Blistering may show a positive test. Bubble drift - symptoms, causes, treatment. Several types of disease

21.04.2019

Bubble drift during pregnancy is one of the rarest complications in the process of carrying a child. Such a deviation occurs due to violations of the fertilization process, which causes wrong development cells that form the placenta.

With a cystic drift, a specialist Veronica
risk of pathology pregnant accuracy
the contraction doctor has clothes

Vesicular motility refers to diseases that have the general name "trophoblastic tumors". They are usually non-cancerous. Although they are likely to spread outside the uterus, tumors are treatable.

Stages and signs of the disease

Bubble drift during pregnancy has several varieties, shown in the photo:

full bladder skid (normal) - represents pathological changes throughout the chorion;
partial cystic drift - changes cover only some part of the chorion;
destroying cystic drift - modified villi penetrate the walls of the uterus. This is the most severe form this disease, since it can lead to the development of dangerous intra-abdominal and external bleeding, and the tumor becomes malignant.

Loss of maternal genes and duplication of paternal chromosomes occurs

Full bladder drift is characterized by the development at the beginning of " interesting situation", during three months. Normal conception implies the presence of 23 paternal and 23 maternal chromosomes in the egg. If a complete cystic drift is observed, the fertilized egg contains only the paternal chromosomes, and does not have the maternal ones. Since there is a duplication of the paternal chromosomes, the egg cell includes 2 sets of them. As a result, the formation of the embryo does not occur, and the natural placental tissue and the fertilized bladder are absent.

Partial hydatidiform mole implies triplody; in other words, cells contain 69 chromosomes. The additional set is characterized by paternal origin.

The fetus with this form of pathology also has signs of triplodia: intrauterine retention, as well as various developmental abnormalities, for example, hydrocephalus and syndactyly.

Incomplete hydatidiform mole occurs when a fertilized egg has 23 maternal chromosomes and a double set of paternal chromosomes. This pathology happens when two sperm cells fertilize an egg at once. For this reason, natural placental tissue and cystic placental structure are formed. After appointment correct treatment and constant medical supervision, the development of any abnormalities associated with trophoblastic disease is unlikely.

They are characteristic signs of pathology.

Bleeding caused by detachment of the placenta from the decidua.
An enlarged uterus caused by accumulation of blood and chorionic growth.
Preeclampsia (sometimes eclampsia), which is accompanied by an increase in the size of the uterus.
HCG with cystic drift has a very high level.
Vomiting in women carrying a child, which is caused by complex imbalances in water and electrolyte balance.
Embolism of parts of the pulmonary artery.
Very rarely - thyrotoxicosis, which is accompanied by tremors, tachycardia, high body temperature and moisture in the skin.
Tecaluteal ovarian cyst caused by high level hormones that stimulate the ovaries, and disappear on their own after a few months.

Diagnosis of complications in a woman

During the diagnosis, first of all, the doctor takes into account the complaints of the expectant mother. For example, the following can indirectly indicate the presence of pathology:

bleeding;
discharge of purulent and serous leucorrhoea;
painful sensations in the abdomen, chest, lower back;
strong headache, which leads to vomiting, visual impairment;
neurological signs.

Examination by a specialist is obligatory

Anamnesis analysis is equally important. The main pathologies that are characteristic of this disease are:

preeclampsia on early dates carrying a child;
constant vomiting in the expectant mother;
thyrotoxicosis;
embolism of parts of the pulmonary artery.

Another diagnostic tool is ultrasound diagnostics... With such a disease, the following may be present:

increased size of the uterus;
lack of an embryo;
lack of heartbeat in the embryo;
lack of parts of the embryo;
the presence of a homogeneous small cystic substance;
the presence of a tetalutein ovarian cyst.

Other methods for diagnosing this disease include:

laboratory research ( general analysis blood);
biochemical studies (determination of the level of creatinine, study of kidney function, coagulogram);
examination by a gynecologist (examination of the hardness, shape, size of the uterus, vaginal mucosa);
hysteroscopy, laparoscopy;
chest x-ray;
determination of the karyotype;
CT scan;
Magnetic resonance imaging.

Basic therapy methods

Treatment of the disease can be carried out in different ways. Some approaches are considered standard, some are undergoing research in clinical trials. Such research is needed to improve known methods therapy, as well as obtaining information about the effectiveness of new approaches. Also find out how and what is dangerous.

