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Chemotherapy for gallbladder drift. Bubble drift - symptoms, causes and treatment, repeated pregnancy

Bubble drift refers to diseases associated with the pathology of the trophoblast - a temporary organ necessary for the embryo to attach to the wall of the uterus. Subsequently, the placenta is formed from it. The trophoblast itself is a tissue that begins to differentiate at the early stages of embryonic development and which, with the appearance of the placenta, turns into extraembryonic tissue, which forms the fetal part of the septum, separating the organisms of the embryo and the mother and providing nutrition to the fetus.

Trophoblastic diseases are either tumors or conditions that predispose to the development of tumors. These tumors are rare and unique in that they arise from the products of conception and invade the tissue of the mother's uterus. Since these diseases are associated with pregnancy, they mainly affect young women (the average age of patients is 25 years).

With cystic drift, the trophoblast degenerates into a huge number of small vesicles. These bubbles occupy the entire uterine cavity and tend to grow rapidly and spread to the lungs, i.e. metastasis. The cystic mole cells produce chorionic gonadotropin. Normally, chorionic gonadotropin, a pregnancy hormone, is produced during gestation, but in much smaller quantities. The embryo with cystic drift dies in the early stages of development.

Causes

Bladder motility occurs when, for unknown reasons, there is a loss of maternal genes and duplication of paternal chromosomes. Sometimes (in 5% of cases), gallbladder drift is caused by the fertilization of an empty (non-nuclear) or normal egg with two sperm.

The incidence of gallbladder drift (PV) is relatively low and amounts to 1 case per 1000 births. However, the incidence of the disease is different in different regions. So, in the United States, the disease occurs from 0.6-1.1 per 1000 pregnancies, and in some regions of Asia and South America - 10 times more often (1 case per 120 pregnancies).

Symptoms of the disease

The clinical picture of PZ is extremely diverse and extraordinary. However, the main symptom of this disease is bleeding from the genital tract after a long delay in menstruation. In addition, severe nausea, vomiting, weakness, increased blood pressure, headaches, edema, and the appearance of protein in the urine in early pregnancy may be troubling.

All of the above symptoms should force a woman to immediately consult an obstetrician-gynecologist.

When examined by a specialist, the most characteristic symptom is a discrepancy between the size of the uterus and the period of delay in menstruation. In most cases, the size of the uterus is 3-4 weeks larger than expected. For example, if, judging by the last menstrual period, the gestational age is 8 weeks, then if a cystic drift is suspected, the size of the uterus will correspond to 12 weeks of pregnancy.

However, the size of the uterus may correspond to the expected duration of pregnancy, and in the early stages of pregnancy it may be even less than the obstetrician-gynecologist suggests.

In addition, the presence of ovarian cysts (cavities with liquid contents), which can reach up to 15 cm in diameter, is characteristic, but not necessary for PZ.

Diagnostics and treatment

In connection with the development of ultrasound diagnostics, the diagnosis of "gallbladder drift" does not cause great difficulties, since the ultrasound picture typical of this disease is well known to specialists.

Treatment of a benign form of trophoblastic disease of cystic drift is mainly reduced to its removal using vacuum aspiration - suction of the contents of the uterus using metal cylindrical tips and an electric vacuum pump.

After histological confirmation of the diagnosis (examination under a microscope of the material obtained from the uterus), the patient should be referred to a specialized oncological institution.

Follow-up for 8 weeks after surgery includes a study of human chorionic gonadotropin in blood serum (HCG) once a week and an ultrasound examination of the small pelvis (US) once every two weeks.

In the absence of signs of the disease (normal HCG up to 15 MMU / ml, the absence of tumor formations according to ultrasound of the pelvis and X-ray examination of the lungs, as well as restoration of the normal menstrual cycle), chemotherapy is not performed.

A further study of HCG in the blood serum is carried out once every two weeks for 3 months, and then - once a month for six months. The optimal period for the onset of the desired pregnancy is a year after the evacuation of the cystic drift.

If, 8 weeks after the evacuation of the cystic drift, normalization of HCG indicators is not observed or there is a tendency to an increase in HCG, the patient is prescribed an in-depth examination, since these test results indicate that the cells of the cystic drift are preserved in the uterus or other organs, which produce HG.

