Bubble drift indicators of hCG. Symptoms, causes, treatment of partial and complete cystic drift during pregnancy: what it is and what it looks like

10.08.2019

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 spermatozoa at once, as a result of which there are extra chromosomes 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).

Causes and risk factors of the disease

Placenta previa

Premature
detachment normally located
placenta (PNRP)

Rupture of the uterus.

Currently,
after the appearance of ultrasound, and they began to put
diagnosis of placenta previa before the onset
bleeding, then the main group
maternal mortality, make up
women with PONRP.

Ruptured cervix

Ruptured uterus

If there is a gap
uterus, it develops very quickly
serious condition of a woman associated
with traumatic and hemorrhagic
shock, intrapartum death occurs
fetus, and then the diagnosis is clear. But maybe
erased symptoms.

Diagnosis of PONRP
very difficult, because the contractions
attempts to join, tone of the uterus
significantly increased, and most often the diagnosis
placed after the birth of the fetus, on
the basis of discharge following the fetus
dark-blooded clots.

If has
the place of the rupture of the uterus in the second period and
the head is on the pelvic floor, then
need to apply obstetric forceps
or extraction of the fetus by the pelvic end.

With PONRP - shortening the period of exile
perineotomy or obstetric
forceps.

Associated with a violation of separation and
allocation of the placenta.

Tight attachment

True increment (only for partial
true increment or partial
tight attachment possible
bleeding).

Infringement of the placenta in the internal
throat (throat spasm).

Remains of placental tissue in the uterus

The bleeding can be profuse.

Risk group:

Women with burdened
obstetric and gynecological history

Complicated pregnancy
preeclampsia

Childbirth with a large fetus

Polyhydramnios

Multiple pregnancies

Experts do not identify specific reasons that contribute to the appearance of a cystic drift in the female body. It is reliably known that the disease is a consequence of chromosomal abnormalities during the gestational period: the loss of the mother's genes, the duplication of the father's genes and the fertilization of an egg that does not have a nucleus with two sperm.

With an ectopic pregnancy, bubbles may appear on the walls of the fallopian tubes.

Not so long ago, in medicine, a hypothesis was put forward that infectious diseases and a low level of estrogen production can provoke the development of cystic drift.

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.

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.

Clinical presentation: how to identify a hydatidiform mole

Classification of cystic drift

There are such types of pathology:

complete blistering skid;
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:

Simple hydatidiform mole. Chorionic villi are large, edematous, located inside the uterine cavity.
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.

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. In the full form, all chorionic villi are transformed, in the partial form, only a certain part of them.

In all cases, the fetus dies, however, the development of pathological formations continues, which is accompanied by a fairly rapid increase in 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.

Pregnancy after cystic drift

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.

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.

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 monitor so that pregnancy does not occur, since there is a risk of re-development of this pathological condition.

The most optimal method for planning a pregnancy is hormonal contraceptives, which should be taken after consulting a gynecologist.

Bubble drift - symptoms

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

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 following symptoms indicate the possible presence of a cystic drift in a pregnant woman:

severe bleeding and blistering;
an increase in the size of the uterus, which is not typical for a certain period of pregnancy;
the absence of the main signs of fetal development: heartbeat and its mobility;
strong manifestation toxicosis in a pregnant woman: frequent bouts of vomiting, repeated bleeding.

Considering the factor that with the development of cystic drift, the fetus dies, the presence of violations can be established only with the help of ultrasound, pregnancy tests will have a positive result.

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.

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.

When diagnosed, this disease is differentiated with polyhydramnios, multiple pregnancies, spontaneous miscarriage, pregnancy against the background of uterine fibroids. Distinctive features of 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.

The diagnosis of bladder drift is very difficult. The development of the disease in the early stages does not manifest itself at all, pregnancy proceeds without complications.

However, at the first appearance of bleeding from the vagina, which a pregnant woman should not have, it is necessary to urgently contact a antenatal clinic.

