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Vesical skid treatment after curettage. Bubble skid - symptoms, causes, treatment. Treatment for signs of hydatidiform mole

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

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

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

Causes of hydatidiform mole

The occurrence of cystic drift has a rather complex mechanism, which implies the presence of several factors that contribute to the appearance of an abnormal product of conception. It is conditionally possible to divide all causes into primary and secondary.

Some have general character, may be noted at a large number women, but is not a guarantee that all of these women will be pregnant with a mole.

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

Primary Causes

  • Serious disruption endocrine system. Usually a woman has very low levels of estrogen.
  • Infectious diseases. For example, at the time of conception, the expectant mother had a serious exacerbation of some type of STD.
  • The age of the patient. The frequency of hydatidiform mole increases in women over 37 years of age.

Secondary Causes

  • Fertilization of an ovum that does not have a nucleus. As a result, the product of conception has a 46XY karyotype. The production of such eggs is activated in women over 35 when childbearing period is nearing completion.
  • The fertilization of the egg occurred without pathologies, but then the maternal genes were lost, and the paternal genes were duplicated. This product of conception has a 46XX karyotype.
  • Fertilization of an egg by two sperm at once. In this case, the maternal chromosomes are in the minority and the karyotype of the zygote looks like 69XXY or 69XXX.

Complete and partial hydatidiform mole

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

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

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

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

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

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

  • Ultrasound picture: partial hydatidiform drift may not be noticeable in the first trimester of pregnancy. The embryo may have a normal structure, heartbeat, movements can be determined. However, at a 12-week screening, in 80% of such cases, the doctor diagnoses the presence of vesicular growths. There are examples of postnatal diagnosis of hydatidiform drift in the study of the placenta after childbirth.
  • Picture in the study of aborted material: a neoplasm consisting of vesicles with inclusions separate parts embryo or the entire body of the fetus.

Signs of cystic drift, symptoms

If the focus of the hydatidiform mole is small and, according to the results of ultrasound, the fetus does not have abnormalities and developmental delays, then expectant mother nothing will say that something is wrong with her pregnancy. However, the signs of complete hydatidiform mole and partial hydatidiform mole with a large focus of the pathologically altered area of ​​the placenta are quite obvious:

  • Swift rise in hCG several times higher than normal.
  • Strongly pronounced manifestations of toxicosis, starting from the first weeks of pregnancy, are a consequence of an exorbitantly increasing hCG.
  • Bleeding.
  • Brown daub that does not stop even after taking Utrozhestan or Duphaston.
  • A rapid increase in the size of the uterus that does not correspond to the gestational age.
  • On the later dates with cystic drift, preeclampsia and eclampsia can be observed.
  • Sharp pains in the uterus.
  • The absence of an embryo in the uterine cavity, the growth of bubbles (doctors use the expression "blizzard").

If a complete or partial hydatidiform drift is detected, termination of pregnancy is necessary. Otherwise, the neoplasm can grow into the uterus or turn into a malignant tumor.

Treatment of the disease - what to do?

A pathologically altered product of conception is not subject to any other treatment than its removal by surgical curettage or vacuum aspiration.

Moreover, the longer the patient delays the visit to the clinic, the more she risks losing the uterus due to heavy bleeding when trying to separate the fetal membranes that have sprouted into the wall of the uterus.

vacuum aspiration

Indicated for those patients whose hydatidiform mole was diagnosed on short term(up to 4 weeks). A pregnant woman is injected with oxytocin, anesthesia intravenously. The doctor then proceeds with the expansion procedure cervical canal accompanied by heavy bleeding.

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

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

Surgical curettage

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

This method of treatment of hydatidiform mole is more preferable than just vacuum aspiration since it allows you to get rid of the product of conception and avoid complications in the form of a relapse of the pathological process.

When scraping after a mole, the cervix also needs to be dilated, but if vacuum aspiration can be performed without general anesthesia, then surgical method treatment involves the introduction of general anesthesia.

After treatment of the uterine cavity, the contents are brought out with the help of a curette (the procedure is called “curettage”).

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

Pregnancy after hydatidiform mole

If a woman has no complications, then doctors allow her to become pregnant six months after surgery and monitoring hCG indicators in blood.