Consider the main methods of treating the disease shown in the photo.

Therapy method	Description
Surgical	Curettage and dilation with gradual curettage is a stretching of the cervix in order to gain access and eliminate all contents of the uterus using special vacuum apparatus... The walls of the uterus are thoroughly scraped to be able to completely remove all contents. As a rule, all symptoms disappear after scraping.
Surgical	Hysterectomy is complete removal uterus. With this disease, the ovaries are not touched.
Chemotherapy	For the implementation of chemotherapy for the treatment of complete skidding, agents are used whose main action is aimed at eliminating cancer cells. This method treatment can be carried out both with tablets and intravenous or intramuscular administration of drugs. Chemotherapy is classified as a systemic treatment, since all drugs go through the same bloodstream and are carried throughout the body, destroying malignant cells in their path.
Radiation therapy	Radiation therapy to remove tumor cells and reduce the size of the tumor involves the use of X-rays and other types of radiation. This method can be carried out using a special apparatus located externally (external therapy) or internally using materials that emit radiation through thin tubes directly to the location of malignant cells (internal therapy).

Traditional methods of treatment

Veronica officinalis is used in the treatment of this pathology.

Symptoms of pathology in the early stages of the "interesting situation" are aggravated by the fact that the tumor grows according to the laws of pregnancy, in other words, it increases every day. At the same time, the growth rate is much higher than during the normal course of pregnancy. That is why, when making decisions about self-treatment diseases, you risk your life.

It's another matter if you combine folk recipes with the means that the doctor has prescribed for you. This will help prevent side effects and new cases of such pregnancies.

Tincture of Veronica officinalis:

2 tbsp. spoons of herbs;
500 ml of water;
chop the grass;
to boil water;
close the lid;
insist 2 hours;
strain.

Application.

Take 3 times / day, 150 ml.
The duration of the course is 2 months.

Baths with lacfiol:

4 tbsp. spoons of herbs;
2 liters of water;
chop the grass;
to boil water;
pour boiling water over chopped grass;
Boil for 15 minutes;
strain;
cool to 40 C.

Application.

Pour the prepared solution into a basin.
Take a sitz bath for about 20 minutes.
The duration of therapy is 1 week.

Carrots with cod liver:

1 medium carrot;
50 g cod liver;
finely grate carrots;
simmer for 5 minutes in a dry frying pan;
mix with ready-made cod liver.

Application.

Eat this salad every day.
Take a break for a week.
Repeat 2 more courses.
Carry out therapy 2 times / year.

Development hazards and prevention

One of the complications is an increased risk of birth abnormalities.

The main complication of this disease is the development of chorionicarcinoma - it is a malignant disease, which implies the growth of pathological tissues into the uterus, lungs, liver and brain. This, in turn, can lead to lethal outcome... The following stages of tumors are distinguished.

Chorionepithelioma of the uterus or cystic drift, the main symptom of which is the presence of a neoplasm within the uterus.
Placenta bed - the location of the tumor in the muscle of the organ, as well as the placenta attachment.
Non-metastatic neoplasm - penetration of similar tissues into the uterus after childbirth, abortion.
A metastatic neoplasm with a good prognosis is a malignant tumor that does not leave the uterine cavity (positive dynamics is possible if the last pregnancy was less than 4 months ago, there are no metastases in the brain and liver).
Metastatic tumor with bad prognosis- the cancerous tumor spreads outside the uterus to other organs.

Other complications:

the impossibility of the onset of subsequent pregnancies (infertility) - such a consequence is observed in almost 30% of women who have had this disease;
amenorrhea - permanent or temporary absence of menstrual bleeding, this pathology is typical for 12% of women;
thrombosis;
septic diseases.

Among the methods of preventing this disease are:

preparation for pregnancy, passing all examinations and tests in advance;
to give up smoking, alcoholic beverages and narcotic substances;
reception folic acid 3 months before the planned pregnancy, as well as within 1 month of the "interesting situation";
regular visits to the gynecologist;
timely registration in the antenatal clinic.

Attention!

The information published on the site is for informational purposes only and is intended for information only. Site visitors should not use them as medical advice! The editors of the site do not advise to self-medicate. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your attending physician! Remember that only complete diagnostics and therapy under the supervision of a doctor will help to completely get rid of the disease!