The doctor initially conducts a vaginal examination, studying neoplasms in the uterine cavity, which makes it possible to determine the presence of trophoblast diseases.

The nature of the formations can be determined in detail using ultrasound. To confirm the diagnosis, the patient's blood is taken for an analysis of hormonal levels.

Throughout pregnancy, beta-chorionic gonadotropin does not exceed the norm, but if this hormone is found in a woman who is not expecting a child, then this may indicate the development of cystic drift.

Bubble drift: the ultrasound photo resembles a bunch of grapes, so a specialist can easily recognize the presence of a neoplasm.
.

Regardless of the stage of development of the disease, the bubbles of the disease must be removed. The material obtained from the uterine cavity is subject to further study by specialists, and the patient must undergo treatment in an oncological institution.

Additional measures to strengthen the general condition of a woman will help prevent the formation of malignant tumors. The rehabilitation period after the operation is at least two months, during which changes in the level of chorionic gonadotropin are regularly examined, a complete examination of the pelvic organs is carried out using ultrasound equipment.

Eight weeks after the removal of the bubbles, all processes should be normalized, if no improvement is observed, then the patient is prescribed an additional course of examinations, since the cells of the cystic drift could remain in the body, which does not allow the treatment to be completed.

If a woman has no signs of pregnancy and no cancer is found, chemotherapy is usually not given. Subsequent pregnancies should proceed under the constant supervision of a doctor.

Timely diagnosis of the disease will help to choose the right course of treatment, prevent possible complications and guarantee the onset of the next pregnancies, as well as the normal bearing of the fetus.

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.

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

How to treat a hydatidiform mole?

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.

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 the contraction of this organ, pituitrin or oxytocin is prescribed. In rare cases, spontaneous expulsion from the uterine cavity of the cystic drift can be observed.

When the reproductive function is fulfilled or the development of threatening bleeding, the 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

Chemotherapy uses drugs that target cancer cells. It can be administered intramuscularly, intravenously, or in pill form.

Chemotherapy is a systemic method of treatment, since all drugs enter the bloodstream and are carried to all organs and tissues, killing all malignant cells in their path.

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

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).

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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

How to get pregnant without consequences

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.

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.

One of the rare, and at the same time, severe complications of pregnancy is considered a partial cystic drift. This condition is characterized by an abnormal course of pregnancy, in which the fetus stops developing and the chorionic villi turn into fluid-filled bubbles.

Cystic motility, being one of the most common forms of trophoblastic disease, occurs with a frequency of 1 case per 1000-1500 pregnancies, and is divided into complete and incomplete, or partial. In the first case, embryonic tissues are completely absent, while with incomplete vesicular drift, there are separate parts of the embryo.

What is Partial Bladder Skid?

Already five days after meeting with the sperm, the fertilized egg is ready for implantation into the wall of the uterus for further growth and development. To be inserted into the wall of the uterus and securely fixed in it, the ovum has an embryonic membrane - a chorion, which has villi that grow into the thickness of the endometrium, followed by fusion with blood vessels. The chorion in the first trimester supplies the ovum with blood, as does the placenta in the subsequent. In the case of the development of a cystic drift, instead of the transformation of the chorion into the placenta, its villi turn into vesicles filled with fluid. At the same time, edema of the stroma of the villi develops, the number of bubbles increases, they merge with each other, resembling a bunch of grapes during ultrasound scanning. The yellowish liquid in the vesicles includes a large amount of hCG (human chorionic gonadotropin), the level of which is tenfold in women with partial cystic drift.

Due to the compression of the villi due to edema, the blood supply to the ovum is disrupted, as a result of which the embryo does not receive nutrition, therefore, it is deprived of the opportunity to fully grow, and dies in the early stages of gestation, at about 10 weeks.

Abnormal growing chorionic tissue (chorionadenoma) sometimes penetrates deep into the uterus, penetrating into its muscle layer, and can also grow into the abdominal cavity, provoking the development of massive bleeding - we are talking about an invasive, destructive cystic drift. With cystic drift, malignant degeneration of chorionadenoma is also possible.

