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Symptoms, causes, treatment of partial and complete cystic drift during pregnancy: what is it and what does it look like? Bubble drift: what is it

Bubble drift- This is a rare pathology of pregnancy associated with the defective function of fertilization of the egg, incompatible with the development of pregnancy and the birth of a live fetus.

The result of the pathological process with cystic drift is the formation of an unusual tissue in the uterus instead of the normal placenta, consisting of aciniform clusters of vesicles filled with liquid. Chorionic villi are the source of such transformation. If the abnormal growth fills the entire uterine cavity, the cystic mole is classified as complete (classic). Partial cystic drift is localized only in a certain area of ​​the fetal membrane.

Sometimes there is another name for the cystic drift - chorionadenoma.

There is reliable data on the possible malignant transformation of any form of cystic drift. The malignant, and most severe, form of the disease is called a destructive cystic drift.

To understand the pathogenesis of pathology, it is necessary to recall the events following fertilization. Recall that two sex cells - an egg and a sperm - merge into one. Moreover, each of the "parental" cells endows the future embryo with chromosomes - female (X) and male (Y), 23 chromosomes from each. Of the 46 chromosomes belonging to the parents, the fertilized egg inherits only 23, and the male / female ratio determines the gender of the fetus.

A few hours after fertilization, the egg begins to divide, turning into a multicellular structure, which gradually moves towards the uterine cavity along the fallopian tube. After five days, the beginning of a new life reaches the uterus and is implanted (implanted) into its mucous layer.

Since the embryo has to constantly develop and grow, its outer shell must be firmly fixed at the implantation site. For this purpose, the outer embryonic membrane (chorion) at the point of attachment of the embryo to the uterine wall (the future placental site) forms peculiar outgrowths - branched villi, which, like the roots of a tree, sink deeply into the mucous membrane and connect to the blood vessels of the uterus, subsequently these villi will become a source the formation of the placenta. The remaining cells of the outer shell of the embryo are transformed into the umbilical cord and fetal membranes.

With cystic drift, the villi surrounding the fertilized egg do not form the placenta, but are reborn into a completely non-viable structure - an unusual, bubble-like tissue. The stroma around the villi swells, they grow with the formation of bubble-like extensions (cysts). When combined, these extensions become like bunches of grapes. Each cyst is filled with an iridescent yellowish liquid that secretes hCG chorionic gonadotropin (pregnancy hormone), therefore, hCG numbers for cystic drift have an important diagnostic meaning.

The embryo, which requires oxygen and nutrition for development, receives what it needs from the placenta during normal pregnancy, and in the case of cystic drift, there is simply no such source, therefore, inevitable degradation and death of germ cells occurs.

The degenerated tissue is not limited to the place of its primary formation, it begins to grow, and the area of ​​the lesion increases. This behavior of the tissues of the cystic drift makes it possible to compare it with a tumor.

The causes of cystic drift remain unclear, but reliable studies have established a connection between the development of pathology and the process of fertilization, when during the fusion of germ cells, the loss of maternal chromosomes and duplication of male chromosomes occur.

The clinical symptoms of cystic drift are ambiguous and depend on the behavior of the expanding chorion and the gestational age. More often, uterine pains, bloody leucorrhoea and a discrepancy between the size of the pregnant uterus and the established date are noted. Motor activity (movement) of the fetus, of course, is not observed.

The presence of a cystic drift is well visualized during an ultrasound scan, since the modified tissue has characteristic features. No signs of the presence of an embryo in the uterine cavity are detected during scanning. The final diagnosis is carried out after the evacuation of the cystic drift and the study of the resulting tissues in the histological laboratory.

Unfortunately, in the treatment of cystic drift, the preservation of pregnancy is not provided, because the nonviability of the fetus in conditions of complete isolation from the elements necessary for development is beyond doubt.

Removal of the cystic mole is the only treatment. The unpredictable behavior of the growing unusual tissue requires its complete elimination, therefore, exclusively surgical techniques are used. The uniqueness of this ailment lies in the fact that, with its aggressiveness, the process can be completely eliminated if it is detected correctly and in a timely manner, without any consequences.

Pregnancy after a cystic drift is possible, but it is necessary to first be examined in order to prevent a repetition of the sad scenario. A clear pattern of recurrences of cystic drift has not been established, so the subsequent one can proceed and end properly.

The incidence of gallbladder drift is very small (less than 1%), but sometimes it appears in the conclusions of ultrasound diagnostics specialists, which is very frightening for patients. Meanwhile, not a single conclusion of a functionalist is a diagnosis, because for a correct diagnosis it is necessary to carry out several measures that will unequivocally indicate a certain pathology. Sometimes a cystic mole (especially a partial one) is simulated by other, less dangerous, pathologies that look very similar on the monitor, and the specialist writes a presumed, not a final diagnosis of a cystic mole, which, fortunately, is often not confirmed.

What is a bubble skid

Vesiculate motility is the result of chromosomal abnormalities. It belongs to a special group of pathologies, united by the term "trophoblastic disease", which includes several conditions associated with abnormalities of the trophoblast (the outermost shell of the embryo).

Trophoblastic diseases are always either tumors or conditions close to them in structure and behavior, which in the end, in most cases, provoke a tumor process. They are unique and very rare, as they have a unique path of development - they appear from the products of conception, that is, they are diagnosed only in pregnant women.

As a result of physiological fertilization, the egg has 46 chromosomes - 23 female and 23 male. Bladder drift can develop in full, when a fertilized egg is completely devoid of maternal, female, genes, and instead of them there are duplicated genes of the father, male in the amount of 46. It can also be caused by an egg without a nucleus fertilized simultaneously by two spermatozoa. Since the chromosomes of any cell are located in its nucleus, a nuclear-free egg does not contain them, and a double set of male chromosomes is provided by two spermatozoa.

Full bladder skid does not imply the development of the embryo, only a significant proliferation of villi occurs.

Partial hydatidiform mole is formed in a different way: the egg has the necessary nucleus with female chromosomes (there are 23 of them), but the double set of male chromosomes (46) is present in the sperm fertilizing it. As a result, 96 (46 + 23) chromosomes are present in the egg, and the fetus, nevertheless, begins to develop, but has multiple malformations due to the large number of additional chromosomes, so it is also not viable.