Pregnancy after a hydatidiform mole is no different, but before you start planning, you need to put it in order hormonal background and cure STDs, if any. This will reduce the risk reappearance pathologically altered embryo.

Complications after removal of surgery

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

In some women's consultations every pregnant woman with a hydatidiform mole is registered with an oncologist until the level of chorionic gonadotropin returns to normal.

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

It must be remembered that with a competent approach medical professionals hydatidiform mole can be 100% curable.

How often women look forward to those cherished two stripes on the test that will turn their lives upside down! But, unfortunately, the joy of pregnancy does not always last as long as we would like. Exists great amount pathologies, as a result of which this process must be interrupted. Many people know about miscarriage. But besides them, there is another deviation, as a result of which a woman fails to enjoy motherhood. This is the so-called bubble skid. So, what is this pathology and why does it occur? Let's analyze this question more.

What happens when you get sick?

Bubble drift is a disease of the chorion, during which its villi turn into formations from bubbles, the size of which can reach the size of a large grape berry and even more. They are interconnected by gray tree-like trunks containing a clear liquid with albumin or mucin.

According to statistics, hydatidiform drift occurs in one pregnant woman out of a hundred. The outcome of the disease is almost always the same - either the independent death of the fetus with its subsequent expulsion from the uterine cavity, or interruption pregnancy. The birth of a child, especially a healthy one, is possible with this pathology, but this is rather an exception to the rule, which has a 1 chance in a million.

Causes of the disease

The exact factor that provokes the development of the disease has not yet been identified. Previously, it was believed that cystic drift during pregnancy is the result of pathologies such as syphilis, anemia, chlorosis, nephritis, and so on. But in Lately The opinion of doctors has changed significantly. Experts are divided into two camps.

The former assure that cystic drift occurs as a result of inflammation of the uterine wall, and the process of degeneration of the chorionic villi into vesicles is already a secondary phenomenon. This theory even has scientific evidence. For example, in a woman who becomes pregnant with different men, this pathology occurs during each conception. At the same time, scientists have suggestions that not the entire mucous membrane of the uterus, but only part of it, may be affected. To prove this conjecture, an example is given when, during a twin pregnancy, only one fetal egg degenerated, while the other remained healthy and did not become ill.

The second camp of doctors and scientists believes that the causes of the pathology are the following: the primary disease of the egg, which occurs even at the stage of its presence in the ovary, and secondary violations of its development already beyond the redistribution of the egg. At the same time, their theory is confirmed by the fact that during the illness there are very often cases when a fine-grained degeneration of both ovaries occurs. Then such formations will be defined as a sausage-shaped or spherical tumor with a bumpy surface.

Another reason that can cause hydatidiform mole is the presence of a set of paternal chromosomes in the fetus, while they are present in the mother. not enough or absent altogether. Such a pathology occurs when there is a simultaneous fertilization of one egg by two spermatozoa.

Several types of disease

A simple hydatidiform drift occurs in the first three months of pregnancy. The reason for the development of the deviation is the presence in the fertilized egg of only paternal chromosomes. At the same time, maternal ones are completely absent. Duplication of paternal chromosomes leads to the fact that the formation of the embryo does not occur, there is no placenta and a fertilized bladder. A complete cystic drift can be detected by ultrasound. During the procedure, it will be seen that the size of the uterus is significantly different from the expected gestational age (they are enlarged). There may also be formation malignant tumor and the appearance of metastases.

Partial hydatidiform drift is characterized by the presence in the fertilized egg of one set of maternal chromosomes and two paternal. Such situations occur when one egg is inseminated by two spermatozoa. It can also happen when paternal chromosomes are duplicated. This type hydatidiform mole develops after 12 weeks of pregnancy. In this case, the formation of a placental structure of a cystic nature and placental tissue occurs.

There is also an invasive form of the disease, in which villi grow into the very depths of the myometrium, destroying all tissues. This pathology may be accompanied by the appearance of bleeding.

disease development

Most often, cystic drift occurs when:

  • repeated pregnancies;
  • the presence of many abortions;
  • immunodeficiency;
  • ectopic pregnancy;
  • lack of vitamin A and animal fats in food;
  • thyrotoxicosis (thyroid disease);
  • early (under 18) or late pregnancy(after 40 years);
  • closely related intimate relationships.