A cystic drift is understood as a pathology. fetal egg, which is characterized by the transformation of chorionic villi (outer embryonic membrane) into cysts - vesicles containing fluid, proliferation of villous epithelium and, as a result, fetal death.

This pathological condition manifests itself early toxicosis, an increase in the size of the uterus in comparison with gestational age, bleeding.

Bubble drift is detected by ultrasound, vaginal examination, determination of the content of β-hCG, FKG of the fetus.

Treatment consists in removing the skid by curettage of the uterine cavity, vacuum aspiration, in rare cases - carrying out a hysterectomy.

This pathological condition develops in 0.02 - 0.8% of all pregnancies. With this disease, there is an edema of the stroma (shell) and the proliferation of chorionic villi with the formation of specific bubble-like extensions that resemble bunches of grapes.

Cysts (vesicles) reach a size of twenty-five millimeters, contain a yellowish or opalescent liquid, which includes globulins, amino acids, chorionic gonadotropin, albumins. Cysts, as a rule, do not have vessels; it is rarely possible to identify single capillaries in them.

Classification of cystic drift

There are several classifications of cystic drift. They are based on histological and morphological features. According to the degree of degeneration of the chorionic villi, a partial and complete drift is distinguished. At full form all chorionic villi are transformed, with partial - only a certain part of them.

In all cases, the fetus dies, however, the development of pathological formations continues, which is accompanied by a rather rapid increase the size of the uterus. In addition to all this, there is an invasive (destructive) form of cystic drift, which is characterized by the germination of villi into the thickness of the muscular membrane of the uterus and subsequent destruction of tissues.

This condition can be worsened by the development of severe intraperitoneal (intra-abdominal) bleeding. By histological type, depending on the ratio of trophoblast structures, syncytial, mixed, cytotrophoblastic vesicular drift is isolated.

Causes and risk factors of the disease

Vesiculate motility develops as a result of chromosomal abnormalities during gestation. Full version This pathology occurs when the maternal genes are lost and the set (haploid) of the paternal genes is duplicated or when a non-nucleated egg is fertilized simultaneously by two spermatozoa.

Partial hydatidiform mole also develops as a consequence. genetic disorders: fertilization of an egg by a sperm cell that has a diploid set of chromosomes. A similar condition often accompanied by the development of multiple malformations (syndactyly, hydrocephalus, etc.).

Bubble drift develops three times more often with repeated pregnancies, in young patients, as well as pregnant women over thirty-five to forty years. This pathology can be a complication ectopic pregnancy and therefore localize in the fallopian tube.

Multiple births, abortions, immunodeficiencies, thyrotoxicosis, lack of vitamin A and animal fats in food, closely related marriages are factors that several times increase the likelihood of developing cystic drift.

Symptoms that accompany the pathology

One of the most characteristic signs for this pathological condition is the allocation of a dark liquid blood from the genital tract, which contains rejected drift vesicles.

Such bleeding can lead to significant anemization and, in some cases, become life-threatening.

The germination of elements of the cystic drift into the thickness of the muscular membrane of the uterus may be accompanied by its perforation and massive intra-abdominal bleeding.

The rapid enlargement of the uterus is the result of rapid proliferation of vesicles. Moreover, its size does not correspond in any way to the expected gestational age.

Bubble drift is often accompanied by the development of toxicosis. At the same time, nausea, repeated vomiting, salivation, exhaustion, increasing liver failure, symptoms of preeclampsia, eclampsia and preeclampsia are observed already in the first trimester of pregnancy.

Since with a cystic drift, the fetus dies in the early stages, there are no reliable signs of pregnancy - parts of the fetus are not detected by palpation and ultrasound, the heartbeat is not heard and is not recorded by various hardware methods, there are no fetal movements.

At the same time, carrying out immunological and biological tests for pregnancy gives positive results... In thirty to forty percent of patients' observations, bilateral cysts (tecalutein) are detected, which regress on their own after removal of the cystic drift.

This pathological condition poses the greatest danger due to the possibility emergence of dangerous malignant tumors , which later metastasize to the walls of the vagina, vulva, brain, lungs, abdominal organs.