The tissues of the cystic drift behave like a malignant tumor - they not only grow significantly, grow through the uterine wall, but can also "spread" (metastasize) from the uterine cavity into the lungs. The degenerated trophoblast secretes chorionic gonadotropin, and since the tissue increases its volume excessively, the concentration of the hormone becomes excessive.

There are hypotheses about the influence of infectious processes on the regeneration of chorionic villi, and viral infections are also called especially dangerous in this regard.

One cannot reject the arguments of another popular theory of the origin of cystic drift, which links incorrect fertilization with hormonal dysfunction. As you know, for the full development of the egg, a sufficient amount of estrogens is required, they provide the processes of folliculogenesis and subsequent ovulation. In conditions of estrogen deficiency, according to some experts, the egg cell can grow defective.

In re-pregnant women, as well as women who have undergone abortions, the chance of developing a hydatidiform mole increases threefold.

Symptoms and signs of gallbladder drift

Bubble drift is classified as complete or partial. A more rare invasive (destructive) form is distinguished separately.

The main criterion is the degree of degeneration of the chorionic villi: if the zone of their pathological transformation covers the entire chorion, the drift is considered complete, and if the chorion is not completely modified, it is partial. Regardless of the form of cystic drift, the fetus dies, and the pathological process continues. The altered structures of the chorion grow quickly enough, so the uterus also becomes larger. It is the discrepancy between its size and the expected gestational age that suggests the dysfunctional development of pregnancy.

The timing of the formation of cystic drift is very variable: early cystic drift can be detected as early as the 9th week of pregnancy, and sometimes it is detected only by the 34th week.

The clinical picture of cystic drift is the more pronounced, the larger its area, therefore, with different forms, although it has similar symptoms, it is somewhat different.

1. Partial cystic drift - symptoms in the early stages.

Partial cystic drifts, as already mentioned, do not affect the entire chorion. In the chromosome set with this form, there are both male (Y) and female (X) chromosomes, but their number and ratio do not correspond to the norm: a single female chromosome accounts for twice the number of male chromosomes. The hypertrophied tissue of the expanding chorion contains fragments of an unchanged embryo and placenta, chorionic villi in a state of pronounced edema.

At the initial stages, cystic drift mimics the symptoms of pregnancy, so it is difficult to diagnose it without additional examination.

Since the cystic drift does not cover the entire uterine cavity, the growth of the modified tissue occurs more slowly, the uterus remains normal for the gestational age or is slightly smaller. Therefore, at the beginning of the development of pathology, its symptoms may not be obvious, however, suspicious changes can be detected during an ultrasound scan.

Incomplete cystic drift does not exclude the development of pregnancy, since the pathological process starts after the third month of gestation and affects only part of the placenta. The fetus can die if the placenta is affected by more than a third.

2. Complete cystic drift - symptoms in the early stages.

It is diagnosed at the 11th - 25th week of gestation. All available chromomsomes are exclusively male. Signs of development of the embryo and embryo are completely absent, the uterus is filled with modified edematous villi and vesicles. With this form, the vesicular drift grows rapidly, so the uterus becomes large in the early stages.

3. A destructive form of cystic drift. It is even rarer than its other two forms. It is characterized by aggressive germination of villi to the entire depth of the uterine wall, followed by destruction of the surrounding myometrium tissues. Differs in pronounced internal bleeding.

Invasive cystic drift is essentially similar to a tumor process. The features of invasive cystic drift are:

- the tumor is usually local, with invasive (inward) growth;

- infrequently (20-40%) metastases to the nearby vagina and vulva, less often metastases are "sent" to the lungs;

- much more often than other forms of drift, it is transformed into a malignant structure - chorionic carcinoma;

- despite the aggressive course and the likelihood of malignant transformation, it responds very well to therapy and is 100% cured.

The size of the uterus, which does not coincide with the period, with cystic drift does not allow one to suspect this particular pathology without additional symptoms. It is especially difficult to determine on this basis early cystic drift in a partial form. Several other symptoms indicate the presence of chorionadenoma:

- Bleeding. It has a specific feature - the presence of typical drift bubbles in the bloody discharge.

When the regenerated chorionic villi grow, the excess tissue with bubbles is gradually separated from the uterine wall and "falls" into the uterine cavity, and from there it is evacuated outward along with the blood.

Blood loss provokes typical signs of anemia and worsens the well-being of the pregnant woman.

- Toxicosis. Depending on the period, they have a clinic of early toxicosis (nausea, vomiting, weakness, and so on) or gestosis (s).

- Lack of fetal signs. The fetus, against the background of a cystic drift (if it begins to form at all), dies very early, therefore all studies conducted indicate its absence. Pregnant women note that they do not feel how the fetus is moving.

Diagnostics of the cystic drift

The clinical presentation of cystic drift is not always obvious and can simulate other pathologies. Symptoms of cystic drift, namely an asymmetric increase in the uterus, must be differentiated from those with polyhydramnios and pregnancy against the background of fibroids. Any bleeding that occurs may indicate a spontaneous miscarriage.

The most reliable sign is the appearance of typical vesicles in the vaginal discharge, as a rule, their appearance heralds the "expulsion" of the cystic drift.

External examination does not allow you to feel parts of the fetus and listen to its heart. Vaginal examination helps to palpate areas of softening of the uterus, and also to establish that its size does not correspond to the gestational period.

An ultrasound scan shows a pattern that is rather typical for a cystic drift:

- an increase in the uterus, not comparable with the gestational age;

- the absence of the ovum in the early and the fetus in the later stages, with a partial form of drift, the preserved parts of the fetus can be visualized;

- the presence of a homogeneous fine-grained tissue (symptom of a "snow storm"), filling the uterine cavity;

- in every second pregnant woman, and against the background of hormonal dysfunction with cystic drift, luteal cysts are recorded in the ovaries of large (more than 8 cm) sizes, and in both ovaries symmetrically.

With an increase in the duration of pregnancy, the ultrasound picture of the cystic drift becomes more and more obvious.