Why does a partial cystic drift develop?

Normally, the ovum carries 23 female and paternal chromosomes, that is, only 46, while with a complete cystic drift, the fertilized egg contains a duplicated set of male genes in the complete absence of female genetic material. In the case of incomplete cystic drift, the ovum may have a duplicated set of dad's chromosomes - 46, and a set of mom's chromosomes - 23, which makes 69 chromosomes in total. This phenomenon most often occurs when two sperm are trapped in one egg.

Predisposing factors for the development of cystic drift include:

Hormonal disorders: thyrotoxicosis, as well as a decrease in the level of estrogen in the blood (hypoestrogenism)
Complicated obstetric history (multiple births, medical abortions, recurrent miscarriage, ectopic pregnancy)
Weakened immunity
Age under 16 and over 35

How to suspect a partial blistering mole?

The clinic with a partial cystic drift very remotely resembles a normal pregnancy, so this pathology can be diagnosed at an early stage. The primary symptom is severe toxicosis, which is characterized by severe nausea and repeated vomiting, while there is not a decrease, but, on the contrary, an increase in blood pressure in a pregnant woman. In addition, in the presence of incomplete vesicular drift, there is a rapid growth of the uterus, which does not correspond to the gestational age. With a positive pregnancy test, a woman notes the presence of bloody discharge from the genital tract, which may contain drift tissue in the form of small bubbles, with the subsequent development of moderate and severe anemia against this background. With both full and partial cystic drift, the fetal heartbeat is not heard, its motor activity is absent.

IMPORTANT! Bleeding from the vagina, indomitable vomiting, as well as the absence of fetal movement in due time are the main clinical signs of cystic drift, when they appear, you should immediately seek medical help from a doctor.

How is Partial Bladder Skid Treated?

The diagnosis of cystic drift is confirmed both serologically (an increase in the level of hCG by several tens of times), and by ultrasound examination of the uterus ("bunch of grapes", a picture of a "snow storm", the absence of heart sounds, parts of the fetus). The earlier the diagnosis is made, the more favorable the prognosis of the disease.

Due to the fact that with a cystic drift, the embryo is doomed to death, the treatment consists in removing the ovum and abnormal chorionic tissues from the body of the uterus. In the early stages of pregnancy, removal of trophoblastic tissues is performed by vacuum aspiration of the contents of the uterine cavity, while at a later stage, curettage of the uterus may be required.

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 perforation of the uterus 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:

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.
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).

Bubble drift is a pathological condition in which instead of a long-awaited pregnancy in a woman's uterus, the trophoblast (a temporary organ necessary for the attachment of the ovum to the walls) degenerates into a huge number of small bubbles. With this pathology, the appearance of the ovum resembles bunches of grapes. The embryo with such a pathology dies in the early stages of pregnancy.

Classification

In medical practice, there are several types of pathology such as cystic drift. The primary classification divides this disease into two forms: simple and invasive. When we are talking about a simple form, we mean the formation in the uterine cavity of a cystic drift, which has a certain localization and does not affect the organ tissues located near it. In the invasive form, the cystic drift grows into the walls of the uterus, which leads to tissue destruction and possible perforation, with the development of massive intra-abdominal bleeding.

Another classification divides this pathology into two forms: partial and complete. Most often, there is a complete cystic drift, in which it contains a diploid set of chromosomes, both of which belong to the father. If we talk about a partial cystic drift, then it occurs when the transformation does not affect all the villous layers of the chorion. Sometimes, with this form of the disease, a triploid set of chromosomes can occur, of which one is maternal and two are paternal.

A diploid set of chromosomes with a cystic drift of a full form is observed mainly in those cases when it was formed in the early stages of pregnancy. Triploids occur if partial bladder motility develops between 9 and 30 gestational weeks. At the same time, both in that and in that case the fetus in the mother's womb dies, but if a complete cystic drift occurs at an early stage, the embryo is not found in the fertilized egg at all. With such a violation as a partial cystic drift in the ovum, unchanged particles of the fetus and placenta can be found, while with complete they are absent altogether.