Complete (simple) bladder skid

This pathological condition is the most frequent form trophoblastic disease. It occurs with a frequency of 1/1000 - 1/1500 pregnancies (in Western countries). Greatest risk the development of a complete cystic drift in women younger than fifteen years old and over forty years old.

Other risk factors are a history of miscarriages, abortion, and dietary errors (lack of vitamin A and animal fats). This pathological condition is characterized by the presence huge amount bubbles with transparent content.

In this case, fetal tissue is completely absent. Clinically, this disease is manifested by a delay in menstruation. Pregnancy symptoms such as vomiting and nausea are more than normal, due to the high content of HCT, which is synthesized by abnormal trophoblast. Some patients may develop hyperthyroidism due to the fact that HCT has a weak stimulating effect on the thyroid tissue.

Partial hydatidiform mole

This pathological condition is diagnosed when a fetus is found together with proliferating villi with degeneration of the hydropic type.

The fetus usually dies at the end of the first or at the beginning of the second trimester, while analysis of the placenta is needed to make a diagnosis, since the hydropic villi are not expressed to the same extent as with a complete cystic drift.

The age of the patients is somewhat older than with complete cystic drift. This condition is associated to a lesser extent with the risk of subsequent malignancy.

How to get pregnant without consequences

After removal of the cystic drift, a woman should be registered with a gynecologist for another year and a half.

During this control period, it is necessary to carefully make sure that pregnancy does not occur as there is a risk re-development this pathological condition.

The most optimal method pregnancy planning will be hormonal contraceptives, which must be taken after consulting a gynecologist.

Due to the specific hormonal effects, the work of the ovaries will be regulated in better side, since during the operation and in the presence of complications it could be disturbed.

The next pregnancy should be under strict control, both by the medical staff and by the woman. This is important, since the likelihood of pathologists and difficult childbirth after this state increases several times. It is also important to know that after surgery or chemotherapy conception must be planned on time, no earlier than in a year.

Modern methods for the diagnosis of cystic drift

When diagnosed, this disease is differentiated from polyhydramnios, multiple pregnancies, spontaneous miscarriage, pregnancy on the background of uterine fibroids. Distinctive features this pathology is the presence of bubbles in the bloody discharge, which is usually observed before the expulsion of the cystic drift.

Conducting a gynecological examination allows you to determine the change in the consistency of the uterus to a densely elastic form with the presence of areas of excessive softening, as well as an increase in the size of the uterus relative to the gestational period.

Ultrasound examination allows to confirm the enlargement of the uterus and the absence of the fetus, while the symptom of a "snow storm" (the presence of homogeneous fine-grained tissue), thecalutein ovarian cysts, having a diameter of more than six centimeters, is detected.

When conducting phonocardiography, fetal heartbeat is not recorded. According to indications, hysteroscopy, diagnostic laparoscopy, laparoscopic echography, ultrasound hysterosalpingoscopy can be performed.

If you suspect the development of cystic drift in mandatory the content of chorionic gonadotropin (CG) is investigated, if necessary, biochemical liver tests are performed, the level of creatinine and coagulogram are determined.

In order to exclude metastatic screenings of the cystic drift, a survey radiography of the abdominal organs is performed, chest, MRI or CT of the brain. After removal of the pathological tissue, a special histological examination is performed, as well as the determination of the karyotype.

Methods for treating cystic drift

The main method of treating cystic drift is the removal of this formation. For this, methods of vacuum aspiration with control curettage are used after preliminary dilatation (expansion) of the cervix. To improve contraction this body prescribe pituitrin or oxytocin. In rare cases, spontaneous expulsion from the uterine cavity of the cystic drift can be observed.

When fulfilled reproductive function or the development of threatening bleeding, removal (extirpation) of the uterus without appendages is performed. The removed tissue must be subject to special histological examination.

After removal of the cystic drift for the next two months, the patient undergoes a weekly determination of the level of hCG in the blood serum, once every two weeks - an ultrasound of the pelvis, as well as an X-ray of the lungs. If there are no signs of developing chorionepithelioma, then subsequent chemotherapy is not indicated.

Chemotherapy and radiation therapy

For chemotherapy, they are used drugs that act on cancer cells... It can be administered intramuscularly, intravenously, or in pill form.

Chemotherapy is a systemic treatment because all medicines enter the bloodstream and are carried to all organs and tissues, killing all malignant cells in their path.