Bubble skid: symptoms

by the most obvious sign the presence of the disease is the appearance of secretions from the genital tract of a dark red color with an admixture of rejected drift vesicles. They are not very abundant and irregular. But if this deviation is detected, urgent hospitalization of the pregnant woman is required, since there is a risk of death. If deep growth of elements of cystic drift occurred in the thickness of the myometrium, then intra-abdominal bleeding is possible.

The presence of pathologists may also be indicated by the absence of the simplest symptoms of pregnancy: which cannot be heard even with the help of ultrasound, its movement, as well as probing parts of the child. With all this, a pregnancy test shows positive result, but the concentration of hCG exceeds due date norm. In such a situation, a cystic skid is quite obvious.

Signs that may also indicate a pathology:

  • toxicosis, accompanied by vomiting;
  • increase in liver failure;
  • profuse salivation;
  • weight loss;
  • symptoms of eclampsia and preeclampsia in the first trimester;
  • protein in the urine;
  • puffiness;
  • stomach ache;
  • headaches;
  • increased blood pressure;
  • weakness.

Also, hydatidiform drift, the symptoms of which, as already mentioned, can occur both in the first and second semester, is characterized by an active increase in the size of the uterus. As a rule, they significantly exceed the norm for the established period.

Bubble skid: consequences

The main complication of the disease is the development of chorionic carcinoma. This is a malignant form, which is characterized by the germination of pathological tissues in the uterus, liver, lungs and brain. And this is already leading to death.

There are several stages of gestational tumors:

  • the cystic drift itself, characterized by the presence of malignancy within the uterus;
  • the so-called placental bed - the localization of the tumor in the muscles of the organ and at the site of attachment of the placenta;
  • non-metastatic tumor - germination in the uterus of similar tissues of childbirth or cystic drift;
  • metastatic tumors with a good prognosis - a malignant tumor does not leave the uterine cavity (a positive outcome of the disease is possible if last pregnancy was less than 4 months ago, there are no metastases in the brain and liver, the patient did not have chemotherapy, the level of beta-CHG does not exceed the norm);
  • metastatic tumors with bad prognosis The cancer has spread outside the uterus to other organs.

In addition to this pathology, cystic drift has several more negative consequences. For example:


Diagnosis of the disease. Methods

Detection of pathology early stages almost impossible without an ultrasound. After all, the appearance of nausea, fatigue and many other signs of illness is also characteristic of a normal pregnancy. As a rule, a woman learns about a cystic drift either during a planned ultrasound procedure, or only after the appearance of bleeding or the absence of fetal movements in due time.

Methods for diagnosing the disease:

  • gynecological examination, during which the doctor can feel the densely elastic consistency of the uterus and determine the increase in its size;
  • Ultrasound - shows the presence of ovarian cysts and homogeneous fine-grained tissue;
  • phonocardiography - listens to the fetal heartbeat, which is absent during the disease;
  • studies of chorionic gonadotropin (in rare cases, an analysis of the determination of the coagulogram and creatinine is performed, and liver samples are also taken);
  • hysteroscopy;
  • biopsy;
  • diagnostic laparoscopy;
  • abdominal x-ray and chest, MRI of the brain - carried out in order to exclude screenings of hydatidiform mole;
  • laparoscopic echography.

Analyzes necessary to detect pathology:

  • blood biochemistry;
  • general urine and blood tests.

A patient who has been diagnosed with a disease should be consulted by an oncologist, surgeon, endocrinologist and nephrologist.

Solution to the problem

After the diagnosis of "cystic drift", the treatment of which is aimed at removing the neoplasm from the uterine cavity, is confirmed, the woman is sent to the hospital. If the disease does not have complications and the gestational age does not exceed 12 weeks, then a scraping procedure is performed. To do this, the neck is stretched, which provides better access to its cavity, and with the help of a curette (a special tool), all uterine contents are removed.

Vacuum aspiration is used even when the uterus is 20 weeks pregnant. Is this procedure in suctioning the contents of the cavity with the help of special equipment. Often it is performed along with scraping.