There is also a classification of such a pathology as cystic drift, in accordance with the gestotype, that is, depending on which cells of the trophoblast undergo degeneration. According to this classification, there are three types of pathology: cytotrophoblastic, syncytial and mixed.

Reasons for development

Since gallbladder drift is a chromosomal pathology that occurs during gestation, it is impossible to determine exactly what leads to the development of such disorders. At the same time, the causes of gallbladder drift lie in the fact that during fertilization, maternal genes are lost, and paternal genes, replacing them, are duplicated.

In addition, pathology can occur if an egg that does not have a nucleus is fertilized by two sperm.

If we talk about risk factors, then several times more often this disease occurs in women who are either not ripe for pregnancy (14-15 years old), or are already over 40 years old. Multiple childbirth, abortion, lack of certain microelements and vitamins in the diet, immunodeficiency, as well as the creation of families between close relatives - all these factors can cause the development of this serious pathology in a woman during pregnancy. Fortunately, this phenomenon is quite rare - on average, it occurs in 1 pregnant woman in 1000, although these indicators are relative.

Clinical manifestations

The symptoms of this pathology are ambiguous - they can manifest themselves in different ways in different women. Since the drift is formed at different stages of pregnancy and can be of different forms, this is the defining criterion of the clinical picture.

However, the main symptoms that can bother a woman with this disorder are:

after a long period of delay in menstruation, she develops uterine bleeding with dark blood, which can be from minor to profuse;
which many women mistake for pregnancy symptoms are nausea and vomiting, lack of appetite and exhaustion, drooling and dizziness.

In severe cases, when a cystic drift grows into the walls of the uterus, causing their destruction, intraperitoneal bleeding may occur, and if the woman does not receive urgent treatment, the likelihood of death is very high. Also, one of the indicative symptoms of complete cystic drift is the discrepancy between the size of the uterus and the gestational period of pregnancy, which is confirmed by both visual examination and ultrasound.

Another characteristic symptom of this pathological condition is the presence of bilateral fluid cysts of the ovaries, which can reach 10 cm or more in size. They are easy to detect on ultrasound, but not all women with cystic moles develop them. Treatment of such cysts is not carried out, since they disappear on their own after the uterine cavity has been cleaned from cystic drift.

Separately, it should be said about hCG with cystic drift - its level is several times higher than the norm. Therefore, during treatment, it is mandatory to check it before the period when it does not return to normal. At the same time, after treatment, when the level of hCG is normalized, a woman will still have to take this test regularly for six months with a preventive purpose. Signs of a cystic drift of a partial form can mimic its signs in the early stages of pregnancy, therefore, it is problematic to diagnose a violation during this period.

Separately, it should be said about the most serious complication caused by cystic drift - its transition to a malignant form, due to the spread of bubbles to various organs, mainly to the lungs. Very often, women with this pathology are faced with the development of chorionepithelioma (choriocarcinoma) after removal of the cystic drift. The prognosis of the course of the disease in this case is extremely unfavorable - in most cases, death occurs. Therefore, the earlier a pathology is detected and its treatment is started, the higher the likelihood that the process will regress irrevocably, and the woman's health will suffer minimally.

Other complications of the pathology are:

septicemia;
intrauterine infection.

Diagnostics and treatment

Diagnosis of the disease is based on a gynecological examination of the patient and palpation of her uterus, with the establishment of the size, consistency and density of the organ. Also, an ultrasound scan is mandatory. Moreover, it is ultrasound that is the most informative method that allows you to see a cystic drift.

Ultrasound can be either external or vaginal. During ultrasound, bilateral fluid cysts of the ovaries may be found, and, in addition, the absence of the fetus in the uterus can be seen. Phonocardiography shows the absence of a heartbeat in the fetus, which is also a diagnostic sign. Also, for the differential diagnosis of this pathology with others, hysteroscopy, CT and MRI may be required.