V radiation therapy to destroy tumor cells, as well as to reduce the size of the neoplasm, X-rays or other types of radiation are used.

It can be carried out with the help of special devices located outside or inside with the help of materials that produce radiation, through thin plastic tubes directly to the area where malignant cells are located (internal irradiation).

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 highlight the following types 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. At further development pregnancy in the uterus can be found areas normal placenta, tissue of the embryo. 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 mismatch in the size of the genital organ current date pregnancy. For precise definition diseases, an ultrasound scan is prescribed, on which it is possible to identify all the changes that occur with 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 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 pathology is accompanied by frequent bleeding, which can threaten the life of a pregnant woman. When pathology is detected on late stage the only way therapy is the removal of 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 characteristic symptoms... One of the first signs doctors call the discharge from the genital tract of liquid dark blood which contains rejected bubbles. 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 similar clinical manifestations phenomena:

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 will be determined already on early stages 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 following signs 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 for bladder skid 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 existing a large number bubbles that come out along with bloody discharge... If this does not happen, a surgical operation is prescribed.

It is held 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:

Dilation and curettage. Involves preliminary stretching of the cervix to ensure full access to the uterine cavity and remove all contents of the genital organ. This method is used for a partial form of violation.
Hysterectomy - complete removal of the uterus with all its contents. TO this way resort to full drift, expressed by the sprouting 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 condition 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 next pregnancy immediately after the transferred skid. The recovery period lasts at least six months. During this period, may be assigned hormonal drugs... It is better to use barrier methods (condoms).

Some women during pregnancy are faced with such a concept as cystic drift; the reasons, symptoms, methods of diagnosis and control will be discussed.

The concept of cystic drift and its development mechanism

Bubble drift (synonym - molar pregnancy) is a complication in which the chorionic membrane villi degenerate into vesicular structures with a benign (usually) course. In their structure, these bubbles resemble bunches of grapes, the size of which can vary from small to very large.

Grape-like cysts are filled with a light yellow liquid containing albumin, chorionic gonadotropin, globulins and various amino acids.

This pathological process It is considered quite rare and occurs in about 1 woman in 1000.

Bubble drift during pregnancy can develop according to 2 different mechanisms:

when fertilization of a nuclear-free female reproductive cell occurred, followed by the replacement of maternal chromosomes (which are not enough) with paternal ones. Chorionic villi are replaced by cysts. Embryo formation in in this case not happening. This type is called complete, it is detected, as a rule, during the gestation period between 11 and 25 weeks;
as a result of penetration of 2 spermatozoa into a functionally complete egg cell. Consequently, 3 sets of chromosomes are formed in the zygote. The death of the embryo is observed in the early stages of its development. By this mechanism, an incomplete drift occurs.

The reasons for the development of complications

Currently, there is more than one hypothesis for the occurrence of trophoblast pathologies.

Among the main ones, it is customary to distinguish:

gestational chromosomal abnormalities: homogeneous disomy, triplodia, or a defect resulting from the fertilization of one functionally defective egg with 2 spermatozoa;
exposure to an infectious agent: bacteria, viruses, protozoa;
localization of the embryo in one of the fallopian tubes.

At the same time, there are a number of factors provoking this pathology. These include:

pregnancy in women under 18 and over 45;
history of spontaneous abortion;
history of trophoblastic diseases;
various immunodeficiency states;
multiple births;
thyrotoxicosis;
closely related marriages.

The reasons for the degeneration of trophoblast can be combined with each other, thereby increasing the likelihood of its occurrence in this and subsequent pregnancies.

Clinical picture

At the earliest stages of embryo development (up to 4-12 weeks), it is almost impossible to suspect pathology. At the same time, a rather vivid clinical picture may appear, on the basis of which, however, a final diagnosis cannot be made.

You can suspect the development of molar pregnancy when the following symptoms appear:

uterine bleeding, which is characterized by bright, saturated red-brown pathological discharge from the genital tract, sometimes upon detailed examination of which, one can notice chorionic villi, resembling in shape grape bunches... If we are talking about an invasive form, the development of massive intra-abdominal bleeding is possible;
enlarged, not corresponding to the gestational age, the size of the uterus as a result of the active growth of cysts;
lack of fetal heartbeat during ultrasound;
nonspecific signs that are similar to the manifestation of classical toxicosis, but many times stronger: nausea, vomiting, salivation, exhausting weakness, preeclampsia, as well as eclampsia (edema, elevated level protein in urine, arterial hypertension);
arterial hypertension;
anemia.