Since the cystic drift provokes an excessive accumulation of the pregnancy hormone, laboratory determination of its concentration is of great diagnostic value. The concentration of hCG with cystic drift does not change in the same way as during normal pregnancy: it exceeds 100,000 mIU / ml and does not decrease after one week.

The presence of hCG after cystic drift, or rather, its concentration, is also an important indicator in the diagnosis. As a rule, after adequate treatment, the amount of hCG after a cystic drift begins to decrease and normalizes by the 8th week. If such dynamics are not observed, and the amount of the hormone remains high, there is a possibility of a dangerous complication - a malignant tumor of the trophoblast.

Bubble drift can provoke a number of complications:

- toxicosis in the form of necrotizing vomiting;

- early development of arterial hypertension and preeclampsia;

- hyperfunction of the thyroid gland ();

- rupture of the formed ovarian cysts;

- infection of the contents of the uterus and the subsequent septic process;

- bleeding, especially in the invasive form;

- trophoblastic embolization: the penetration of vesicles from the uterine cavity into the pulmonary (through the vessels) and the development of the clinic of embolism;

- pronounced violations of the processes of blood coagulation, leading to.

Treatment of bladder skid

Any chosen tactic for the treatment of cystic drift is based on the need to remove the pathologically enlarged trophoblast. The specialist is faced with the task of choosing the most acceptable way to eliminate pathology.

The first stage of therapy for cystic drift is similar to abortion by vacuum aspiration. The method is suitable even with significant sizes (up to 20 weeks) of the uterus. After the contents of the uterine cavity are aspirated, an additional control curettage is performed to remove those small villi that are too tightly attached to the mucous membrane. In order for the uterus to return to its original state as soon as possible after the procedure, uterotonics are used - uterine-reducing agents (oxytocin, pituitrin).

Mechanical removal of the cystic drift is at the same time both therapeutic and diagnostic manipulation, since the study of the obtained tissues helps to clarify the diagnosis and study the laboratory cell composition of the material obtained. The presence of modified chorionic villi in the material indicates the reliability of the diagnosis of cystic drift.

The presence of rare and sometimes "dangerous" consequences of the diagnosis in the panel greatly scares the patients, especially if they seek to obtain additional information from not entirely reliable sources. In addition, each of them experiences stress from the thought of a failed pregnancy and the death of a child. Therefore, before starting therapy, a detailed conversation is needed that:

- this pregnancy began to develop incorrectly, and it has no chance of becoming "normal";

- even the most unfavorable course of cystic drift does not exclude a complete cure;

- the next pregnancy after a cystic drift has every chance of being absolutely normal, subject to proper rehabilitation.

Often, it is also possible to self-expel the cystic drift, when, against the background of the introduction of reducing agents, the uterus independently evacuates the pathological contents.

The quality of the performed manipulation of elimination of the skid is controlled by ultrasound scanning, it is performed several times at two-week intervals to make sure that the uterus and surrounding tissues are "cleaned".

Radiography of the lungs is indicated for all survivors of the procedure for removing the cystic drift in order to exclude the presence of metastases.

After removal of the cystic drift, it is also necessary to control the dynamics of hCG. Laboratory control is carried out weekly for the next two months.

A patient is considered healthy if:

- hCG after cystic drift after two months does not exceed 15 MMU / ml;

- ultrasound control does not detect tumors or metastases;

- radiographically "clean" lungs;

- menstrual function has recovered.

If the level of chorial gonadotropin remains high eight weeks after the removal of the skid, there is reason to suspect the presence of trophoblast cells (in the uterus or other organs) remaining after the operation, which continue to secrete gonadotropin, or a malignant tumor of the trophoblast, therefore additional diagnostic measures are taken: examination, ultrasound diagnostics and radiography of the lungs. In such a situation, further treatment with chemotherapy is necessary, methotrexate and dactinomycin are used separately or in combination with leukoverin. Treatment continues until complete diagnostic well-being, the criterion of which is the absence of pathological foci and the restoration of normal hCG values. In order to prevent relapses, chemotherapy drugs in a course dose are taken in two more courses.

Therapy with chemotherapy drugs allows to cure 100% (all) of patients with trophoblast pathology, and in 90% menstrual function returns to normal and does not need additional correction.

In the case when the cystic drift is complicated by threatening bleeding, preeclampsia or other dangerous conditions, the treatment tactics changes: first, they compensate for the threatening condition, and then eliminate the cystic drift.

Destructive cystic drift cannot be eliminated by the aspiration method, because it literally grows into the uterine wall and vagina. The high probability of dangerous bleeding and rupture of the uterus is the basis for using a more radical surgical technique - it is performed (hysterectomy) along with pathological tissues.

In the case of a successful cure of the cystic drift, the patient is still observed by a specialist for at least a year, and then must be re-examined. A subsequent pregnancy, if needed, should be planned with your doctor. As a rule, pregnancy after cystic drift is recommended after the final follow-up examination, that is, after a year or more, subject to good results. This recommendation is explained by the fact that if pregnancy occurs within a year after treatment, when a woman is under observation and undergoes control tests, the level of chorionic gonadotropin begins to rise, and it becomes impossible to understand what is causing its growth - a returned tumor or a real pregnancy.

Prevention of cystic drift

Like any pathology, cystic drift leaves negative consequences. Sometimes a woman who has experienced an episode of cystic drift has problems with subsequent conception, menstrual dysfunction occurs, or the risk of a pathological course of subsequent births increases. In children born in pregnancies after cystic drift, pathologies are recorded more often. Also, the risk of pathology in childbirth increases in those who give birth after cystic drift.

It should be remembered that after healing at the site of foci of cystic drift, wherever they are (uterus, vagina, lungs), small scars remain - areas of connective tissue. They persist for a long time even after complete recovery, but they dissolve over time, therefore they do not belong to complications.

And, finally, the most unfavorable consequence of cystic drift is the formation of malignant degeneration (up to 20%).

Bubble drift is a rare and still poorly understood pathology. Its main feature is a clear connection with pregnancy, so we can say that the absence of pregnancy is the only reliable measure for the prevention of the disease. However, such a measure, for obvious reasons, can be recommended only to those women who do not plan the desired pregnancy.