Laboratory tests are necessarily carried out - the level of hCG is determined, biochemical samples of the liver are taken and a coagulogram is prescribed.

As for the treatment, it is extremely fast. For this purpose, vacuum aspiration devices are used, followed by cleaning the uterine cavity using curettage. With such a pathology as a simple cystic drift, sometimes it is spontaneously removed from the uterus. In this case, vacuum aspiration is still performed in order to make sure that there is nothing left in the uterus. And the material extracted from the uterus is sent for research to confirm or refute the malignant transformation of cells. With an invasive form, the risk of bleeding is high, and upon finding this form on an ultrasound scan, the doctor must urgently hospitalize the woman in a hospital and prescribe her surgical treatment with the removal of the uterus and preservation of the ovaries (if possible).

In cases where the disease has a malignant course, chemotherapy is indicated, the regimen and drugs for which are selected individually for each patient. After treatment, patients are also shown a diagnostic ultrasound scan to examine the uterine cavity.

Many women are interested in whether pregnancy is possible after a cystic drift. There is no unambiguous answer to this question, since a lot depends on the woman's age, her state of health and complications caused by pathology. According to studies, 30% of women after this pathology suffer from infertility, but if it was detected in a timely manner and the treatment was carried out with high quality, then the chances of becoming a mother are good for a woman.

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How often women look forward to those cherished two stripes on the dough that will turn their lives upside down! But, unfortunately, the joy of getting pregnant does not always last as long as we would like. There are a huge number of 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 cannot enjoy motherhood. This is the so-called bubble drift. So, what is this pathology and why does it arise? Let's take a closer look at this issue.

What happens when you get sick?

Bubble drift is a chorionic disease, 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 connected with each other by gray tree-like trunks containing a clear liquid with albumin or mucin.

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

Causes of the disease

The exact factor that provokes the development of the disease has not yet been identified. It used to be thought that gallbladder drift during pregnancy is the result of pathologies such as syphilis, anemia, chlorosis, nephritis, and so on. But recently, the opinion of doctors has changed significantly. The specialists were divided into two camps.

The first assure that the 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 from different men, this pathology occurs during each conception. At the same time, scientists have assumptions that not the entire mucous membrane of the uterus may be affected, but only part of it. To prove this conjecture, an example is given, when during a two-egg pregnancy, only one ovum was reborn, while the other remained healthy and did not undergo a disease.

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 disorders of its development already beyond the redistribution of the egg. At the same time, confirmation of their theory is 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 or spherical tumor with a bumpy surface.

Another reason that can cause cystic drift disease is the presence in the fetus of a set of father's chromosomes, while from the mother they are insufficient 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 mole appears in the first three months of pregnancy. The reason for the development of the deviation is the presence of only paternal chromosomes in the fertilized egg. At the same time, maternal ones are completely absent. Duplication of the paternal chromosomes leads to the fact that the formation of the embryo does not occur, there is no placenta and no fertilized bladder. It is possible to identify a complete cystic drift using an ultrasound method. During the procedure, it will be seen that the size of the uterus differs significantly from the expected gestational age (they are enlarged). The formation of a malignant tumor and the appearance of metastases can also be observed.

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

There is also an invasive form of the disease, in which the villi grow deep into 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 (before 18 years) or late pregnancy (after 40 years);
closely related intimate relationships.

Bubble drift: symptoms

The most obvious sign of the presence of the disease is the appearance of a dark red discharge from the genital tract with an admixture of rejected drift bubbles. They are not very abundant and irregular. But if this deviation is found, urgent hospitalization of the pregnant woman is required, since there is a risk of death. If in the thickness of the myometrium there was a deep growth of elements of the cystic drift, 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 an ultrasound scan, its movements, as well as probing parts of the child. With all this, the pregnancy test shows a positive result, but the concentration of hCG exceeds the norm due to the deadline. In such a situation, bubble drift is quite obvious.

