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Bladder skid disease. Bubble drift: a brief description

Bubble drift is a trophoblast pathology in which the villi of the outer embryonic membrane (chorion) degenerate into cysts - a huge number of small bubbles filled with fluid and gradually occupying the entire uterine cavity. Cysts tend to grow very rapidly. Distinguish between a complete cystic drift, when the signs of the embryo are absent, and incomplete, when the body of the embryo or some of its parts are present.

There are cases when a pregnant woman in the early stages notices bleeding from the vagina. Unfortunately, many are in no hurry to see a doctor, considering it normal. In fact, this can be a sign of a serious pathology. Bubble drift occurs due to deviations of the trophoblast (the primary organ that serves as an attachment of the embryo to the walls of the uterus). Ideally, it should become the placenta. The trophoblast begins to rebuild in the early stages of pregnancy, and with the appearance of the placenta, it is an extra-embryonic tissue that forms partitions between the embryo and the mother's body and provides nutrition to the fetus.

Trophoblast abnormalities are tumors or precancerous formations. Their peculiarity is that they appear as a result of conception, are formed from its products and tend to pass into the body of the mother's uterus. With a cystic drift, the trophoblast fills the entire uterine cavity with bubbles, as a result of which metastasis may occur (the transition of the tumor to other organs). The embryo with this diagnosis dies in the very first days of development.

Since this disease is associated with the pathology of pregnancy, it mainly affects women of reproductive age (the average age of women susceptible to cystic drift is 25 years).

Pathogenesis

When the villi are completely filled with fluid, the trophoblast vessels atrophy. The layer covering the vesicles tends to grow and penetrate into the muscular layer of the uterus, carrying a destructive force. It can reach the complete destruction of the walls of the uterus and the development of the disease into the abdominal cavity, which can provoke internal bleeding.

With a complete cystic drift, the fetus dies immediately, but the uterus continues to enlarge due to the progression of the disease. With incomplete cystic skid, there is a small chance that the fetus will be born.

A trophoblastic tumor is a very serious malignant tumor. In the first stage of cystic drift, conception occurs in the uterus, but the fetus does not develop or dies. Instead, formations appear on the walls of the uterus that resemble a bunch of grapes. In this case, overgrowth outside the uterus does not occur. But if the disease was not diagnosed in time, then choriocarcinoma occurs - a tumor that begins to develop in other organs, outside the uterus (mainly in the lungs). It can also occur as a result of an abortion or after childbirth.

Causes

Bladder motility in women occurs when there is a sharp loss of maternal genes and a double prevalence of paternal genes. In fact, paternal genes seem to replace maternal genes. The reasons for this change have not yet been studied. In several cases (5%), the occurrence of a cystic drift was observed during the fertilization of an empty egg or a normal egg, but with two spermatozoa.

Fortunately, this disease is not so common: it occurs in 1 case in 1000. However, the frequency of its occurrence is different in different regions. For example, in the United States, the incidence of bladder infections is 0.6-1.1 per 1000 pregnant women. The situation is completely different in South America and some regions of Asia: there the disease occurs 10 times more often, 1 woman out of 120 suffers from it. In Russia, the situation does not look so depressing: 1 case of this pathology occurs in 820-3000 pregnancies.

Symptoms

Bladder motility exhibits fairly pronounced symptoms, and every pregnant woman can determine the first signs of this disease.

  1. A sharp jump in the level of hCG (chorionic gonadotropin - a pregnancy hormone in a woman's body). The level is several times higher than the norm in a normal pregnancy.
  2. The appearance of bloody discharge, which intensifies towards the middle of pregnancy. It is at this time that the expulsion of the skid by the uterus occurs.
  3. The size of the uterus exceeds the norm for a normal pregnancy at the same period for almost a month. However, there are cases when the size of the uterus is within the normal range (correspond to the expected gestational age) or may even be less than normal (such a deviation in the case of cystic drift sometimes occurs in the early stages of pregnancy).
  4. Lack of obvious signs of the existence of the fetus (movements, jerks, palpitations).
  5. Increased toxicosis. Although this fact is inherent in pregnant women, excessive nausea and vomiting, fatigue and weakness can indicate serious abnormalities in your body. Anemia may also occur due to recurrent bleeding.
  6. Increased blood pressure.
  7. The appearance of protein in the urine in early pregnancy.
  8. The presence of white blisters filled with liquid on the laundry along with discharge (they are rather difficult to notice).
  9. It is also possible the appearance of a bilateral ovarian cyst (cavity formation with liquid contents), which sometimes grows up to 15 cm in diameter.

The above symptoms are quite difficult to ignore, so a pregnant woman, upon discovering at least some of them, should immediately consult her doctor.