According to the ultrasound of the small pelvis, foci of cystic drift in the uterus can be detected, and with X-ray examination of the lungs, metastatic lesions can be detected. These patients are prescribed chemotherapy. Most often, chemotherapy is used to treat this disease. METOTREXAT and DACTINOMYCIN or their combination in combination with LEUKOVORIN. Treatment is carried out until the normalization of hCG indicators, restoration of the menstrual cycle, the disappearance of pathological foci in the uterus and lungs. However, it must be remembered that fibrotic changes - foci of connective tissue at the site of pathological foci in the uterus and lungs - can persist for quite a long time, despite complete recovery.

After reaching clinical and laboratory remission (a period when there are no symptoms of the disease and all tests are normal), another 2 - 3 preventive courses of chemotherapy with the same drugs are performed.

After the treatment, the patient remains under the supervision of an oncologist for 1-1.5 years (during this time, the determination of HCG in the blood serum is carried out every month). At this time, abstinence from the onset of pregnancy is recommended, while the optimal option for preventing unwanted pregnancy is hormonal contraception, which, simultaneously with the contraceptive effect, regulates the function of the ovaries, impaired as a result of the previous illness and chemotherapy.

Timely diagnostics and correct treatment tactics allow to preserve the woman's reproductive function and guarantee the onset of a normal pregnancy and subsequent childbirth.

According to the Russian Oncology Center. N.N. Blokhin, thanks to the success of chemotherapy, it was possible to cure almost 100% of patients suffering from PZ. In 90% of patients receiving chemotherapy, menstrual function fully recovered, and in 70% pregnancy, which ended in normal delivery.

It should be noted that pathological changes in children born to women after suffering from cystic drift occur somewhat more often than in children of healthy women. At the same time, the pathology during childbirth (bleeding, weakness of labor duration, etc.) in patients who underwent trophoblastic disease was slightly higher than in healthy women. This fact indicates that after this disease, a woman needs especially careful monitoring by doctors.

Vesiculate mole during pregnancy. This is a rare complication, but it can lead to death of the fetus and a threat to the health of the mother.

Now let's dwell on this in more detail.

What is bubble drift?

Bubble drift is an abnormality in the development of the ovum. If this pathology has arisen, the formation of the placenta does not occur. Chorionic villi are reborn into bubbles, inside of which there is liquid. It is yellowish in color and consists of:

  • amino acids;
  • chorionic gonadotropin;
  • albumin.

The diameter of the bubbles does not exceed 25 ml. Bubble drift occurs in 0.02-0.8% of pregnancies. There are several types of the disease, the list of which includes:

  1. Complete or simple hydatidiform mole. The disease is characterized by pathological changes throughout the chorion.
  2. Partial hydatidiform mole. Pathological changes affect the chorion only partially.
  3. Destructive cystic drift. This is the most severe form of the disease. It is malignant.

The first type of pathology appears in a woman during. In the presence of this form of the disease, the fetus dies and then dissolves.

Partial blistering may appear after. In this situation, the pregnancy is not terminated. There is a possibility that it will end with the birth of a live child. In most cases, childbirth occurs prematurely. However, the child may appear on time. If the pathology appeared during a multiple pregnancy, it can affect only one placenta or both of them.

What does a bubble skid look like from a photo?

If a woman develops a cystic drift, the villi of the outer embryonic membrane turn into cysts. This name was given to bubbles containing liquid. In addition, the proliferation of villous epithelium is observed. Pathology can lead to fetal death. To better understand what a bubble drift looks like, it is recommended that you familiarize yourself with the photo.

If the pathology develops in the first 1-2 weeks of pregnancy, all primary villi of the ovum are reborn. Severe hyperplasia is present in the layers of trophoblasts. In this situation, we are talking about the appearance of 1 form of pathology. Sometimes the type of disease is called early bladder drift. This is due to the timing of the onset of pathology. During this period of pregnancy, cystic drift is characterized by:

  • proliferation of trophoblasts lining the villi from the inside;
  • there is swelling of the villi and their increase;
  • the villi epithelium is not defined or undergoes dystrophic changes;
  • there are no blood vessels in the villi;
  • the embryo is absorbed.

If the pathology developed between 3 months and up to 34 weeks inclusive, usually only part of the chorionic villi is reborn. In this case, we are talking about the so-called incomplete cystic drift. In this case, the villi that have not been reborn have a normal appearance. Their blood supply is maintained. In this case, the fetus is observed in the uterus. However, pathology can lead to his death.

In the case of multiple pregnancies, the problem may affect only one placenta. At the same time, 2 is able to remain in its normal form and continue to function.

