necessary in order to remove the chorionic villi that are firmly attached to the walls.

The material extracted from the uterus is submitted for examination. This is necessary to exclude the likelihood of oncology.

After the operation, the woman should be monitored, regularly checking the following indicators:

  • the level of hCG in the urine;
  • indications obtained during ultrasound examination;
  • X-ray of the lungs (needed to exclude the appearance of metastases - the penetration of bubbles into the alveoli themselves).

What to do next?

Of course, this disease is a great tragedy, especially for those women who planned and wanted a child. The diagnosis scares them, the operation and long rehabilitation lead to despair. However, medicine has established three factors associated with skidding:

  • The fetus could not develop under such conditions, which means that it was initially not viable.
  • Even with the most unfavorable results of pathology studies, it is 100% cured.
  • A normal pregnancy after a cystic drift is possible.

Having passed the necessary rehabilitation, which includes control of the condition, normalization of hormonal levels and restoration of the menstrual cycle, a woman can bear and give birth to a healthy baby. This unpleasant and frightening disease is not a death sentence, and modern medicine is able to cope with it.

In gynecology, there is a special section that includes the pathology of the trophoblast - a temporary organ that initially attaches the ovum to the uterus, and subsequently transforms into the fetal part of the placental septum. It is the trophoblast that is subsequently responsible for the nutrition of the fetus and shares its body with the mother's. One of the diseases of trophoblast is cystic drift. It refers to tumor processes, as it predisposes to the development of malignant cells, which occurs in 5-20% of cases.

Pathology is mainly detected in young women (23-25 ​​years old) and in pregnant women after 37 years old and should be differentiated from other trophoblast diseases, which often become its complication:

  • choriocarcinoma;
  • swelling of the placenta bed;
  • epithelioid tumor of the trophoblast.

Bubble drift is a rare disease (up to 0.02-0.7% among pregnant women), it arises from the tissues involved in the formation of the membranes and, if untreated, can grow deeply into the tissues of the uterus. The characteristic features of cystic drift are severe swelling of the stroma, proliferation of chorionic villi, and the formation of vesicles in the form of bunches of grapes.

Inside the bubbles, reaching 2-3 cm, there is a liquid medium. It includes chorionic gonadotropin (hCG), proteins and other compounds. Vesicles are rarely supplied with blood, only occasionally small single capillaries are present on them. A large amount of the hormone hCG causes the appearance of cysts on the ovaries, as well as other disorders in the body. Thus, with a cystic drift, instead of the normal development of the embryo, there is a bubble-like proliferation of chorionic villi occupying the entire uterine cavity. The embryo itself most often dies immediately.

Bubble drift: classification

There are such types of pathology:

  1. complete blistering skid;
  2. incomplete cystic drift (partial).

Complete cystic drift is a disease in which there are no embryonic tissues at all, that is, the regeneration of the chorionic villi covers their entire area. As a rule, this type of disease is found at 11-25 weeks of gestation.

Partial cystic drift is manifested by the same clinical signs, but there are separate elements of the ovum with it. Pathological changes affect only part of the chorionic villi. Partial cystic motility is usually diagnosed 9-34 weeks after conception, that is, at almost any gestational age.

According to the degree of invasion, the disease can be:

  1. Simple hydatidiform mole. Chorionic villi are large, edematous, located inside the uterine cavity.
  2. Proliferating cystic drift (destructive). In this case, chorionic villi grow deep into the muscular layer of the uterus, destroying its tissues. This type of illness often leads to life-threatening bleeding.

Why does cystic drift occur?

The causes of cystic drift lie in anomalies in the development of the embryo. In the study of a partial vesicular mole, it was found that its set contains a maternal and two paternal chromosomes. Thus, the egg is fertilized by 2 sperm at once, as a result of which extra chromosomes are present in the embryo, and it itself is not viable. This type of pathology degenerates into cancer in 5% of cases.

The causes of complete gallbladder drift consist in the fertilization of a defective female reproductive cell, in which there is no set of chromosomes. As the embryo develops, the father's chromosomes double, but instead of the development of the ovum, a bubble-like transformation of chorionic villi is observed. When diagnosed, two X chromosomes are found, which are paternal. Occasionally, paternal chromosomes form the 46XY karyotype (no more than 13% of cases). Malignant transformation of the disease is diagnosed much more often (up to 20% of pathologies).