However, the lack of effective preventive measures does not prevent the elimination of factors that, according to experts, can increase the risk of developing cystic drift. These can be roughly classified into those that are necessary for women planning pregnancy, and those that are already suitable for pregnant women.

When planning a pregnancy, women should first examine their health status and find out how prepared they are for a difficult and long period of pregnancy, as well as for childbirth. Since there is evidence of a higher risk of cystic drift in patients with infectious diseases and hormonal dysfunction, it is necessary to eliminate the source of infection and restore normal menstrual rhythm.

If the pregnancy has already taken place and is accompanied by a hydatidiform mole, the diagnosis should be made as early as possible. In addition to timely diagnosis, the patient's attentive attitude to pregnancy and the implementation of all recommendations given by the doctor helps.

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An embryo is formed by the fusion of a male sperm and a female egg. But when conception is abnormal, the resulting pregnancy is doomed to death and no drugs, no operations can help the fetus develop normally.

One of these anomalies is a cystic drift, which not only does not end with the birth of a live baby, but can also become a serious threat to a woman's life. Pathology is not uncommon: in some countries, its incidence is 1 in 100 pregnancies.

Bubble drift Is a product of the fusion of an egg and a sperm cell, which is able to rapidly increase in size, does not have a definite structure, and the chorionic villi, which ideally should become part of the future placenta, grow in the form of bubbles inside which there is liquid.

Causes of blistering skid

The occurrence of cystic drift has a rather complex mechanism, which implies the presence of several factors that contribute to the appearance of an abnormal product of conception. All causes can be conditionally divided into primary and secondary.

Some are of a general nature, can be noted in a large number of women, but are not a guarantee that all these women will be pregnant with a hydatidiform mole.

Secondary causes are a kind of triggering mechanism, the appearance of which is due to primary factors. They are guaranteed to cause an abnormality in the development of the embryo.

Primary causes

  • Serious malfunction of the endocrine system. Usually a woman has very low estrogen levels.
  • Infectious diseases. For example, at the time of conception, the expectant mother had a serious exacerbation of any type of STD.
  • The age of the patient. The incidence of cystic drift increases in women over 37 years of age.

Secondary causes

  • Fertilization of an egg without a nucleus. As a result, the product of conception has a 46XY karyotype. The production of such eggs is activated in women over 35 years of age, when the childbearing period is nearing completion.
  • Fertilization of the egg took place without pathologies, but then the maternal genes were lost, and the paternal ones were duplicated. This conception product has a 46XX karyotype.
  • Fertilization of an egg with two sperm at once. In this case, the maternal chromosomes are in the minority and the karyotype of the zygote looks like 69XXY or 69XXX.

Complete and partial bladder skid

Depending on the reason why the product of conception has developmental abnormalities, two types of pathology can be distinguished:

Full bladder skid- is formed in cases where fertilization of a defective egg takes place, during which the maternal chromosomes are completely lost. The embryo does not develop; instead, chorionic villi begin to grow in large quantities.

  • Picture on ultrasound: when scanning, multiple formations are found, located chaotically and filling the entire uterine cavity.
  • The picture in the study of aborted material: a neoplasm consisting of bubbles of various diameters, randomly located relative to each other. Parts of the embryo are not detected.

Partial hydatidiform mole- is formed in cases when one egg is fertilized by two sperm at once. In this case, the embryo can partially develop, sometimes its body is formed completely, but even in this case, it is very likely that it will die.

Although, with a partial cystic drift and provided that all vital organs are developed, a woman can give birth to a live child. However, in most cases, such a baby will have genetic pathologies and low vitality.

If the area of ​​cystic drift is very small, then the expectant mother has enough chances to bear a healthy child.

  • Ultrasound picture: partial cystic drift may not be noticeable in the first trimester of pregnancy. The embryo may have a normal structure, palpitations, and movements may be determined. However, at a screening of 12 weeks in 80% of such cases, the doctor diagnoses the presence of bubble growths. There are examples of postnatal diagnosis of gallbladder drift when examining the placenta after childbirth.
  • The picture in the study of aborted material: a neoplasm consisting of vesicles with inclusions of individual parts of the embryo or the entire body of the fetus as a whole.

Signs of cystic drift, symptoms

If the focus of cystic drift is small and, according to the results of ultrasound, the fetus has no abnormalities and developmental delays, then nothing will tell the expectant mother that something is wrong with her pregnancy. However, the signs of complete cystic drift and partial cystic drift with a large focus of the pathologically altered placenta area are quite obvious:

  • The rapid growth of hCG is several times higher than the norm.
  • Strong manifestations of toxicosis, starting from the first weeks of pregnancy, are a consequence of the excessively increasing hCG.
  • Bleeding.
  • Brown daub that does not stop even after taking Utrozhestan or Duphaston.
  • A rapid increase in the size of the uterus, not corresponding to the gestational age.
  • In later stages, with cystic drift, preeclampsia and eclampsia may occur.
  • Sharp pain in the uterus.
  • Absence of an embryo in the uterine cavity, proliferation of bubbles (doctors use the expression "snow storm").

If a complete or partial cystic drift is found, an abortion is necessary. Otherwise, the neoplasm may grow into the uterus or turn into a malignant tumor.

Treatment of the disease - what to do?

The pathologically altered product of conception is not subject to any other treatment, except for its removal by surgical curettage or vacuum aspiration.

Moreover, the longer the patient will delay the visit to the clinic, the more she runs the risk of losing the uterus due to profuse bleeding when trying to separate the membranes that have grown into the uterine wall.

Vacuum aspiration

It is indicated for those patients who have been diagnosed with cystic motility at a short time (up to 4 weeks). The pregnant woman is given oxytocin, intravenous anesthesia. Then the doctor proceeds to the procedure for expanding the cervical canal, which is accompanied by severe bleeding.

When the cervix is ​​prepared, you can start vacuum aspiration of the uterine body cavity using a 12 mm diameter tip for the apparatus. With the other hand, the specialist massages the uterus abdominally, through the abdominal wall.