Invasive cystic drift can occur against the background of a complete or partial type of pathology. Varieties of the disease are characterized by the following symptoms:

  • bubbles can grow into the muscle layers of the uterus;
  • villi can penetrate the blood vessels and the lymphatic network, grow through the serous membrane of the uterus and myometrium, spreading throughout the body, and also affect the internal organs;
  • the placental structure of the villi is preserved.

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

The first signs of cystic drift

If a woman has developed a cystic drift, one of the signs of the disease is early toxicosis. It can be accompanied by an increase in temperature, as well as moisture in the skin. The patient is often nauseous. Against the background of nausea arises. It appears due to severe violations of water and electrolyte balance.

The appearance of bloody discharge is an alarming sign. They result from uterine bleeding. Bloody discharge can occur early in pregnancy and continue until childbirth or oocyte removal surgery. The discharge is dark in color and fluid. They are not abundant, but appear regularly.

Another sign is the abnormal size of the uterus. So, a three-month period in terms of size can correspond to 5 months.

Symptoms and signs of cystic skid

The symptoms of cystic drift may differ from woman to woman. The fact is that pathology can form at different periods of bearing a child. The forms of the disease also differ. All this affects the clinical picture of pathology.

Usually, a woman faced with a problem begins to worry about uterine bleeding. Highlights are dark in color. Bleeding ranges from minor to profuse. Symptoms of toxicosis appear. Women often mistake them for signs of pregnancy. The patient is often worried about nausea and. She may have increased drooling and dizziness. No appetite. Against this background, exhaustion may occur.

In severe cases, cystic drift can grow into the walls of the uterus. This leads to a violation of its integrity, which in turn provokes the occurrence of intra-abdominal bleeding. Symptoms require immediate hospitalization and adequate therapy. Otherwise, there is a possibility of death.

The visual size of the uterus does not correspond to the gestational age. This can be confirmed by visual inspection and ultrasound. A woman suffering from pathology has bilateral fluid cysts of the ovaries. Their size can reach 10 cm or more. Cysts are easily detected during an ultrasound scan. However, this symptom is not manifested in all women who are faced with a hydatidiform mole. Treatment in this situation is not carried out. They will disappear on their own after the uterine cavity is cleared of cystic drift.

With pathology, it is several times higher than the norm. During treatment, the doctor will necessarily check this indicator until it returns to normal. Even when the level returns to normal, a woman will still have to take this test regularly for six months. The action is carried out for a preventive purpose. The symptoms of gallbladder drift can appear in the early stages of pregnancy and mimic its signs. Therefore, it is quite problematic to diagnose the problem during this period.

If the disease has developed into a malignant form, the bubbles are able to spread to other organs, mainly to the lungs. The prognosis in this case is unfavorable. Death often occurs. For this reason, it is important to detect the pathology as early as possible and begin its treatment. This will make it possible to count on the fact that the process will regress irrevocably, and the woman's health will suffer minimally. There are other complications of diseases, the list of which includes:

  • the occurrence of infertility;
  • the appearance of an intrauterine infection;
  • septicemia;
  • the occurrence of thrombosis;

Causes and prevention of signs of cystic drift

Separately, there are categories of women who are at risk of developing the disease more than others. The risk group includes girls who are not yet ripe for pregnancy. The problem can arise if conception occurred at the age of 14-15 years. The risk of pathology is also present if the woman is over 40 years old. Other reasons that increase the likelihood of cystic drift are:

  • the woman gave birth many times;
  • conception occurred between close relatives;
  • there is an immunodeficiency;
  • a woman's diet lacks some trace elements and vitamins.

The phenomenon is quite rare. On average, pathology is detected in 1 out of a thousand pregnant women. However, the indicator is quite relative.

As mentioned earlier, the exact causes of the disease have not been established. Therefore, there is no specific prophylaxis for cystic drift. However, experts have identified a number of measures that reduce the risk of pathology. The list includes:

  • timely access to a doctor after pregnancy. You must register before 12 weeks;
  • a woman must completely stop taking drugs, alcohol, and also smoking;
  • it is necessary to regularly visit an obstetrician-gynecologist. During it should be shown to the doctor once a month. In the second trimester, the number of visits increases to 1 time in 2-3 weeks. In the third trimester, you need to go to a specialist once every 7-10 days;
  • pregnancy must be planned consciously. It is preliminarily recommended to pass all the necessary examinations;
  • within 3 months before the planned pregnancy and during the 1st trimester, it is recommended to take folic acid.