With an increase in the volume of the uterus to a size that corresponds to 24 weeks of pregnancy, they also perform thinning of its walls, perforation with a cystic drift and the presence of metastases in the lungs or vagina. In this case, the ovaries are not removed.

After removing the cystic drift from the uterine cavity, its tissues are sent for histological examination to exclude chorionepithelioma. If this procedure showed malignancy of the formation, the level of hCG after cystic drift tends to increase, and foci of metastatic origin are found in the lungs, then the patient is prescribed chemotherapy.

For the treatment of pathology, the means "Methotrexate" and "Dactinomycin" or a drug that combines these two drugs - "Leucovorin" are used. The main direction of action of these medicines is to destroy cancer cells. The intake of these drugs is prescribed until the level of hCG is normalized and menstrual cycle, pathological foci in the lungs and uterus will not disappear. After getting rid of these symptoms, the patient is prescribed several more preventive courses of chemotherapy with the same drugs.

In some cases, it may be necessary to radiotherapy in the form of X-rays and other types of radiation. It is carried out both outside, with the help of devices, and from the inside. In the latter case, so-called radioisotopes are used, which produce radiation on the area where the malignant cells are located, using thin plastic tubes.

Follow-up of the patient after treatment

For approximately two years after the operation, the woman is under careful control oncologist. At this time, she goes through the following procedures:

  • Control over hCG level every week for 1-2 months until the result is negative 3 times in a row. After that, this analysis is carried out, but much less frequently.
  • performed at intervals of once a month until the hCG level normalizes.
  • 14 days after the operation to remove the mole, an ultrasound of the pelvic organs is done. Then the procedure is performed every month until the hCG levels are negative.

Is pregnancy possible after the disease?

Bubble drift, the consequences of which can be very deplorable, is not a disease leading to complete infertility. But it is worth considering that throughout the entire time of observation of the patient by the oncologist, she is not recommended to become pregnant. The main method of contraception at this time is to take hormonal drugs. This is due to them positive impact on the regulation of ovarian function, impaired as a result of the disease.

It is necessary to plan the next pregnancy no earlier than 2 years after the operation. This is especially true if the patient was undergoing chemotherapy. After the onset of conception, a woman should be closely monitored medical staff, since there is a high probability of complications during pregnancy and childbirth.

A patient who has had a mole and wants to get pregnant again should not set herself up for a worse outcome and the inability to have children. Thanks to modern medicine almost 70% of women experience the joy of motherhood after overcoming this disease.

Can the disease return?

As a rule, the recurrence of the disease manifests itself in the form malignancy in the pancreas, lungs and other organs and tissues.

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

And now let's dwell on this in more detail.

What is a "bubbly drift"?

Bubble drift is a deviation in development gestational sac. If this pathology occurs, the formation of the placenta does not occur. Chorionic villi are reborn into blisters, inside of which there is a liquid. She has yellowish color and consists of:

  • amino acids;
  • chorionic gonadotropin;
  • albumin.

The diameter of the bubbles does not exceed 25 ml. Vesicular mole occurs in 0.02-0.8% of pregnancies. There are several varieties 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 hydatidiform mole. This is the most severe form of the disease. She 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 resolves.

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

What does a bubble drift look like with a photo

If a woman develops a mole, the villi of the outer germinal membrane turn into cysts. This is the name given to the bubbles containing liquid. In addition, the growth of the epithelium of the villi is observed. Pathology can lead to the death of the fetus. To better understand what a cystic skid looks like, it is recommended that you familiarize yourself with the photo.

If the pathology has developed in the first 1-2 weeks of pregnancy, all the primary villi of the fetal egg are reborn. In the layers of trophoblasts there is pronounced hyperplasia. In this situation, we are talking about the appearance of 1 form of pathology. Sometimes a type of disease is called early hydatidiform mole. 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 epithelium of the villi is not defined or undergoes dystrophic changes;
  • there are no blood vessels in the villi;
  • the embryo is resorbed.

If the pathology developed in the period from 3 months to 34 weeks inclusive, usually only a part of the chorionic villi is reborn. In this case, we are talking about the so-called incomplete hydatidiform mole. In this case, the villi that have not been reborn have a normal appearance. Their blood supply is preserved. In this case, the fetus in the uterus is observed. 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 can be preserved in normal form and continue to function.