Sometimes cystic drift is a consequence of an ectopic (tubal) pregnancy, so it is localized in the fallopian tube.

Clinical presentation: how to identify a hydatidiform mole

Symptoms of cystic drift at the initial stage practically do not appear, therefore, the course of pregnancy is normal and with the development of the disease may not differ. Subsequently, signs of cystic drift make themselves felt against the background of excess production of hCG in the form of severe morning nausea, vomiting. Partial cystic drift has less pronounced symptoms, complete, and especially invasive, already from 5-7 weeks can give a vivid clinical picture:

  • Discharge of blood (in almost 100% of cases), which occurs due to the exfoliation of the child's place from the shell (the blood is dark, includes small separated bubbles). Sometimes the blood flows profusely, which causes a sharp decrease in hemoglobin.
  • Inadequate growth of the uterus. Due to the fact that the bubbles of the chorionic villi grow very quickly, the size of the uterus becomes larger much faster than during a normal pregnancy.
  • Toxicosis with indomitable vomiting, salivation, electrolyte imbalance (this occurs with the participation of the hCG hormone).
  • Symptoms of severe preeclampsia, including preeclampsia, eclampsia, liver failure with edema, proteinuria, increased blood pressure. A characteristic feature of cystic drift is the appearance of signs of preeclampsia from the 1st trimester.
  • Increase in thyroid-stimulating hormone to the level of hyperthyroidism. More often this symptom is observed with a complete cystic drift. Usually, pathology occurs if the level of hCG is significantly increased in a pregnant woman.
  • Luteal cysts on the ovaries. Against the background of a high level of hCG, half of the patients develop large cysts (up to 15 cm), since the hormone continuously stimulates the ovaries. After removal of the skid, hCG normalizes, and the cysts spontaneously dissolve. Due to the presence of large cysts, a woman can be tormented by pain, pressure, and distention inside the abdomen.

If a cystic drift grows into the myometrium of the uterus, there are sharp, cutting pains. Since after the malignant transformation of the skid, metastasis occurs quite quickly, even during pregnancy, a woman may begin to worry about hemoptysis (with metastases to the lungs), headaches, visual impairments (with metastases to the brain).

Possible complications of cystic drift

If the pathology is invasive, its complication can be perforation of the uterine wall and massive hemorrhage into the peritoneum. As a result of severe eclampsia, embolism of the branch of the pulmonary artery with respiratory failure, pulmonary edema is possible. Sometimes cystic drift is complicated by vascular thrombosis, intrauterine infections, and even after removal can cause infertility.

Serious consequences of gallbladder drift are the development of choriocarcinoma, a malignant gestational trophoblastic tumor. This tumor quickly metastases to the vagina, vulva, as well as to distant organs (brain, lungs, liver, kidneys). Without surgery and chemotherapy, this type of cancer can be fatal.

Diagnostics of the cystic drift

Usually, with the development of the disease, the fetus dies in the first weeks of pregnancy, and therefore the heartbeat and other signs of normal gestation are not determined by ultrasound. But due to the production of the hCG hormone by the cystic drip, the pregnancy test always gives a positive result. Without a medical examination, pathology can be suspected by the presence of bleeding, lack of motor activity of the child according to the timing.

Methods for diagnosing cystic drift include:

  1. Ultrasound. Usually, instead of a normal embryo, a variegated picture is revealed due to the presence of drift bubbles. In addition, cysts on the ovaries can be found in some women.
  2. Blood test for hCG. The level of the hormone exceeds that characteristic of a particular gestational age. Additionally, after removal of the drift, an analysis is carried out for hCG once a week for 8 weeks, then once a month for another 6 months.
  3. Gynecological examination. The doctor can see the swelling through the internal os of the cervix.
  4. Histological examination of tissues. It is carried out after the treatment has been performed. Bubble drift necessitates the referral of a woman to the oncology department of the hospital after receiving the results of histology.
  5. X-ray of the lungs, brain. It will be required if you suspect metastases.

If, even after the treatment, the hCG indicators do not normalize, a more thorough examination should be carried out with the involvement of narrow specialists. This fact may mean that the tumor cells have spread to other areas of the body.

How is cystic drift treated?