  • After aspiration, the body cavity of the uterus is scraped out - this is necessary in order to completely eliminate all particles of the cystic drift.

Surgical curettage

It is almost always used in cases where the gestational age is more than 4 weeks.

This method of treating cystic drift is more preferable than just vacuum aspiration, as it allows you to get rid of the product of conception and avoid complications in the form of a relapse of the pathological process.

When scraping after a cystic drift, the cervix must also be expanded, but if vacuum aspiration can be performed without general anesthesia, then the surgical method of treatment involves the introduction of general anesthesia.

After processing the uterine cavity, the contents are taken out using a curette (a procedure called "curettage").

Typically, doctors use a combination of these two methods: vacuum aspiration is performed in conjunction with curettage and subsequent curettage.

Pregnancy after cystic drift

If a woman has no complications, then doctors are allowed to become pregnant already six months after the operation and monitoring the hCG levels in the blood.

Pregnancy after a cystic drift is no different from others, but before starting planning, you need to put in order the hormonal background and cure STDs, if any. This will reduce the risk of reappearance of the pathologically altered embryo.

Complications after elimination of surgery

For several months, the doctor is obliged to monitor the patient's blood counts and monitor the dynamics of the decrease in hCG after surgery. If the hormone remains at the same level or increases, then this is a reason to prescribe a referral to a gynecologist-oncologist for a woman.

In some antenatal clinics, each pregnant woman with a cystic drift is registered with an oncologist until the level of human chorionic gonadotropin returns to normal.

Such precautions are due to the fact that chorionic villi, growing in the form of bubbles, can become a malignant tumor. If the hCG level remains unchanged or increases, then the patient is prescribed a course of chemotherapy.

It must be remembered that with the competent approach of medical specialists, gallbladder drift can be 100% curable.

Bubble drift, although it does not belong to true neoplasms, is included in the group of trophoblast diseases and is inextricably linked with pregnancy. In fact, this disease is considered, although quite rare, but a complication of pregnancy (including ectopic). On average, according to statistics, the disease occurs in 1 case per 1000 pregnancies.

Epidemiology

The prevalence of the disease depends on geographic location and race. For example, in North America, this pathology is diagnosed in 1 case per 1200 pregnancies, in the Far East (Japan, China) and South America, cystic drift is diagnosed more often, about 1 episode per 120 pregnant women, and in the Russian Federation, the disease is detected in one case per 820 - 3000 gestations.

Separately, it should be said about chorionepithelioma, there are 2 cases of the disease per 100,000 births.

Bubble drift and its types

By cystic drift, they mean the pathology of the ovum, specifically the chorion, which in the future should be transformed into the placenta. The chorion or villous membrane of the embryo undergoes a certain transformation, during which the villi degenerate into grape-like formations (cysts), ranging in size from lentils to grapes and outwardly resembling bunches of grapes. The diameter of the bubbles reaches 25 mm, and they are filled with an opalescent transparent liquid, which, in addition to hCG, contains albumins and globulins, and various amino acids.

The disease, as already indicated, has a connection with pregnancy, and its development can occur against the background of a gestation pregnancy, after an abortion (see) or miscarriage, after delivery. Possible development of cystic drift after ectopic pregnancy (in the tube).

There are several types of cystic drift:

  1. Depending on the histological structure:
    • a simple form of cystic skid;
    • destructive or invasive;
    • chorionic carcinoma;
  2. Depending on the area of ​​the chorion lesion:
    • complete blistering skid;
    • incomplete or partial blistering skid.

According to the international classification from 1992 (Singapore), if the disease has a malignant course, in this case we are talking about invasive cystic drift, then its stage is determined:

  • Stage 0 - low or high risk hydatidiform mole (like 0A or 0B);
  • Stage I - the tumor is within the uterus;
  • Stage II - there are foci of metastasis in the pelvic organs and the vagina;
  • Stage III - metastases are found in the lungs;
  • Stage IV - distant metastases (brain, liver) were diagnosed.

Characteristics of the types of cystic drift

If the disease develops in the first 12 weeks of gestation, and all the primary chorionic villi are reborn and there is pronounced hyperplasia of both layers of the trophoblast, then they speak of the full form of the disease. Some patients call it early cystic drift (apparently due to the timing of the onset). Morphologically, this type of pathology is characterized by:

  • absence of an embryo (it is absorbed);
  • there are no blood vessels in the villi;
  • the epithelium of the chorionic villi is not determined or has undergone dystrophic changes;
  • the villi are swollen and enlarged (enlarged);
  • proliferation of trophoblasts covering the villi from the inside.

The onset of pathology at a later stage of gestation (after 3 months, up to 34 weeks) and the degeneration of part of the chorionic villi is called incomplete cystic drift. Intact villi of normal appearance, blood supply and vascularization are preserved. In this case, there is a fetus, but its death occurs when the pathological process spreads to more than a third of the placenta.

In the case of multiple pregnancies, with the development of a disease in one of the placentas, it is possible to preserve a normal second placenta.

Invasive cystic drift can develop against the background of complete (more often) and partial. Distinctive morphological features are:

  • bubbles grow into the muscle layer of the uterus;
  • the trophoblast is hyperplastic, but retains the placental structure of the villi;
  • villi, germinating the myometrium and the serous membrane of the uterus, enter the blood and lymphatic vessels and spread throughout the body, affecting the internal organs.

The destructive form of the disease occurs in 5 - 6% of cases and is the most severe.

Causes and mechanism of development

The mechanism of development of the disease lies in the pathological set of chromosomes of the embryo, when it has a double paternal set of chromosomes in the event of loss or initially complete absence of maternal chromosomes in the egg.

In the full form of the disease, the karyotype of the embryo is represented by a set of 46XX, if the egg has "lost" the maternal chromosomes and the paternal haploid genome has doubled. But it is possible to fertilize an initially empty egg with 2 sperm at the same time, in which case the karyotype of the embryo looks like 46XX or 46XY. As a result, the embryo dies in the early stages of development, even before the formation of placental circulation, but later the chorionic villi develop and grow.