Treating signs of cystic drift

Treatment of cystic drift during pregnancy depends on the individual characteristics of the course of the pathology, the period of bearing the child, as well as the type of disease. In some cases, the fetus can be saved. However, often the disease leads to its miscarriage or the need to remove the ovum. If an accurate diagnosis is made, a woman is often asked to undergo minor surgery. During it, curettage of the uterus is performed. The action is carried out in order to remove the remnants of pathological tissues. Then, for 8 weeks after the operation, it is necessary to be monitored stably. The woman will have to be tested regularly and undergo an ultrasound scan every two weeks.

After the cystic mole has been removed from the uterus by surgery, the blood level is monitored. The value of the indicator should gradually fall. This will be the main sign that the pathological processes in the uterus have stopped. If a negative value is obtained, the analysis must be taken again without fail. Actions are performed in order to make sure that the disease is indeed healed. Additionally, a woman should be examined by a gynecologist-oncologist.

If an ultrasound scan shows that there is cystic drift activity, and an X-ray of the lungs indicates metastatic lesions, chemotherapy is given. After it is possible to achieve remission, and laboratory parameters return to normal, 2-3 additional courses are carried out. The action is performed for prevention.

A patient faced with a cystic drift should be observed by an oncologist for another year. Blood levels are monitored monthly. It is not recommended to plan a pregnancy during this period. The best means of protection against its onset are hormonal contraceptives. They allow you to normalize ovarian function after undergoing chemotherapy and getting rid of the disease. Treatment is applied until the menstrual cycle is completely back to normal.

If there is no need for chemotherapy, and the treatment was carried out in other ways, doctors recommend refraining from pregnancy during the weather. Otherwise, the period is extended to 12 months. If conception occurs during this period, the level will certainly increase. This will lead to the fact that doctors will not be able to reliably determine the cause of the incident. It should be borne in mind that cystic drift can recur. The likelihood of this is 1-2%. However, the re-emergence of pathology is still possible. In the overwhelming majority of cases, pathology does not in any way affect the ability to have a child in the future. A mother who has had the disease can have a healthy baby. The chance of premature birth is also not increased.

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 this may be a sign of a 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).

What is cystic drift and what is the danger of this disease - today the site for mothers will tell the site.

Any pregnancy, be it long-awaited or in the form of a surprise, should only bring joy. But sometimes the presence of a serious pathology can deprive a pregnant woman of the opportunity to count on a happy outcome of childbirth.

Some diseases require termination of pregnancy, and the sooner the better.

Bubble drift is a formidable disease of the ovum, which is characterized by regeneration of chorionic villi(outer germ membrane) into bubbles of liquid, outwardly very reminiscent of grapes. Pathology causes the proliferation of villi of the epithelium and the inevitable death of the fetus.

Fortunately, it is rare - in about one out of two thousand pregnant women.

Varieties of the disease

  • With a simple cystic drift, manifestations of the disease are observed in the first trimester of pregnancy. This form is characterized by the presence of two sets of paternal chromosomes in a fertilized egg. The maternal genotype is completely absent. The embryo is not formed, the formation of the ovum and placenta does not occur.
  • With a partial vesicular mole, the egg contains two sets of paternal chromosomes and one maternal genotype. This situation can occur if the egg is fertilized by two sperm at the same time. This form of pathology is observed in. Placental tissue has time to form, but is cystic in nature.
  • The invasive form of the disease is characterized by an extensive proliferation of chorionic villi inside the myometrium. The destruction of tissues can lead to severe bleeding.

Causes of blistering skid

Experts still do not have precise information about why this disease develops.

Some argue that the primary cause of cystic drift lies in initial pathology of the walls of the uterus, as a result of which the transformation of the chorionic villi occurs.

Proponents of another theory believe that the egg itself is initially unhealthy, being in. Leaving the ovary ovum affected by pathology after conception, it starts the development of cystic drift in the entire uterine cavity.

The third reason is incorrect set of chromosomes during fertilization: the presence of a duplicate of the paternal chromosomes with partial or complete absence of the maternal genotype.

Signs and symptoms of blistering skid

A pregnant woman can record the characteristic signs of the disease:

  • severe toxicosis with persistent saliva and frequent vomiting;
  • exhaustion;
  • the manifestation of preeclampsia, which is not characteristic of early periods;
  • liver failure;
  • the presence of protein in urine tests;
  • pain in the abdomen;
  • iron deficiency in the body.

And yet, pregnancy after suffering a cystic drift is possible in most cases. But not earlier than two years after the end of chemotherapy and taking anticancer drugs.

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, a bubble-like proliferation of chorionic villi occupying the entire uterine cavity occurs. 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.