Simple blistering. Complete hydatidiform mole

A hydatidiform mole (molar pregnancy) is a rare pregnancy complication that occurs in approximately one woman in a thousand. It occurs when the villi of the chorion - the membrane that surrounds the fetus and attaches it to the wall of the uterus - degenerate into bubble structures that resemble bunches of grapes. Their size is very different: from half a match head to a large grape. These neoplasms are considered benign.

In pregnant women with twins rare cases one fetus may develop normally, and the second embryo does not form or dies as a result of hydatidiform mole. In such cases, many women can endure and give birth healthy child.

What happens during a hydatidiform mole?

At normal pregnancy a fertilized egg (zygote) begins to divide, and upon reaching a certain number of cells, they are divided into two groups: an embryo is formed from one, and an embryo is formed from the other membranes including the chorion. Bubble skid develops in two cases:

1. The spermatozoon fertilizes the egg, which does not have its own nucleus. In the future, the paternal chromosomes are doubled, thus replacing the missing maternal ones. But such a zygote is not viable, the embryo does not form from it, and the chorionic villi turn into abnormal vesicles. This type of hydatidiform drift is called complete.
2. Two sperm enter a normal egg at the same time. Zygote cells contain 3 sets of chromosomes, which leads to the death of the embryo on early stages development. The chorionic villi also develop abnormally and form vesicles. This pathology is called incomplete hydatidiform mole.

Causes of hydatidiform mole

The causes of hydatidiform drift have not been established at present. But there are factors that increase the risk of its development:

• age: complete hydatidiform mole occurs at adolescence and those over 45. The number of previous pregnancies does not matter. Significant connection between partial skid and age is not established;
• history of molar pregnancy - if a woman has had such a pathology before, the chances of re-development are regarded as 1-2% (without such experience 0.6%). Two or more hydatidiform drifts increase this figure to 15-20%;
• ethnicity: this complication of the course of pregnancy is most often found in representatives of Asian countries (Philippines, Japan, Taiwan);
• previous miscarriages.

Symptoms

A molar pregnancy is often perfectly disguised as a normal pregnancy and the diagnosis is usually made during the planned first ultrasound (at the 10-14th week of pregnancy).

If there are signs of violations, then they usually occur between the 4th and 12th weeks. The most common symptom is uterine bleeding, brown-reddish discharge from the vagina, in which altered chorionic villi are sometimes visible, resembling a bunch of grapes. These are serious symptoms that require immediate medical attention. Standard Diagnostics causes of bleeding include ultrasound, during which a picture characteristic of a mole is detected.

Many women who are subsequently diagnosed with a molar pregnancy report weakness and nausea in the first semester, usually more intense than during normal childbearing.

If a miscarriage occurs, the tissues of the fetus must be sent for examination in order to exclude a hydatidiform mole.

At medical examination other signs of hydatidiform drift may be detected:

• uterus has big sizes than is typical for the current term;
• high blood pressure;
• preeclampsia;
• ovarian cysts;
• anemia
• hyperthyroidism;
• lack of movement and fetal heartbeat.

Diagnostics

Diagnosis begins with a conversation with a doctor. It is very good to prepare answers to some questions in advance:

• date last menstrual period?
• when were the symptoms first noticed?
• Is the discomfort permanent or does it happen from time to time?
• is there any pain? if so, what is the nature and intensity of the pain?
• compared to the most intense day normal menstruation discharge stronger, weaker, the same?
• Are you worried about dizziness?
• Has a hydatidiform mole been previously diagnosed?
• which chronic diseases are there?
• are you going to get pregnant in the future?

The next steps to confirm the diagnosis are a gynecological examination and laboratory diagnostics. The woman takes blood for general and biochemical analysis, determine the level chorionic gonadotropin sent for ultrasound abdominal cavity. If a molar pregnancy has already been diagnosed, then in a number of other cases, using visual diagnostic methods (X-ray, CT, MRI), the presence of metastases in the lungs, brain, and liver is checked.

Treatment of hydatidiform mole

Bubble drift cannot end in the birth of a child (the exception is twins). Therefore, when such a pathology is detected, the pregnancy is interrupted. Sometimes the body independently cleans the uterine cavity from cysts that come out along with the discharge. If it doesn't, they are removed. surgically. Usually under general anesthesia. Standard procedure called dilation and curettage of the uterus. During it, the doctor, using a gynecological speculum, gains access to the cervix, opens it and vacuum apparatus removes the contents of the organ cavity.

It is difficult to get rid of absolutely all pathological cells. Fortunately, after surgery, in 90% of women, they die on their own.