Invasive hydatidiform mole can occur against the background of a complete or partial variety of pathology. Varieties of the disease are characterized by the following symptoms:

  • vesicles can grow into the muscular layers of the uterus;
  • villi can penetrate the blood vessels and lymphatic network, grow through the serous cover of the uterus and myometrium, spread throughout the body, and also affect 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 hydatidiform mole

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

An alarming sign is the appearance of bloody discharge. They occur as a result of uterine bleeding. Bloody issues may occur on early dates pregnancy and continue until childbirth or surgery to remove the egg. Allocations have dark color and liquid density. They are not abundant, but appear regularly.

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

Symptoms signs of hydatidiform mole

Symptoms of hydatidiform mole different women may manifest themselves in different ways. The fact is that pathology can form on different terms bearing a child. The forms of the disease also differ. All this affects the clinical picture of pathology.

Usually a woman who is faced with a problem begins to be disturbed uterine bleeding. The discharge is dark in color. Bleeding ranges from light to heavy. There are symptoms of toxicosis. Women often mistake them for signs of pregnancy. The patient is often worried about nausea and. She may experience increased salivation and dizziness. There is no appetite. Against this background, exhaustion may occur.

In severe cases, the 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. In a woman suffering from pathology, bilateral liquid ovarian cysts are detected. Their size can reach 10 cm or more. Cysts are easily detected during ultrasound. However, this symptom does not appear 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 hydatidiform mole.

In pathology, it is several times higher than the norm. During treatment, the doctor without fail will 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 performed with preventive purpose. Mole symptoms can appear early in pregnancy and mimic pregnancy symptoms. Therefore, diagnosing the problem during this period is quite problematic.

If the disease has become malignant, the vesicles can spread to other organs, mainly to the lungs. The prognosis in this case is unfavorable. Happens quite often fatal outcome. For this reason, it is important to detect the pathology as early as possible and start its treatment. This will allow you 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 signs of hydatidiform mole

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 may arise if conception occurred at the age of 14-15 years. The risk of pathology is also present if a woman is older than 40 years. Other reasons that increase the likelihood of hydatidiform mole are:

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

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

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

  • timely visit to the doctor on the fact of pregnancy. You need to register before 12 weeks;
  • a woman should completely refuse to take narcotic substances, alcohol, and smoking;
  • it is necessary to visit the obstetrician-gynecologist regularly. During the course, 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. Preliminary it is 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.

Treatment for signs of hydatidiform mole

Treatment of hydatidiform mole during pregnancy depends on individual features the course of the pathology, the period of bearing the child, as well as the variety of the disease. In some cases, the fetus can be saved. However, often the disease leads to a miscarriage or the need to remove the fetal egg. If an accurate diagnosis is made, it is not uncommon for a woman to be offered a minor operation. During it, curettage of the uterus is performed. The action is carried out in order to remove the remnants of pathological tissues. Then within 8 weeks after the operation it is necessary to observe stably. The woman will have to take regular tests and undergo an ultrasound every two weeks.

After the hydatidiform mole has been removed from the uterus with surgical intervention blood levels are monitored. The value of the indicator should gradually decrease. This will be the main sign that the pathological processes in the uterus have stopped. Upon receipt of a negative value, the analysis is necessarily taken again. Actions are taken to make sure that the disease is actually cured. Additionally, a woman should be examined by a gynecologist-oncologist.

If an ultrasound shows that there is activity of a mole, and an X-ray examination of the lungs indicates a metastatic lesion, chemotherapy is performed. Once remission is achieved, and laboratory indicators return to normal, 2-3 additional courses are carried out. The action is carried out for prevention.

A patient who is faced with a hydatidiform mole should be observed by an oncologist for another year. Blood levels are monitored monthly. During this period, planning a pregnancy is not recommended. By the best means protection from 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 moment when the menstrual cycle fully returns to normal.

If there is no need for chemotherapy, and the treatment was performed 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 definitely 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 the cystic skid is able to recur. The probability of this is 1-2%. However, the recurrence of the pathology is still possible. In the vast majority of cases, pathology does not affect the possibility of having a child in the future. A mother who has had the disease may have healthy child. Chance for premature birth also does not increase.