Now the disease is treated with surgery, supplementing it with chemotherapy if necessary. In parallel, new tests are being carried out, which are aimed at improving the existing methods. Most often, in the absence of cancerous tissues in the cystic drift, curettage is performed by step-by-step curettage. The tissues of the uterus are stretched, after which drugs are injected to reduce its walls (pituitrin, oxytocin) and the entire contents of the organ are evacuated. Then the walls of the uterus are scraped out so that there are no drift particles left. After the surgical treatment of cystic drift is completed, chemotherapy is prescribed (if necessary). It aims to destroy individual cancer cells that are not visible to a specialist during surgery.

In some cases, complete removal of the uterus (hysteoctomy) will be required. This is necessary if a malignant tumor is already developing against the background of a cystic drift. The ovaries are usually preserved. Extirpation of the uterus (its removal without the cervix, ovaries and tubes) can be urgently done in the presence of life-threatening bleeding.

If the patient wants to have children in the future, chemotherapy is first performed (Methotrexate, Leurovorin, Dactinomycin are used in combination more often), and only if this method did not help completely eliminate the tumor, the uterus is removed. If there are metastases, a decision may be made to apply radiation therapy to the immediate area of ​​cancer. As mentioned above, after treatment, a weekly (later monthly) diagnosis of hCG in the blood, as well as regular ultrasound examinations, are required. A woman is on dispensary observation for at least 2 years, and during this period she takes hormonal contraceptives.

Is pregnancy possible after removal of the cystic skid?

If the diagnosis of the disease was timely, and the treatment was adequate, this will help preserve the woman's fertility in the future. If chemotherapy is not required, then the hCG hormone will normally disappear from the blood in 5-6 months. After treatment with chemotherapy, the doctor will recommend not planning conception for 1-2 years, since pregnancy after cystic drift, which occurred earlier, will not allow assessing the severity of the situation. The fact is that the chorionic gonadotropin increases in pregnant women, and it will be unclear whether such an increase was caused by a recurrence of cystic drift (this happens in 2% of cases).

Fortunately, if the organs of the reproductive system were not removed, the transferred disease does not affect conception in the future. More than 70% of women, after elimination of the pathology, can have children. To further exclude such problems, a woman is advised to carefully plan a pregnancy, as well as be monitored by ultrasound from the first weeks of gestation and assess the level of hCG. Usually, pregnancy proceeds normally, but there is evidence of a slightly more frequent weakness of labor, bleeding during childbirth in women who have previously undergone trophoblast pathology.

Recovery prognosis

Timely use of surgery and chemotherapy in combination can heal up to 100% of women, and 90% of them have a restoration of the menstrual cycle. Even in the presence of pathological foci in distant organs, they are completely destroyed, but after that connective tissue cords and scars remain.

Invasive types of drift have a more serious prognosis, as well as the development of choriocarcinoma, or tumor recurrence in other organs after treatment. Re-emergence of a tumor, or resistant trophoblastic disease, is diagnosed in 15% of cases after a complete skid. Such an outcome of events will require additional chemotherapy courses until complete recovery (sometimes they last several months). In the presence of choriocarcinoma metastases, the prognosis is favorable in 70% of cases.

How to prevent the development of cystic drift

Surely it is almost impossible to prevent the development of pathology, but measures that contribute to the normal course of pregnancy and the development of the baby can be giving up bad habits, avoiding abortions, planning pregnancy together with an obstetrician-gynecologist after passing all the necessary tests, early registration.

Bubble drift is the pathology of the ovum, as a result of which the chorionic villi degenerate into vesicles with liquid, the epithelium and syncytium grows. The disease does not differ in frequency - it is estimated in one case in 1000 pregnancies. Medical practice knows cases of cystic drift that are not associated with pregnancy, when a chorion is formed in the uterus, and chorionic gonadotropin is contained in the blood.

Distinguish between complete and incomplete cystic drift, the mechanisms of development of which have some differences:

  • complete cystic drift is characterized by the absolute absence of embryonic tissue, which occurs due to the fertilization of a defective egg, for example, one that does not have chromosomes; even a further doubling of the paternal chromosomes leaves such a zygote unviable - the embryo does not arise, but only the chorionic villi grow; usually develops in the first trimester of pregnancy;
  • incomplete cystic drift is a consequence of the fertilization of the egg with two sperm, which again provokes a violation of the chromosomal set, and such a zygote is extremely rarely viable and full-term pregnancy is a huge rarity; usually develops in the last trimester of pregnancy, the fetus dies if more than a third of the placenta is damaged, and childbirth threatens to be premature.