To ensure the success of treatment, women regularly donate blood for 6 months or more to control the level of human chorionic gonadotropin (CG). If at the end of this period the hormone is still present in the blood, this may indicate a relapse of the disease or the degeneration of benign growths into malignant ones. Normally, the hCG hormone is secreted during pregnancy. Therefore, women are asked to refrain from conception for six months to a year in order to avoid misinterpretation of the results, and in case of incomplete removal of abnormal chorion tissue, the development of a second molar pregnancy.

Women who no longer plan to have children may have their uterus removed (hysterectomy).

Folk treatment of hydatidiform mole

There are many "grandmother's" recipes on the Web that supposedly help cure molar pregnancy. But none of them has proven effectiveness. The time spent on ineffective procedures may be enough for the transformation of a benign neoplasm into a malignant one, which is much more difficult to treat.

Complications

In some cases, unremoved cells do not die, but continue to multiply, forming more and more cysts (recurrent hydatidiform mole). The worst option is the transformation of the tumor into a malignant choriocarcinoma. Cancer cells penetrate into the tissues of the uterus, sometimes germinating through it and provoking internal bleeding. When germinating into the vessels, tumor cells are carried with the blood to the organs and form metastases, most often in the lungs, brain or liver.

Chemotherapy is highly effective if choriocarcinoma and recurrent hydatidiform mole are detected in time. Relapse after treatment occurs in approximately 1-3% of women. It is necessary to control the level of hCG, as this indicator helps to notice in time re-development disease and timely start a course of chemotherapy.

Forecast

Complete cure is possible in most cases. Only 1% of women in the future may recurrence. After a second molar pregnancy, the risk of developing a third one is much higher - up to 15-20%.

In rare cases benign neoplasms become malignant. But even with this option, chemotherapy leads to a complete recovery in 90% of women.

Emotional Complications

Subsequent pregnancies

Re-pregnancy should be planned only after the entire period of monitoring the level of hCG is completed. Later, the woman has good chances conceive, bear and give birth to a healthy child. The doctor leading the pregnancy must be aware of previous cystic drifts, as well as other features of previous pregnancies. Because once diagnosed women are slightly more high risk its development, they may be recommended the first ultrasound for more early dates than with a standard examination.

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

The concept of cystic drift and its development mechanism

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

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

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

Vesicle drift during pregnancy can develop by 2 different mechanisms:

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

Reasons for the development of complications

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

Among the main ones it is customary to single out:

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

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

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

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

Clinical picture

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

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

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

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

Diagnostic algorithm

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

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

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

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

Treatment

When a diagnosis of "paint pregnancy" is made, a woman will not be able to endure and give birth to a baby. The exception is cases of bearing several fetuses when it comes to twins. Then one of the fruits develops fully, and the second dies.

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

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

The early postoperative period includes the control of hCG for six months. This examination is mandatory to detect a possible recurrence. After all, it is chorionic gonadotropin that indicates the completed conception, and can be released due to the presence of residual non-removed villi. Besides, in postoperative period shows the control of ultrasound of the pelvic organs and x-ray of the lungs.

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

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

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

Is pregnancy possible after hydatidiform mole?

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

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

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

Conclusion

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

- pathology of the fetal egg, characterized by the transformation of the villi of the outer germinal membrane (chorion) into cysts - fluid-containing vesicles, the growth of the epithelium of the villi, and the death of the fetus. Bubble drift appears early toxicosis, bleeding, an increase in the size of the uterus compared with the gestational age. A mole is detected using a vaginal examination, ultrasound, determination of the content of β-CHG, fetal PCG. Treatment consists of removing the mole by vacuum aspiration, curettage of the uterine cavity, and sometimes a hysterectomy.

ICD-10

O01

General information

Cystic drift is included in the group of so-called trophoblastic diseases. Under the term "trophoblastic disease", gynecology unites various forms trophoblast pathologies: simple and invasive hydatidiform mole, choriocarcinoma, placental bed tumor and epithelioid trophoblastic tumor. Malignant tumors of the trophoblast can develop during pregnancy, after an abortion, ectopic pregnancy, childbirth, but more often they are the result of hydatidiform mole.

Vesicular mole develops in 0.02-0.8% of all pregnancies. With this pathology, there is a sharp edema of the stroma and the growth 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, albumins, chorionic gonadotropin. As a rule, cysts are devoid of vessels; occasionally they are determined by single formed capillaries. Microscopically, the elements of hydatidiform mole are characterized by cystic and edematous degeneration of the stroma, the absence of signs of vascularization, hypertrophy of the trophoblast epithelium (syncytium, Langhans layer).