Signs that may also indicate pathology:

toxicosis, accompanied by vomiting;
an increase in liver failure;
profuse salivation;
weight loss;
symptoms of eclamasia and preeclampsia in the first trimester;
protein in the urine;
swelling;
stomach ache;
headache;
increased blood pressure;
weakness.

Also, gallbladder, the symptoms of which, as already mentioned, can appear in both 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 drift: consequences

The main complication of the disease is the development of chorionic carcinoma. It is a malignant form, which is characterized by the invasion of abnormal tissues into the uterus, liver, lungs and brain. And this is already leading to death.

There are several stages of gestational tumors:

the gallbladder itself, characterized by the presence of malignancy within the uterus;
the so-called bed of the placenta - the localization of the tumor in the muscles of the organ and in the placenta attachment;
non-metastatic tumor - germination of similar tissues of childbirth or cystic drift into the uterus;
metastatic tumors with a good prognosis - the malignant formation does not leave the uterine cavity (a positive outcome of the disease is possible if the 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-hCG does not exceed the norm) ;
metastatic tumors with a poor prognosis - cancer spreads 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 in the early stages without ultrasound is almost impossible. After all, the appearance of nausea, fatigue and many other signs of an ailment is also characteristic of a normally proceeding 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 movement 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 heartbeat of the fetus, which is absent in case of a disease;
studies of chorionic gonadotropin (in rare cases, an analysis of the determination of a coagulogram and creatinine is carried out, and liver samples are also taken);
hysteroscopy;
biopsy;
diagnostic laparoscopy;
X-ray of the abdominal cavity and chest, MRI of the brain - are carried out in order to exclude screenings of the cystic drift;
laparoscopic echography.

Analyzes required to identify pathology:

blood biochemistry;
general urine and blood tests.

A patient who has been diagnosed with a disease needs to consult an oncologist, surgeon, endocrinologist and nephrologist.

Solution

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 a hospital. If the disease has no complications and the gestational age does not exceed 12 weeks, then a scraping procedure is performed. For this, the neck is stretched, which provides better access to its cavity, and with the help of a curette (a special instrument), all uterine contents are removed.

Vacuum aspiration is used even in cases where the uterus has a size corresponding to 20 weeks of pregnancy. This procedure consists in sucking the contents of the cavity using special equipment. Often it is performed together with scraping.

With an increase in the volume of the uterus to a size that corresponds to 24 weeks of pregnancy, they also perform indications for the operation: thinning of its walls, perforation of the 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 a malignancy of the formation, the level of hCG after a 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" are used, or a drug that combines these two drugs - "Leucovorin". The main course of action of these medicines is to destroy cancer cells. Reception of these drugs is prescribed until the level of hCG and the menstrual cycle is normalized, pathological foci in the lungs and uterus disappear. After getting rid of these symptoms, the patient is prescribed several more preventive chemotherapy courses with the same drugs.

In some cases, it may be necessary to carry out radiation therapy in the form of X-rays and other types of radiation. It is carried out both outside, with the help of apparatus, and from the inside. In the latter case, the so-called radioisotopes are used, which produce radiation to 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 the close supervision of an oncologist. At this time, she undergoes the following procedures:

Control over the level of hCG 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 often.
performed once a month until the hCG level is normalized.
14 days after the operation to remove the cystic drift, an ultrasound of the pelvic organs is done. Then the procedure is performed every month until negative hCG levels.

Is pregnancy possible after an illness?

Bladder motility, the consequences of which can be very dire, is not a disease that leads to complete infertility. But it should be borne in mind that during the entire time of observation of the patient with an oncologist, she is not recommended to become pregnant. The main method of contraception at this time is taking hormonal drugs. This is due to their positive effect 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 underwent chemotherapy. After the onset of conception, a woman should be closely monitored by medical personnel, since the likelihood of complications in the course of pregnancy and childbirth is high.

A patient who has suffered a cystic drift 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, a relapse of the disease manifests itself in the form of a malignant formation in the pancreas, lungs and other organs and tissues.