Diagnostics

To determine the presence of a cystic drift, it is a qualified diagnosis that is very important. Experienced specialists and modern equipment are able to make an accurate diagnosis.

First of all, a general examination by a gynecologist is required. This is a rather unpleasant procedure in which the doctor feels the uterus with both hands through the vagina to determine its size and condition. To the touch, the uterus becomes compacted, areas of softening are felt. In normal pregnancy, the uterus is doughy and uniform to the touch.

Next, the doctor prescribes an ultrasound examination (ultrasound) of the pelvic organs. At the same time, instead of a normal embryo, heterogeneous and bumpy walls of the uterus are noticed, a symptom of a "snow storm" (the presence of fine-grained tissue), cysts are found in the ovaries.

For an accurate diagnosis, it may be necessary to determine the level of hCG in the body; with cystic drift, it can exceed its norm several times. If necessary, liver biochemical tests are performed, creatinine levels are measured and a coagulogram (blood clotting test) is performed.

Having diagnosed a cystic mole in a woman, in order to exclude metastasis, many other studies are performed: plain X-ray of the abdominal cavity organs, chest, MRI or CT of the brain.

Treatment

To eliminate the cystic drift, it is necessary to carry out a surgical intervention. After preliminary dilation of the cervix, the doctor uses the vacuum method followed by curettage. The doctor then prescribes a series of medications to improve the contraction of the uterus. However, it happens that the uterus gets rid of the skid on its own.

If the disease is extensive, the likelihood of removing the uterus is high. After that, the removed organ should become a source of histology study.

After the operation, the woman should be monitored by a doctor: donate blood to determine the level of hCG every week, and undergo an X-ray of the lungs 1 time in 14 days. If deviations and complications were not noticed, then subsequent treatment can be canceled.

If neoplasms appear in the uterine cavity after the operation, or if the tests do not give comforting results, then radiation or chemotherapy is necessary.

Chemotherapy uses drugs that kill cancer cells. The course can be in the form of tablets or injections. This procedure is a system-wide treatment, since medicinal substances, entering the woman's bloodstream, destroy all malicious bacteria in their path.

Radiation therapy is aimed at removing or shrinking the tumor. For this, x-rays or other types of rays are used. It is performed using special equipment using materials that conduct rays through plastic tubes aimed at the affected area.

Consequences of eliminating cystic drift

After the diagnosis and treatment of cystic drift, a woman needs to be under the supervision of a doctor for about 6 months. It is not necessary to spend this time in a hospital. A weekly clinic visit is enough. Otherwise, there may be risks of a return of the disease or the appearance of a trophoblastic tumor, which occurs if infected cells remain in the uterus.

Subsequently, the cells of this tumor begin intensive division. At the same time, there is a great danger of spreading the disease with blood flow to various organs (lungs, liver, brain). Therefore, observation by a gynecologist should last until all indicators return to normal.

There are also cases (fortunately, they are quite rare) of occurrence after the transfer of cystic drift of choriocarcinoma - this is an oncological disease that can turn the placental tissue into malignant. In the early stages, this disease is completely eliminated and is not so terrible for a woman's health. This pathology is seen in 1 out of 30,000 cases. Chemotherapy drugs are used for treatment.

After removal of the bladder drift, doctors give preventive chemotherapy if the hCG level does not decrease. The occurrence of metastases also entails this procedure. In most women, after the operation, remission occurs, after which the need for additional treatment disappears by itself.

Analysis of the hCG level can give a clear picture of what is happening, therefore chemotherapy is not prescribed for all patients who have undergone surgery to remove the vesicular mole.

Sometimes, after the treatment, a woman should be observed by a gynecologist for a year and a half, donating blood monthly to determine the level of hCG. During this period, the onset of a new pregnancy is strongly discouraged, hormonal contraception is shown (which, while protecting against pregnancy, at the same time regulates the function of the ovaries, impaired as a result of the disease and the course of chemotherapy carried out after it).

According to statistics, after treatment, almost 100% of women who have had a cystic drift recover. At the same time, 90% of them fully restore their menstrual function, and about 70% subsequently have a new pregnancy.

Unfortunately, after women have suffered from cystic drift, children born to them may have pathological changes. At the same time, the new pregnancy itself most often has a number of pathologies and during childbirth may be accompanied by weakness of labor, bleeding. This suggests that after an illness, women need careful monitoring by doctors for quite a long time. If control is carried out properly, women have every chance of maintaining reproductive function, the onset of normal pregnancy and the absence of pathologies during childbirth.

Sources of

  1. Non-operative gynecology. Smetnik V.P., Tumilovich L.G. 2005 Publisher: MIA.
  2. Practical Gynecology: Clinical Lectures. Kulakov V.I., Prilepskaya V.N. 2008 Publisher: MEDpress-inform.