The incomplete form of the disease is caused by triploidy - the result of fertilization of the egg by 2 sperm with a delay in the haploid set of the mother's chromosomes. The embryo karyotype can contain 69XXY, 69XXX or 69XYY chromosomes. In this case, the death of the embryo occurs at 10 weeks of gestation (due to numerous developmental abnormalities), but it is possible (in rare cases) to develop a viable fetus.

The causes of cystic drift have not yet been identified, but there are a number of theories explaining the occurrence of chromosomal abnormalities after fertilization of the egg:

  • viral theory (viruses, including Toxoplasma, have a damaging effect on the set of chromosomes of the mother and father);
  • damage to the egg cell in the ovary - a defective egg matures in the follicle;
  • decidual theory - endometritis develops in the decidual membrane, which leads to changes in the chorionic villi);
  • immunological theory - the embryo and fetus are considered as antigens to the woman's body and against the background of an insufficiently expressed immune response, the chorionic villi are degenerated instead of a miscarriage;
  • enzymatic theory - based on an increased level of an enzyme - hyaluronidase, which dissolves the vascular wall;
  • lack of protein - its deficiency leads to a shortage of genes in the chromosomes of a fertilized egg.

Factors that increase the likelihood of the disease:

  • age (young pregnant women - up to 18 years old, or over 40);
  • numerous childbirth;
  • repeated abortions and miscarriages;
  • weakened immunity;
  • insufficient nutrition (deficiency of animal proteins and vitamin A);
  • thyrotoxicosis;
  • closely related marriages.

Clinical picture

Symptoms of the disease in the early stages are not always pronounced. The woman feels pregnant, as evidenced by the absence of menstruation, a positive pregnancy test and signs of early toxicosis. Often, pathology is discovered by chance, during an abortion.

It is characteristic that early toxicosis in patients is difficult, vomiting, sometimes indomitable and salivation, lead to dehydration (see) of the body and electrolyte disturbances, significant weakness and lethargy. Early severe toxicosis is diagnosed in 20 - 35% of patients. In 27% of cases, signs of early toxicosis are combined with symptoms of late toxicosis or preeclampsia. They appear, blood pressure rises, a large amount of protein is found in the urine, which is of fetal origin. Eclampsia may develop as early as 3-4 months of gestation. Gestosis is characteristic of the full form of the disease and develops with a significant size of the uterus and an excessively high level of the β-subunit of hCG in the blood. Therefore, the development of preeclampsia in the early stages of gestation should alert the doctor in relation to cystic drift.

Cystic drift is indicated by symptoms such as repeated bleeding from the genital tract, which occurs in 90 - 100% of cases, and the size of the uterus exceeding the duration of pregnancy. Uterine bleeding is disguised as a spontaneous abortion and usually occurs early. In some cases, spotting coincides with the onset of menstruation (see). In more than half of patients (up to 68%), the asymptomatic period lasts less than 2 months. An undeniable symptom of the disease is the detection of bubbles in the blood secretions characteristic of the disease.

In the case of germination of myometrial villi and the serous membrane of the uterus (destroying cystic drift), intra-abdominal bleeding with symptoms of an acute abdomen is possible. The invasive form of the disease is also dangerous with the occurrence of profuse bleeding, requiring urgent measures. Massive and prolonged bleeding contributes to the patient's anemization and can be fatal.

With a destructive form of pathology, metastases to the vaginal walls, vulva and lungs, to the brain are often observed. In some cases, metastatic foci are found after removal of the cystic drift. Metastases often disappear spontaneously, after the elimination of the main pathological focus, but in some cases they cause severe complications and death.

About 15% of patients complain of pain in the lower abdomen and / or in the lumbar spine. The intensity and nature of pain are different, the appearance of a pain syndrome often precedes bleeding. Aching, dull or pressing pains occur when the uterine walls grow to the serous cover or when neighboring organs are compressed by large tecalutein cysts, and the appearance of acute, paroxysmal pains is associated with torsion or rupture of thecalutein cysts or with intra-abdominal bleeding.

In 7% of patients with the full form of the disease, it develops, which is characterized by and, an increase in the size of the thyroid gland and an increase in the level of thyroid hormones, moist and warm skin. The development of thyrotoxicosis is due to an increase in the level of trophoblastic beta-globulin, which has a weak stimulating effect on thyroid-stimulating hormone receptors.

With the full form of the disease, embolism of the branches of the pulmonary artery and the development of respiratory failure (in 2% of patients) is possible. The complication is characterized by the appearance of chest pain and, tachycardia and tachypnea, cyanosis and cough. On auscultation, scattered rales are heard, and bilateral focal darkening is determined on radiography of the lungs.

Diagnostics

The disease requires differential diagnosis with, pregnancy with more than one fetus or against the background of myomatous nodes, with spontaneous abortion, etc.
After collecting anamnesis and complaints, an examination is carried out on a gynecological cress, during which it is revealed:

  • the size of the uterus exceeds the size of the expected gestational age;
  • heterogeneous structure of the uterus: nodular seals are revealed against the background of a softened uterus;
  • in 50% of cases, bilateral luteal (with an increase in the size of the ovaries more than 6 cm) are palpable, which appear within the first 2 weeks and are considered an unfavorable prognostic sign;
  • the presence of tumor-like formations in the vagina and vulva.

With a large abdomen, reliable signs of pregnancy are not determined (fetal heartbeat, palpation of large parts of the fetus).

Additional diagnostic methods are used:

  • Ultrasound procedure... Reveals the significant size of the uterus, the absence of an embryo or fetus, a characteristic feature - the presence of tissue of a homogeneous fine-grained structure (symptom of "snow storm"), luteal cysts. The diagnostic value of ultrasound is 100%.
  • Chest x-ray... Allows you to detect metastases in the lungs.
  • Hysterosalpingography... The GHA allows you to clarify the diagnosis and control the effect of chemotherapy. On the hysterogram with an invasive form, contour penetration of contrast is visualized at the site of the insertion of the villi into the myometrium.
  • Diagnostic laparoscopy,... Carried out if necessary.
  • Study of the level of hCG in blood. In non-pregnant women, hCG is normally absent in the serum. During gestation, hCG appears on the 8th day after conception, and its peak falls on the 60th day and is 5,000-10,000 U. If the hCG level remains high after 12 weeks, a hydatidiform mole is expected.
  • Immunochemical method... Consists in the determination of trophoblastic beta-globulin in the blood. With the development of this disease, its level is 76 - 93%.
  • Histological method... Helps to determine the morphological variant of the disease (material - scraping from the uterine cavity).