Due to the fact that the fetus dies at the early stages of formation and development, then with gynecological examination the doctor does not always manage to feel the ovum. In addition, an ultrasound photo may also not answer the question of a possible pregnancy.

Diagnostic algorithm

It is not possible to make the final correct final diagnosis based on the clinical picture due to its similarity with numerous gynecological pathologies.

Therefore, there is a clear algorithm that allows differential diagnosis between other pathologies.

To identify a complete or partial cystic drift, the causes of which are not exactly known, allow such research methods as:

gynecological examination in mirrors with bimanual examination of the pelvic organs. The doctor notes an increased size of the genital organ with an area of softening;
determination of the level of hCG;
Ultrasound reproductive organs and the abdominal cavity. An ultrasound examination of the uterus of the ovum is not visible, but cysts are clearly visible (sometimes of huge sizes - up to 15 cm) and small cystic tissue (a symptom of a "snow storm");
hysteroscopy;
ultrasound hysterosalpingoscopy;
laparoscopic echography;
in the presence of indications and difficulty in differential diagnosis - diagnostic laparoscopy;
CT and MRI are performed to exclude metastasis in abdominal cavity and chest.

Treatment

When diagnosed with painting pregnancy, a woman will not be able to bear and give birth to a baby. The exceptions are cases of bearing multiple fetuses when it comes to twins. Then one of the fruits develops fully, and the second dies.

Most often, pregnancy has to be interrupted, and the formed cysts are removed by surgery.

Surgical treatment is represented by dilation and curettage of the uterus. The lesions are removed under general anesthesia. It is almost impossible to eliminate the entire pathological focus, but in most cases the remaining cells die off by themselves. In order to speed up this process, such medications, such as: Leucovorin, Methotrexate, Dactinomycin, etc. After removal, a part of the altered lesion is sent to histology without fail.

The early postoperative period includes HCG control for six months. This examination is mandatory to detect possible relapse. After all, it is the chorionic gonadotropin that indicates the accomplished conception, and can be released due to the presence of residual not removed villi. In addition, in the postoperative period, control of ultrasound of the pelvic organs and X-ray of the lungs are shown.

“Those patients who Rh negative group blood in combination with a partial cystic drift should undergo a course of anti-rhesus immunoglobulin "- advises the Association of Oncologists of Russia.

Any patient treated about the degeneration of the chorionic membrane, must comply clinical guidelines associations of oncologists of Russia, which include:

serum hCG study: weekly until 3 negative results sequentially, then once a month for six months, and then once every 60 days for 6 months;
radiography immediately after removal of the focus, then after 1 and 2 months;
UST half a month after removal of the cystic drift and then every month until the level of chorionic gonadotropin is completely normalized;
self-management of the menogram for at least 3 years.

Is pregnancy possible after cystic drift?

Many pregnant women, faced with a trophoblastic formation, and having insufficient knowledge, assume that it is cancer, and the only method of dealing with it is the complete removal of the genital organ with appendages.

Vesiculate mole, both complete and partial, is a neoplasia that can be benign or, conversely, malignant.

In fact, pregnancy after a skid is possible. But, when planning it, it should be remembered that the previously transferred trophoblast pathology is likely to make itself felt during the next pregnancy and childbirth.

Conclusion

Thoroughly explain to a woman the concept of cystic drift - what it is, what measures should be taken and what complications there may be, should qualified specialist... He also observes the patient in dynamics and prescribes the necessary treatment.

Every woman planning desired pregnancy, with all his soul wants a successful bearing and development of the fetus and is afraid of any deviations in this process. This, unfortunately, happens, although not so often. One of the serious diseases occurring during pregnancy is cystic drift.

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

What is the disease?

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

The mechanism of the onset of pathology

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

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

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

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

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

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

Is pregnancy compatible with this pathology?

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

What are the causes of the pathology?

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

Signs and symptoms

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

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

Diagnostics

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

Most sure sign, which can be used to determine chorionadenoma - the presence of bubbles in vaginal discharge. External examination does not detect palpitations, the uterus is softened in places.

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

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

Treatment

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

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

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

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

What to do next?

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

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

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