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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It is no secret that microorganisms are involved in the body of every person during various processes, including the digestion of food. Dysbacteriosis is a disease in which the ratio and composition of microorganisms inhabiting the intestine is disturbed. This can lead to serious disruption of the stomach and intestines.

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

This pathological condition is manifested by early toxicosis, an increase in the size of the uterus in comparison with gestational age, and bleeding.

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

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

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

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

Classification of cystic drift

There are several classifications of cystic drift. They are based on histological and morphological features. According to the degree of degeneration of the chorionic villi, a partial and complete drift is distinguished. 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.

Causes and risk factors of the disease

Vesiculate motility develops as a result of chromosomal abnormalities during gestation. The full version of this pathology occurs when the maternal genes are lost and the set (haploid) of the paternal genes is duplicated, or when a nuclear-free egg is fertilized simultaneously by two spermatozoa.

Partial cystic motility also develops as a result of genetic disorders: fertilization of an egg by a sperm cell that has a diploid set of chromosomes. This condition is often accompanied by the development of multiple malformations (syndactyly, hydrocephalus, etc.).

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

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

Symptoms that accompany the pathology

One of the most characteristic signs for this pathological condition is the 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 rapid enlargement of the uterus is the result of rapid proliferation of vesicles. Moreover, its size does not correspond in any way to the expected gestational age.

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

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

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

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

Complete (simple) bladder skid

This pathological condition is the most common form of trophoblastic disease. It occurs with a frequency of 1/1000 - 1/1500 pregnancies (in Western countries). The greatest risk of developing complete bladder drift is in women younger than fifteen and older than forty.

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

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

Partial hydatidiform mole

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

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

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

How to get pregnant without consequences

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

During this control period, it is necessary to carefully make sure that pregnancy does not occur, 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.

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

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

Modern methods for the diagnosis of cystic drift

When diagnosed, this disease is differentiated 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.

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

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

If there is a suspicion of the development of cystic drift, the content of chorionic gonadotropin (CG) is necessarily examined, if necessary, then biochemical liver tests are performed, the level of creatinine and a coagulogram are determined.

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

Methods for treating cystic drift

The main method of treating cystic drift is the removal of this formation. For this, methods of vacuum aspiration with control curettage are used after preliminary dilatation (expansion) of the cervix. To improve 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

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

Chemotherapy is a systemic 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.

- pathology of the ovum, characterized by the transformation of the villi of the outer embryonic membrane (chorion) into cysts - fluid-containing bubbles, proliferation of villous epithelium, fetal death. Bubble drift is manifested by early toxicosis, bleeding, and an increase in the size of the uterus compared to the gestational age. Bubble drift is detected by vaginal examination, ultrasound, determination of the content of β-hCG, FKG of the fetus. Treatment consists in removing the vesicular drift by vacuum aspiration, curettage of the uterine cavity, and sometimes in carrying out a hysterectomy.

ICD-10

O01

General information

Bubble drift belongs to the group of so-called trophoblastic diseases. Under the term "trophoblastic disease", gynecology combines various forms of trophoblast pathology: simple and invasive cystic mole, chorionicarcinoma, placental bed tumor and epithelioid trophoblastic tumor. Malignant tumors of the trophoblast can develop during pregnancy, after abortion, ectopic pregnancy, childbirth, but more often they are the result of cystic drift.

Bubble drift develops in 0.02-0.8% of all pregnancies. With this pathology, there is a sharp edema of the stroma and the proliferation of chorionic villi with the formation of bubble-like extensions, resembling bunches of grapes. Vesicles (cysts) reach a size of 25 mm, contain an opalescent or yellowish liquid, which contains amino acids, globulins, albumin, chorionic gonadotropin. As a rule, cysts are devoid of blood vessels; occasionally, single formed capillaries are determined in them. Microscopically, the elements of the cystic drift are characterized by cystic and edematous degeneration of the stroma, the absence of signs of vascularization, hypertrophy of the trophoblast epithelium (syncytia, langans layer).

Classification of cystic drift

According to the degree of degeneration of the chorionic villi, complete and partial cystic drift are distinguished. With the full form of cystic drift, transformation affects all villous elements of the chorion; with partial - only a certain part of them. In both cases, the fetus dies, but the development of cystic drift continues, which is accompanied by a rapid increase in the size of the uterus.

Complete cystic motility is usually detected at 11-25 weeks of gestation, more often it contains the 46XX diploid chromosome set, with both X chromosomes being paternal. In 3-13% of cases, a combination of 46XY occurs with all paternal chromosomes. With a complete cystic drift, signs of the development of the embryo and embryo are absent, vesicles and edematous chorionic villi are visualized. Clinically, complete cystic drift is manifested by an increase in the size of the uterus compared to the duration of pregnancy. In 20% of cases, cystic drift undergoes malignant transformation and the development of metastatic trophoblastic tumors.