Treatment

With the development of cystic drift, treatment consists in its removal, which is carried out by the following methods:

  • scraping of the uterine cavity with preliminary expansion of the cervical canal;
  • vacuum-excohleation (preferable, as it is less traumatic);
  • finger removal, which also requires vacuum aspiration or scraping;
  • excitement of labor with prostaglandins, if the size of the uterus exceeds 20 weeks of pregnancy and an invasive form of pathology is excluded (with ineffectiveness or profuse bleeding - a small cesarean followed by curettage of the uterus);
  • extirpation of the uterus with preservation of the appendages (luteal cysts are not removed, their regression is observed within 3 months after elimination of the cystic drift).

After surgery, cold on the lower abdomen, uterine contractors and antibiotics are shown. After the elimination of the pathology, the patient is discharged under the dispensary observation of the antenatal clinic.

The second stage of treatment is chemotherapy. Indications for its appointment:

  • an increase in the titer of hCG or remains at the same level for a long time;
  • invasive form of the disease after surgical treatment;
  • detection of metastases during or after removal of the cystic drift.

The drug of choice is dactinomycin, which is administered intravenously, the number of courses is determined individually. Metatrexate can be used, but it is more nephrotoxic. Metastases after removal of the cystic drift either disappear on their own or after chemotherapy.

Question answer

What methods of contraception can be used after recovery?

After treatment of the disease, it is recommended to prevent pregnancy for a year after the disappearance of hCG in the blood and urine. It is desirable to use combined oral contraceptives, but contraception by barrier methods is also possible. IUD insertion is not recommended as there is a risk of uterine perforation.

How long does dispensary observation last and what is it?

After elimination of the cystic drift, hCG completely disappears on average after 73 days. Observation consists of:

  1. weekly determination of hCG until 2 negative results are obtained;
  2. then monthly determination of hCG for 6 months, then every 2 months up to a year, in the second year - every quarter, and in the third - every six months;
  3. ultrasound scanning of the pelvic organs every 2 weeks until remission, then every quarter for a year;
  4. X-ray of the lungs annually;
  5. MRI of the brain for 2 years every six months in case of detection of cerebral metastases.

When can a pregnancy be planned?

With a simple form of the disease, pregnancy is allowed 12 months after treatment and normalization of hCG, in the case of an invasive form and chemotherapy, pregnancy planning is possible after 2 years.

Why is cystic drift dangerous?

In 29% of patients after the disease, amenorrhea is observed in 14% of cases, and malignancy occurs in 4% of women (the development of chorionepithelioma). Pregnancy that occurs earlier than 2 years after chemotherapy is fraught with a high risk of developing fetal abnormalities and chromosomal mutations. Complications in childbirth are also possible: bleeding and abnormalities of labor forces.

What is the prognosis after a previous illness?

Current methods of treatment allow achieving 100% recovery of patients, and in 90% of cases and restoration of the menstrual cycle. 70 - 80% of women manage to get pregnant and endure pregnancy.

Bubble drift is one of the variants of gestational trophoblastic disease. The pathology of the trophoblast (the result of the fusion of the egg and sperm), in addition to cystic drift, is also a trophoblastic tumor, or chorionepithelioma, which has a malignant course.

The incidence of cystic drift is on average 0.02–0.8% of all pregnancies.

What is a hydatidiform mole? This pathology got its name because of the characteristic structural changes in the chorionic villi, which are represented by many small vesicles filled with a mucoid transparent liquid. Such bubbles are formed as a result of an edematous increase in the villous membrane of the trophoblast, while the central sections of the villi expand and fill with liquid contents. In this case, the trophoblast's own vessels atrophy.

Such altered chorionic villi can completely or partially replace placental tissue. In the first case, further development of the fetus does not occur, and it dies long before the formation of vital organs. If part of the placenta is affected, in some cases the progression of pregnancy is possible, sometimes up to the term of delivery. But in a significant number of cases, nevertheless termination of pregnancy occurs in the first or second trimester, intrauterine fetal death or the formation of many anomalies of its development, incompatible with life.

Also, with this pathology, germination and introduction of modified chorionic villi into the muscular membrane of the uterus (invasion) can occur. This destroys the wall of the uterus and its blood vessels. This condition can lead to severe internal bleeding. In these cases, they speak of invasive cystic drift, characterized by a severe course and early development of complications.

The tissue elements of the cystic drift synthesize a large amount of chorionic gonadotropin. The concentration of this hormone in the blood of a pregnant woman with such a pathology can exceed normal values ​​several times. This fact determines the occurrence of serious violations of the course of pregnancy, and also provokes the formation of luteal cysts in the ovaries.

Based on the foregoing, it can be determined that cystic drift is a pathological condition in which an irreversible change in the trophoblast structures occurs, leading to an unfavorable outcome of pregnancy, and in some cases - threatening the health and life of the mother.

CAUSES

Bladder motility occurs when a fertilized egg has a double set of paternal chromosomes with the complete absence or delayed formation of female chromosomes. This happens if a defective egg is fertilized by two spermatozoa at once, and in the first case there is a complete cystic drift, and in the second - incomplete, which differ only in terms of fetal death.

According to statistics, gallbladder drift is three times more common in re-pregnant women with a history of multiple births or abortions. An increase in the frequency of this pathology was also noted in women with thyroid diseases (thyrotoxicosis) or impaired immune status. The age of the pregnant woman is not significant, however, in very young or older women (after 35 years), cystic drift is diagnosed more often.

At present, hypotheses are being considered about the possible effect of infection (viruses, toxoplasma) on the degeneration of trophoblast villi. There is also evidence of the influence of hormonal disorders, protein deficiency, certain vitamins and trace elements, etc. However, the exact reasons for the formation of a cystic drift remain unknown.