An expanding cystic drift produces an excessive amount of chorionic gonadotropin, which does not correspond to the gestational age, and if this occurs outside of pregnancy, it is considered a pathology in itself. An excess of hCG causes the formation of luteal cysts in the ovaries, and in some cases, the skid develops into chorionepithelioma (a malignant tumor prone to penetration into healthy tissues and to rapid metastasis).

Causes of cystic drift are called the following:

  • fertilization of an egg with two spermatozoa, it is not possible to predict that;
  • fertilization of a nuclear-free cell, as a result of which the zygote develops abnormally - it does not contain maternal chromosomes;
  • damage to the trophoblast (merged egg and sperm) by malignant cells as a consequence of trophoblastic disease; it originates in the womb.

Scientists still have not succeeded in explaining and reducing the risks of unwanted pathology of the fusion of the egg and sperm.

The risk group includes women of mature age (over 40 years old) or young girls (up to 20 years old). Some experts observe a relationship between the likelihood of cystic drift and the number of pregnancies - so it is argued that cystic drift is less likely in the first pregnancy. Bladder drift is diagnosed even in childhood, but this is rare, and a third of cases occur in the premenopausal period.

Cystic Skid Symptoms very specific. The development of the disease cannot go unnoticed. The manifestations of cystic drift extend to the entire body and are represented, in particular, by such ailments and disorders:

  • uterine bleeding leading to anemia;
  • indomitable vomiting, entailing the need for parenteral administration of fluids, electrolytes and antiemetics;
  • arterial hypertension;
  • moisture and hyperemia of the skin;
  • sometimes an increase in the thyroid gland and the development of thyrotoxicosis;
  • sometimes tachycardia and tremor due to thyrotoxicosis;
  • rarely pulmonary embolism by trophoblast cells, which means shortness of breath, cyanosis, cough.

A blistering mole will be suspected by the doctor examining the woman if

  • a woman complains of frequent toxicosis, anemia,
  • the size of her uterus exceeds the appropriate time frame
  • there are no reliable signs of pregnancy, such as heart sounds and movements of the fetus, its part.

Bladder motility is considered a disease prone to frequent relapses. Recurrence of the disease means the recurrence of the tumor after the treatment. The malignant process sometimes reappears in the pancreas or in any other organs and tissues.

How to treat a hydatidiform mole?

Vesicle motility, if this diagnosis is confirmed, is considered an indication for immediate hospitalization. A woman is advised to immediately eliminate it due to the fact that delay is dangerous with bleeding, thyrotoxicosis and arterial hypertension. Removal of cystic skid is possible by two of the most popular methods:

  • if there are plans to become pregnant in the future, vacuum aspiration is prescribed - it is carried out under general anesthesia, using oxytocin in combination with glucose; artificially with the use of kelp sticks, the cervix of the uterus expands, further scraping is performed with a sharp curette; both seized biometrics are sent separately for histological examination;
  • in the absence of plans for future motherhood, the woman will be offered uterine extrusion, which is certainly radical, but excludes any risks of further relapse.

Before surgery, a woman is analyzed to determine the Rh factor and with negative indicators during treatment of cystic drift the administration of anti-Rh0 (D) -immunoglobulin to a woman is strongly recommended.

Often, chemotherapy and radiotherapy are used as additional methods of treating cystic drift. This is prescribed in the postoperative period if the histological examination of the seized material has given reason to believe the presence of malignant processes. Chemotherapy in this case is represented by pill forms of drugs, and radiotherapy has either external (using a special apparatus located outside) or internal (using radioisotopes delivered locally through thin plastic tubes).

The prognosis for such a pathology is often favorable, especially when the treatment was performed efficiently and in a timely manner. The likelihood of new pregnancies with a normal course is highly assessed.

What diseases can it be associated with

Bubble drift is considered one of the consequences. Trophoblast disease, or gestational trophoblastic tumor, is a rare malignant disease that occurs in women in which tumor cells invade the tissues that form the trophoblast (the result of the fusion of the egg and sperm). Its second manifestation and degeneration of skidding is, however, it is also directly related to skidding, because it is its malignant transformation. Chorionic carcinoma is a malignant tumor prone to invasion into healthy tissues and rapid metastasis.

Bubble drift is manifested by the following dysfunctional disorders:

Treatment of bladder skid at home

Treatment of bladder skid at home it is not carried out due to the fact that the condition is critical and requires urgent hospitalization. It is in the conditions of hospitalization that it is possible to remove the vesicular drift by means of surgical intervention. Even in the postoperative period, the patient is recommended to be regularly monitored by a specialized specialist for a timely response to a recurrent manifestation of the disease.