Classification of hydatidiform mole

According to the degree of degeneration of the chorionic villi, a complete and partial cystic skid is distinguished. At full form cystic skid 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 hydatidiform drift continues, which is accompanied by rapid increases in the size of the uterus.

Complete hydatidiform mole is usually detected at 11-25 weeks of gestation, often contains a diploid chromosome set 46XX, while both X chromosomes are paternal. In 3-13% of cases, a combination of 46XY with all paternal chromosomes occurs. With complete hydatidiform mole, there are no signs of the development of the embryo and the embryo, vesicles and edematous villi of the chorion are visualized. Clinically, complete hydatidiform drift is manifested by an increase in the size of the uterus compared with the gestational age. In 20% of cases, hydatidiform drift undergoes malignant transformation and the development of metastatic trophoblastic tumors.

The timing of the development of partial hydatidiform mole is variable: pathology can be diagnosed at a period of 9-34 weeks of gestation. Partial cystic drifts are triploid (69ХХХ, 69ХХУ, 69ХУУ), their set contains one maternal chromosome, macroscopically there are fragments of an unchanged embryo and placenta, edematous chorionic villi. Clinically, the size of the uterus corresponds to or less time gestation. The probability of malignant transformation is up to 5%.

In addition, there is a destructive (invasive) form of hydatidiform mole, characterized by the germination of villi into the depth of the myometrium and tissue destruction. Proliferating villus invasion 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 hydatidiform mole is distinguished.

Causes and risk factors for hydatidiform mole

A cystic drift develops as a result of chromosomal gestational disorders. Full version cystic drift (uniparental disomy) occurs when the maternal genes are lost and the haploid set of paternal genes is duplicated (46XX zygote karyotype) or when two spermatozoa simultaneously fertilize an inferior non-nuclear egg (46XY, 46XX zygote karyotype). A partial variant of hydatidiform mole is characterized by triplodia, which is the result of dispermy or fertilization of the egg by a sperm with a diploid set of chromosomes (karyotype 69XXY, 69XYY or 69.XXX). With partial hydatidiform drift, the fetus often has multiple malformations (hydrocephalus, syndactyly, etc.).

Due to the rapid growth of skid bubbles, relatively rapid increase uterus, in which its size does not correspond to the expected gestational age. 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 pregnancy - parts of the fetus are not determined by palpation and with the help of ultrasound, the heartbeat is not audible and is not recorded by hardware methods, there are no fetal movements. At the same time, biological and immunological pregnancy tests give a positive result.

In 30-40% of cases, bilateral thecalutein cysts are detected in patients, which spontaneously regress after removal of the hydatidiform mole. The greatest danger of cystic drift is due to the possibility of malignant gestational trophoblastic tumors that metastasize to the walls of the vulva and vagina, lungs, brain, and abdominal organs.

Diagnosis of hydatidiform mole

When diagnosing, cystic drift is differentiated with multiple pregnancies, polyhydramnios, pregnancy against the background of uterine fibroids, spontaneous miscarriage. TO distinctive features the presence of vesicles in the bloody discharge, usually observed before the expulsion of the hydatidiform mole, is included. In a gynecological examination, the dense elastic consistency of the uterus is determined with areas of excessive softening, the excess of the size of the uterus over the gestational age.

Ultrasound reveals an increase in the uterus in the absence of a fetus in it, homogeneous small-cystic tissue (a symptom of a "snow storm"), the presence of tecalutein ovarian cysts with a diameter of more than 6 cm. During fetal phonocardiography, the heartbeat is not recorded. According to the indications for cystic drift, ultrasound, 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 tests of the liver, determination of creatinine and coagulograms are performed. To exclude metastatic screenings of hydatidiform mole, an X-ray of the organs is performed. chest, abdomen, CT or MRI of the brain. After removal of the cystic drift, a histological examination and determination of the karyotype are performed.

Treatment of hydatidiform mole

When a cystic drift is detected, the therapeutic tactic is to remove it. The cystic 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 cystic drift from the uterine cavity. With the development of threatening bleeding or performed reproductive function,

Every woman planning a desired pregnancy wants with all her heart the successful bearing and development of the fetus and is afraid of any deviations in this process. This, unfortunately, happens, although not so often. One of serious illnesses occurring against the background of pregnancy is a cystic skid.

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

What is a disease?