SYMPTOMS

The course of cystic drift is spontaneous: at very early stages, clinical manifestations and any symptoms are absent. In the future, there is a sharp deterioration in the mother's condition, expressed in frequent bleeding from the genital tract with the possible release of small bubbles and the manifestation of symptoms of early toxicosis of pregnant women in severe form.

Disease manifestations:

  • Bloody issues from the genital tract of any intensity with the presence of characteristic vesicles. This is the most common sign of blistering skid.
  • Anemia... Its development is provoked by heavy and prolonged bleeding. In this case, the hemoglobin level can decrease to critical levels.
  • Severe early toxicosis(indomitable vomiting, severe nausea, profuse salivation) often accompanies a cystic drift.
  • Preeclampsia... It is characterized by an increase in blood pressure, the appearance of pronounced edema and protein in the urine. It occurs in the second or third trimesters of pregnancy.
  • Objective lack of reliable signs of pregnancy- heartbeat or fetal movements, its parts on ultrasound.

Over time, the severity of symptoms progresses, and each of them is an indication for urgent hospitalization of a pregnant woman.

OUTCOME OPTIONS

  • Favorable- the disease ends with spontaneous abortion with the preservation of the possibility of repeated pregnancy and without the development of complications. Such an outcome is possible with timely diagnosis and treatment of this pathology.
  • Adverse- the disease can also end in spontaneous abortion, which is accompanied by the development of complications of varying severity.

Complications of cystic drift:

  • Germination of bubbles into the thickness of the uterus with the development of internal bleeding.
  • Chorionepithelioma formation. Occurs in about 15% after complete cystic drift (with incomplete - in 4%). The growth of this malignant tumor may be limited to the area of ​​the uterus and genitals, or have a tendency to spread.
  • Metastasis of a trophoblastic neoplasm. Such metastases through the blood vessels are carried throughout the body and can be detected in the lungs, liver, brain tissue and other organs. The outcome is often poor.

DIAGNOSTICS

Diagnosis of cystic drift is carried out in a comprehensive manner based on complaints from a pregnant woman, the results of a gynecological examination and additional research methods.

Criteria for the diagnosis of cystic drift:

  • The absence of any signs of the presence of a fetus objectively and according to the results of ultrasound.
  • Frequent bleeding with the presence of bubbles in the secreted blood.
  • High level of human chorionic gonadotropin (HCG) in blood serum and urine, many times higher than the normal value.
  • The size of the body of the uterus significantly exceeds the norms corresponding to the current gestational age.

In addition, ultrasound scanning in the uterus reveals multiple cavities and a characteristic motley pattern, called a "snow storm". In a significant number of cases, tecalutein cysts are determined in the ovaries, sometimes reaching large sizes.

TREATMENT

Before the start of the surgical removal of the modified ovum from the uterine cavity, it is necessary to begin therapy for concomitant disorders (compensation of water-electrolyte balance in toxicosis, administration of iron preparations in case of anemia, etc.).

Usually, to remove (evacuate) the cystic drift, it is sufficient to carry out the procedure of vacuum exocleation of the ovum. Only in the presence of complications are more complex surgical interventions performed - dilation and curettage of the uterine cavity or complete removal of the organ (extirpation).

In all cases of diagnosed cystic drift, histological and genetic (determination of the chromosomal composition) of the obtained material is necessary. If chorionepithelioma is detected in the histological material, the woman is sent to the oncologist for further observation and treatment (chemotherapy and radiation therapy).

After successful evacuation of the contents of the uterine cavity with cystic drift, a woman needs medical supervision for several more years.

During this period, dynamic control of the level of hCG in the blood, ultrasound and other diagnostic methods, if necessary, are carried out.

Tactics after evacuating the cystic drift:

  • The increased level of chorionic gonadotropin normalizes on average one and a half to two months after the removal of the modified ovum. Determination of the amount of hCG in the blood during this period is performed with a frequency of twice a month.
  • If, within three weeks after the evacuation of the cystic drift, the level of hCG does not decrease or its increase is observed, an ultrasound scan of the pelvic organs, abdominal cavity and X-ray of the lungs are performed in order to identify possible metastases.
  • In the absence of manifestations of the disease, after the normalization of the hCG numbers, its level is determined once every two months during the first year. Then - once every six months for two to four years.
  • Re-pregnancy is allowed after the observation period has expired.
  • Contraceptive methods at this time are mainly barrier or hormonal contraceptives in the absence of other contraindications to their use. Intrauterine devices are not used.

PREVENTION OF COMPLICATIONS

For the timely detection and prevention of the development of complications of cystic drift, a systematic visit and observation of an obstetrician-gynecologist is often sufficient. During the examination during pregnancy, an ultrasound scan of the uterine cavity and biochemical tests should be performed to detect an increased level of chorionic gonadotropin.

During subsequent pregnancy, which has arisen after a history of cystic drift, a number of additional measures are taken to reduce the risk of complications of this formidable pathology.

Re-pregnancy measures:

  • Ultrasound scanning of the uterine cavity with a frequency of at least once per trimester.
  • Dynamic analysis of the concentration of chorionic gonadotropin in the blood during the current pregnancy, as well as for two months after its completion.
  • Obligatory histological analysis of the ovum or tissue of the placenta (depending on the outcome of pregnancy).

FORECAST

The insidiousness of cystic drift lies in the fact that it is such a disease that almost always has an unfavorable outcome for pregnancy, and sometimes for the mother. The difference between this outcome is only in whether the loss of pregnancy is accompanied by the formation of a malignant tumor, prone to metastasis, or not. Only in isolated cases was the birth of a full-fledged child noted without any pathologies.

A complete cystic mole during pregnancy always ends in spontaneous abortion and usually leads to complications (the formation of malignant tumors with a tendency to spread metastases).

Incomplete cystic drift with the timely formation of maternal chromosomes can result in the birth of a normal child, but there are few mentions of such an outcome of the disease in clinical medicine. In most cases, this form of the disease also ends in miscarriage or premature delivery of an unviable fetus.

The likelihood of recurrence of cystic drift during repeated pregnancy is 1%.

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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.

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