What drugs are used to treat cystic drift?

The drugs used for bladder drift are predominantly chemotherapy drugs. The latter is realized either using one medication, or a combination of them:

  • monochemotherapy in 5-day cycles at 5-7-day intervals, up to a total of 8 cycles:
    • - 75 mg per day,
    • - 1500 mcg per day,
    • - 1.0 g per day,
    • - 50 mg per day;
  • polychemotherapy is usually a five-component combination of EMA-CO Recommended for high risk of antineoplastic resistance.

Treatment of cystic drift with alternative methods

The elimination of cystic drift with folk remedies is fraught with serious complications. In no case should folk drugs be used as the main method, if there is confidence in such drugs, then their use should be agreed with the attending physician and be only an addition in the postoperative period or at the stage of chemotherapy / radiotherapy.

Treatment for bladder moles during pregnancy

Cystic motility during pregnancy is considered an extremely undesirable condition, and dangerous to the health of the mother, and lethal to the fetus. If a pregnant woman has a pathological transformation of the ovum and the degeneration of the chorionic villi, if this is proven during examinations, then the only way to save life and restore health (including for subsequent pregnancies) is to remove the cystic drift, which, of course, excludes the possibility of continuing pregnancy.

Removal of cystic motility in early pregnancy occurs by the same methods as in non-pregnant women. That is, vacuum aspiration and scraping, curettage are used. If the size of the uterus differs in size, then a small cesarean section is used. A minor cesarean section is a method of artificial termination of pregnancy at a later date (more than 13 weeks), prescribed for medical reasons.

Which doctors should I contact if you have a cystic drift?

Bubble drift, being a manifestation of trophoblastic disease, in the process of its diagnosis requires the doctor's confidence in the details of the development of trophoblastic pathology. Trophoblast disease in the early stages and before pregnancy is difficult to detect, and therefore even pregnancy in the early stages develops normally. Towards the middle of pregnancy, atypical bleeding and indomitable vomiting develop, later the child does not give movement. This becomes the reason for a detailed diagnosis for trophoblastic disease and cystic drift.

An unconditional sign of a cystic drift for a gynecologist observing a woman is the release of cystic chorionic villi from the uterus. If there are none, then the methods of detailed diagnostics are used, these are:

  • ultrasound is prescribed if there is a homogeneous fine-grained mass in the uterus;
  • urine analysis for indicators of chorionic gonadotropin - suspicions of pathology are removed when hCG is not more than 500,000 IU / L in daily excretion for a period later than 12 weeks; however, the conclusion cannot be considered the only correct one, it is rather indicative;
  • analysis of blood serum for the content of the cG beta subunit - suspicions of pathology are finally removed when the cG beta subunits are not more than 100 IU / L at 12-14 weeks of gestation.

Trophoblastic disease and cystic drift as its consequence in rare cases, however, it is diagnosed in women who are not in position. Those with characteristic complaints are sent for a vaginal examination, where the doctor, by palpation of the abdomen, reveals swelling and neoplasms in the uterus, the same is possible through ultrasound. The presence of chorionic gonadotropin in the blood, which is detected by analysis, outside the period of pregnancy is taken as a pathology and a sure sign of trophoblast disease.

Histological examination of the biomaterial extracted from the uterus as part of the treatment finally confirms or refutes the diagnosis, and the patient will be recommended to be monitored in a specialized oncological institution. In the absence of threatening signs of relapse within the next two months (based on a weekly blood test and ultrasound examination of the pelvic organs), for another three months (based on similar examinations every two weeks) and during the next six months with a monthly examination are indicators of recovery ... The optimal period for the onset of the desired pregnancy is a year after the evacuation of the cystic drift.

Treatment of other diseases with the letter - p

Pancreatitis treatment
Treatment of pancreatic necrosis
Treatment of papilloma of the trachea
Parametritis treatment
Treatment of paraneoplasias
Treatment of paranephritis
Head lice treatment
Pelvioperitonitis treatment
Testicular torsion treatment
Patella fracture treatment
Shoulder periarthritis treatment
Pericarditis treatment
Hepatic coma treatment

Among the complications of early pregnancy, hydatidiform mole is rare. According to statistics, violation occurs in 0.001% of cases. A feature of the pathology is a vivid symptomatology, knowing which, a woman can consult a doctor in a timely manner.