The timing of the development of a partial vesicular drift is variable: the pathology can be diagnosed at 9-34 weeks of gestation. Partial vesicular drifts are triploid (69XXX, 69XXY, 69XYU), their set contains one maternal chromosome, macroscopically there are fragments of the unchanged embryo and placenta, edematous chorionic villi. Clinically, the size of the uterus corresponds to or less than the gestational age. The probability of malignant transformation is up to 5%.

In addition, there is a destructive (invasive) form of cystic drift, characterized by the germination of villi deep into the myometrium and tissue destruction. Proliferating invading villi into the myometrium may be accompanied by severe intraperitoneal bleeding. According to the histotype, depending on the ratio of the cellular structures of the trophoblast, a mixed, syncytial, cytotrophoblastic vesicular drift is isolated.

Causes and risk factors for cystic drift

Vesiculate motility develops as a result of chromosomal gestational abnormalities. The full variant of cystic drift (uniformed disomy) occurs when the maternal genes are lost and the haploid set of paternal genes is duplicated (zygote karyotype 46XX) or when two spermatozoa are simultaneously fertilized by two spermatozoa of a defective anucleated egg (zygote karyotype 46XY, 46XX). For a partial variant of a cystic drift, triplodia is characteristic, which is a consequence of dyspermia or fertilization of an egg by a sperm with a diploid set of chromosomes (karyotype 69XXY, 69XYY or 69.XXX). With partial cystic drift, the fetus often has multiple malformations (hydrocephalus, syndactyly, etc.).

Due to the rapid growth of drift bubbles, a relatively rapid increase in the uterus occurs, in which its size does not correspond to the expected gestational period. With cystic drift, toxicosis is often noted, accompanied by nausea, repeated vomiting, salivation, exhaustion, increasing liver failure, symptoms of preeclampsia, preeclampsia and eclampsia already in the first trimester.

Since with cystic drift, the fetus, as a rule, dies in the early stages, there are no reliable signs of pregnancy - parts of the fetus are not determined by palpation and ultrasound, the heartbeat is not heard and is not recorded by hardware methods, fetal movements are absent. At the same time, biological and immunological tests for pregnancy give a positive result.

In 30-40% of cases, patients have bilateral tecalutein cysts, which independently regress after removal of the cystic drift. The greatest danger of cystic drift is due to the possibility of malignant gestational trophoblastic tumors metastasizing to the walls of the vulva and vagina, lungs, brain, and abdominal organs.

Diagnostics of the cystic drift

When diagnosed, cystic drift is differentiated from multiple pregnancy, polyhydramnios, pregnancy against the background of uterine fibroids, spontaneous miscarriage. The distinctive features include the presence of bubbles in the bloody discharge, usually observed before the expulsion of the cystic drift. In a gynecological examination, the dense-elastic consistency of the uterus with areas of excessive softening, excess of the size of the uterus of the gestational period is determined.

Ultrasound reveals an enlargement of the uterus in the absence of a fetus, homogeneous small cystic tissue (a symptom of a "snow storm"), the presence of tecalutein ovarian cysts with a diameter of more than 6 cm. When carrying out phonocardiography of the fetus, heartbeat is not recorded. According to the indications for cystic drift, USGSS, hysteroscopy, laparoscopic echography, diagnostic laparoscopy can be performed.

If you suspect the development of cystic drift, the content of chorionic gonadotropin (hCG) is necessarily examined; if necessary, biochemical liver tests, determination of creatinine and coagulogram are performed. To exclude metastatic screenings of the cystic drift, an x-ray of the chest, abdominal cavity, CT or MRI of the brain is performed. After removal of the cystic drift, a histological examination and determination of the karyotype are performed.

Treatment of bladder skid

When a cystic drift is detected, the therapeutic tactic is to remove it. The vesicular drift is removed by vacuum aspiration with control curettage after preliminary dilatation of the cervix. For better contraction of the uterus, oxytocin or pituitrin is prescribed. Sometimes there is an independent expulsion of the cystic drift from the uterine cavity. With the development of threatening bleeding or completed reproductive function,

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

The concept of cystic drift and its development mechanism

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

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

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

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

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

The reasons for the development of complications

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

Among the main ones, it is customary to distinguish:

  1. gestational chromosomal abnormalities: homogeneous disomy, triplodia, or a defect resulting from the fertilization of one functionally defective egg with 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 include:

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

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

Clinical picture







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

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

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

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

Diagnostic algorithm

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

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

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

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

Treatment

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

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

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

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

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

Any patient who has undergone treatment for the degeneration of the chorionic membrane is obliged to comply with the clinical recommendations of the Association of Oncologists of Russia, which include:

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

Is pregnancy possible after cystic drift?

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

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

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

Conclusion

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