Some women during pregnancy are faced with such a concept as hydatidiform mole, the causes, symptoms, methods of diagnosis and control will be discussed.

The concept of cystic drift and its development mechanism

Bubble drift (synonymous with molar pregnancy) is a complication in which there is a degeneration of the chorionic membrane villi 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 sizes.

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

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

Vesicle drift during pregnancy can develop by 2 different mechanisms:

  1. when fertilization of a nuclear-free female germ 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 this case not happening. This type is called complete, it is usually detected during the gestation period between 11 and 25 weeks;
  2. as a result of penetration into a functionally complete egg 2 spermatozoa. Therefore, 3 sets of chromosomes are formed in the zygote. Embryo death is seen in early stages its development. According to this mechanism, an incomplete skid occurs.

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 single out:

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

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

  • pregnancy in women under 18 and over 45;
  • history of spontaneous abortions;
  • trophoblastic diseases in history;
  • various immunodeficiency states;
  • multiple births;
  • thyrotoxicosis;
  • consanguineous marriages.

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

Clinical picture







At the earliest stages of embryo development (up to 4-12 weeks), it is almost impossible to suspect a pathology. At the same time, a rather vivid clinical picture may appear, on the basis of which, however, it is impossible to make a final diagnosis.

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

  • uterine bleeding, which is characterized by bright, rich red-brown pathological discharge from the genital tract, sometimes upon closer examination of which, one can notice the villi of the chorion, resembling in shape bunches of grapes. If we are talking about the 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;
  • non-specific signs that are similar to the manifestation of classic toxicosis, but many times stronger: nausea, vomiting, salivation, debilitating weakness, preeclampsia, and eclampsia (edema, elevated level protein in the urine, arterial hypertension);
  • arterial hypertension;
  • anemia.

Due to the fact that the fetus dies in the early stages of formation and development, then with gynecological examination the doctor is not always able to probe the fetal egg. In addition, an ultrasound photo may also not answer the question of a possible pregnancy.

Diagnostic algorithm

Set the final correct final diagnosis based on clinical picture is not possible due to its similarity in numerous gynecological pathologies.

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

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

  • gynecological examination in mirrors with bimanual examination of the pelvic organs. The doctor notes the increased size reproductive organ with softening area;
  • determining the level of hCG;
  • ultrasound reproductive organs and abdominal cavity. At ultrasound examination the uterus of the fetal egg 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;
  • ultrasonic 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 a diagnosis of "paint pregnancy" is made, a woman will not be able to endure and give birth to a baby. The exception is cases of bearing several fetuses when it comes to twins. Then one of the fruits develops fully, and the second dies.

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

Surgical treatment is represented by dilation and curettage of the uterus. Removal of formations occurs under general anesthesia. It is almost impossible to eliminate the entire pathological focus, but in most cases the remaining cells die off on their own. In order to speed up this process, such medications, like: Leucovorin, Methotrexate, Dactinomycin, etc. After removal, part of the altered focus is sent for histology without fail.

The early postoperative period includes hCG control throughout half a year. This examination is mandatory to detect a possible recurrence. After all, it is chorionic gonadotropin indicates an accomplished conception, and may stand out due to the presence of residual not removed villi. Besides, in postoperative period shows the control of ultrasound of the pelvic organs and x-ray of the lungs.

"Those patients who Rh negative group blood in combination with a partial hydatidiform mole should undergo a course of anti-rhesus immunoglobulin, ”advises the Russian Association of Oncologists.

Any patient treated about the degeneration of the chorionic membrane, is obliged to 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;
  • UZKT in half a month after removal of the cystic mole and then every month until the level of chorionic gonadotropin is completely normalized;
  • independent management of the menogram for at least 3 years.

Is pregnancy possible after hydatidiform mole?

Many pregnant women, faced with a trophoblastic formation, and having insufficient knowledge, assume that this is cancer, and the only way to deal with it is complete removal reproductive organ with appendages.

A cystic drift, both complete and partial, is a neoplasia that can proceed benignly or, conversely, be malignant.

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

Conclusion

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