Bubble drift - what is it?

Having heard a disappointing conclusion from a doctor, a woman is trying to find out on her own what a cystic drift is, how dangerous this violation is. This pathology in obstetrics is customary to denote a disease of the ovum, in which the chorionic villi degenerate into small bubbles with liquid. The process is accompanied by the proliferation of epithelial tissue. Pathology can be diagnosed by conducting an ultrasound examination and by characteristic symptoms.

The pathological process can have varying degrees of prevalence, therefore, to facilitate diagnosis and the correct prescription of therapy, doctors use the classification of cystic drift. So, it is customary to distinguish the following types of pathology:

  • incomplete;
  • full;
  • simple;
  • proliferating drift.

Incomplete bladder skid

Partial hydatidiform mole is inherently a triploid disorder. With its development, using microscopic analysis, doctors can detect 1 maternal chromosome and 2 paternal ones. This happens when an egg is fertilized by 2 sperm at the same time. With the further development of pregnancy, areas of the normal placenta and embryonic tissue can be found in the uterus. In this case, the embryo itself is often strongly deformed and unviable.

Incomplete hydatidiform mole has a variable development time. Pathology is more often diagnosed at 9–34 weeks of gestation. Clinically, it can manifest itself as a discrepancy between the size of the genital organ and the current gestational age. To accurately determine the disease, an ultrasound scan is prescribed, on which it is possible to identify all the changes that occur to the embryo at this time.

Full bladder skid

Complete cystic drift in the early stages is a simultaneous defeat of the entire volume of the villous structures of the chorion. With this type of violation, signs of embryo development are completely absent, and on the ultrasound monitor screen, the doctor visualizes numerous bubbles along with edematous chorionic villi. According to the observations of doctors, pathology undergoes degeneration into a malignant disorder in 20% of cases. As in the case of a partial cystic drift, a complete one does not respond to treatment and requires subsequent cleaning of the uterine cavity.

Simple bladder skid

A simple cystic drift is a pathology in which the edema of the chorionic villi is so pronounced that they merge into a single whole. Microscopic examination reveals large chorionic villi. Often they are edematous, located directly inside the uterine cavity. In terms of its external features, a simple skid is very similar to a complete one, therefore, doctors often identify these two terms.

Proliferating hydatidiform mole

This invasive cystic drift is profoundly disturbed. With its development, there is an increase in the depths of the uterine myometrium. As a result, a destructive process begins, requiring medical attention. This form of pathology is accompanied by frequent bleeding, which can threaten the life of a pregnant woman. If pathology is detected at a late stage, the only way of therapy is to remove the uterus.

Bubble drift - causes

The reasons for the development of pathology are different and depend on the type of violation. So, a complete cystic drift during pregnancy develops with homogeneous disomy - the embryo does not receive the maternal set of genes, and from the father he gets two at once. In some cases, this cystic drift can be caused by the fertilization of a nuclear-free egg with two sperm at the same time. As a result, the fetus dies early in its development.

Incomplete drift develops when the egg is fertilized with two sperm, while the set of maternal chromosomes is delayed. As a result, at one of the stages of division, the embryo receives one set of maternal genes and a double set of paternal genes. After a short time, the death of the embryo occurs. Among the factors contributing to the development of the considered disorders, doctors call:

  • the age of the expectant mother is less than 20 and more than 35 years old;
  • a history of cystic drift;
  • early miscarriage in the past;
  • severe deficiency in the diet of vitamin A.

Bubble drift - symptoms

In the process of gestation, pathology can be assumed by the presence of characteristic symptoms. One of the first signs doctors call the discharge from the genital tract of liquid dark blood, which contains rejected vesicles. Discharge with cystic drift is always abundant, long-term, which can lead to the development of anemia, taking on a character that threatens the health and life of a pregnant woman.

In the invasive form of the disease, vesicles grow into the thickness of the myometrium, resulting in a risk of uterine perforation and intra-abdominal bleeding. There are other manifestations by which you can determine the cystic drift - the symptoms in the early stages of this disorder are as follows:

1. Pronounced manifestations of toxicosis:

  • nausea;
  • excessive vomiting;
  • salivation;
  • exhaustion.

2. Increasing liver failure.

3. Lack of reliable signs of the gestation process:

  • the baby's heart sounds are not audible during ultrasound;
  • in the ovum, parts of the body of the embryo are not found.

Diagnostics of the cystic drift

The diagnosis of "gallbladder drift" is made based on the results of the studies. Initially, the doctor examines the woman in the gynecological chair. During its implementation, the gynecologist determines the densely elastic consistency of the uterus, in which there are areas of excessive softening. At the same time, the dimensions of the organ themselves in practice exceed those that should be in time.

After an examination in a chair, if there is a suspicion of pathology, the doctor prescribes instrumental diagnostic methods:

  • analysis in circulating blood;

When diagnosing, a pathology such as cystic drift is differentiated with phenomena similar in clinical manifestations:

  • multiple pregnancies;
  • pregnancy in the background;
  • spontaneous abortion.

In order to completely exclude metastatic screenings of the cystic drift, doctors may prescribe additional examinations:

  • chest x-ray;
  • examination of the abdominal cavity;
  • MRI of the brain.

Bubble drip - hCG

The level of hCG with cystic drift is one of the indicators of a violation. With this pathology, there is a sharp increase in the concentration of the hormone in the bloodstream. On average, it exceeds 10,000 mmU / ml. The simultaneous increase in the size of the genital organ, which does not correspond to the period, prompts gynecologists to think that, perhaps, this is a sign of cystic drift (cystic drift).

Bubble drift - ultrasound

Bubble drift on ultrasound can be determined already in the early stages of pathology. To confirm their assumptions, doctors carry out it immediately after receiving the result of the analysis for hCG. Among the obvious manifestations of the violation, doctors note the following signs of cystic drift, observed on the ultrasound monitor screen:

  • an enlarged uterus in the absence of a fetus in it;
  • homogeneous small cystic tissue (a symptom of a "blizzard");
  • the presence of tecalutein cysts in the ovaries, the diameter of which is more than 6 cm.

Bubble drift - treatment

Treatment of cystic drift is aimed at preventing possible complications and saving a woman's life. Pregnancy with such a violation requires an urgent termination. In some cases, the body independently cleans the uterine cavity from the presence of a large number of bubbles, which come out together with bloody discharge. If this does not happen, a surgical operation is prescribed.

It is performed under general anesthesia. Whenever possible, doctors choose the laparoscopic method. For complete cleansing of the uterine cavity from the existing embryonic membranes, scraping with a curette is used. Often, to eliminate the presence of residual material, doctors use vacuum aspiration. In this way, complications are prevented.

Removal of cystic skid

A vesicular mole in the uterus can be removed in several ways. The choice of the type of surgical intervention is determined by the type of disorder, its stage, and the severity of the pathological process. For treatment, doctors use the following techniques:

  1. Dilation and curettage. It involves preliminary stretching of the cervix to provide full access to the uterine cavity and remove all contents of the genital organ. This method is used for a partial form of violation.
  2. Hysterectomy - complete removal of the uterus with all its contents. This method is resorted to with complete drift, expressed by the germination of chorionic villi into the deep layers of the organ. The ovaries cannot be removed during this operation.

Bubble drift - treatment after curettage

In order not to cause complications that can provoke a cystic drift, after cleaning the uterine cavity, a dynamic observation is established for the woman. A few days after the operation, an analysis for hCG is prescribed, which is carried out twice, with an interval of 7 days. The result of therapy is satisfactory if 2 negative analytical conclusions are obtained. Also, a woman is prescribed a physical examination of the pelvic organs, which is carried out every 2 weeks for 3 months.

Bubble drift - consequences

The consequences of cystic drift can negatively affect the state of the female reproductive system and health in general. A threatening complication of this disorder is the formation of chorionepithelioma (chorioncarcinoma) - a malignant form of trophoblast disease. It is characterized by invasive germination of the uterus, numerous metastases of areas of the affected tissue in the lungs, liver, and brain. Often, pathology is fatal.

Among other consequences of cystic drift, it is necessary to highlight:

  • intrauterine infections;
  • metrothrombophlebitis;
  • thrombosis;
  • amenorrhea;

Pregnancy after cystic drift

The chances of recurrence are not affected in any way by the transferred cystic drift, and pregnancy after the violation is possible. The exception is those cases when the uterus is removed with strong destructive changes. Doctors advise not to start planning your next pregnancy immediately after a skid. The recovery period lasts at least six months. During this period, hormonal drugs may be prescribed. It is better to use barrier methods (condoms).