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

The mechanism of the occurrence of pathology

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

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

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

The embryo needs nutrition, in addition, it is important for it to attach securely. Therefore, its outer shell - the chorion - is equipped with special villi, which, like the branched roots of a tree, are immersed in the mucous membrane of the uterine wall, fastened to it. blood vessels and begin to form the placenta. The rest of the chorion is transformed - it becomes the umbilical cord and fetal membranes.

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

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

Is pregnancy compatible with this pathology?

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

What are the causes of pathology?

• Absence female X chromosomes in general or doubling the number male Y chromosomes. That is, if normally the embryo receives 46 chromosomes - equally from the mother and father, then this disease involves 46 paternal cells or 69 in general (23 maternal and 46 paternal).
• One of the reasons, according to a group of scientists, is the lack of estrogen, which is caused by a general hormonal dysfunction. predominance male hormone in early pregnancy causes various problems, including hydatidiform mole.
• Infectious diseases, especially transferred at the time of conception.

Signs and symptoms

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

• An increase in the uterus that does not correspond to the gestational age. This is one of the most important features, which characterizes a complete hydatidiform mole, in which all chromosomes are male. The growing tissue of the chorion stretches the walls of the organ, which a specialist can establish during a manual examination. However, the incomplete form of the disease may not have this feature for a long time.
• Signs of hydatidiform mole are usually well seen during ultrasound examination. Overgrown non-viable tissue with clusters of bubbles is easy to distinguish from normal flow pregnancy. Ultrasound allows you to identify the nature of the pathology - partial damage to the uterus, complete or destructive (invasive), when the mutating tissue grows inside the organ. In this case, we can talk about a malignant tumor formation.
• Bleeding. This is a formidable sign in any, including normal pregnancy.
• The hallmark of hydatidiform mole is vaginal discharge with bubbles - particles of the affected tissue.
• Toxicosis, characterized severe vomiting weakness and general malaise.
• The absence of the fetus or its death. Most often, it does not even begin to form. With partial introduction, lack of nutrition leads to the absence of signs of life of the embryo. An ultrasound specialist can determine this during the diagnosis (no heartbeat is heard, the fetus is not visible), the woman herself does not feel the baby's movements.
• Exceeding the norm by ten times the volume hCG hormone, which does not decrease with the course of pregnancy.

Diagnostics

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

Most sure sign, by which chorionadenomas can be determined - the presence of bubbles in the discharge from the vagina. External examination does not reveal a heartbeat, the uterus is softened in places.

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

• enlarged uterus;
• there is no ovum or fetus, sometimes parts of it are visualized;
• presence in the uterus characteristic appearance tissues with many bubbles;
• 50% of pregnant women diagnosed with hydatidiform drift have large symmetrical luteal cysts in both ovaries at the same time.

Treatment

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

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

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

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

How to be further?

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

• The fetus could not develop in such conditions, which means that it was not viable from the beginning.
• Even with the most unfavorable results of pathology studies, it is 100% cured.
• A normal pregnancy after a hydatidiform mole is possible.

Having passed necessary rehabilitation, which includes state control, normalization hormonal background and recovery menstrual cycle, a woman can bear and give birth healthy baby. This unpleasant and frightening disease is not a sentence, and modern medicine able to deal with it.

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

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

With cystic drift, the trophoblast degenerates into great amount small bubbles. These vesicles occupy the entire uterine cavity, tend to rapid growth and distribution to the lungs, ie. metastasis. The cells of the hydatidiform mole produce human chorionic gonadotropin. Normally, chorionic gonadotropin - the hormone of pregnancy - is produced during the bearing of the baby, but in much smaller quantities. The embryo with cystic drift dies in the early stages of development.

Causes

A hydatidiform mole occurs when maternal genes are lost and paternal chromosomes are duplicated for unknown reasons. Sometimes (in 5% of cases) hydatidiform mole is caused by the fertilization of an empty (non-nuclear) or normal egg by two spermatozoa.

The incidence of hydatidiform mole (MM) is relatively low and amounts to 1 case per 1000 births. However, the frequency of the disease varies different regions. So, in the USA the disease occurs from 0.6-1.1 per 1000 pregnancies, and in some areas of Asia and South America - 10 times more often (1 case per 120 pregnancies).

Symptoms of the disease

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

All of the above symptoms should make a woman immediately contact an obstetrician-gynecologist.

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

However, the size of the uterus may correspond to the expected gestational age, and in early pregnancy it may even be smaller than the obstetrician-gynecologist suggests.

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

Diagnosis and treatment

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

Treatment of a benign form of trophoblastic disease of hydatidiform mole mainly comes down to its removal using vacuum aspiration - suction of the contents of the uterus using metal cylindrical tips and an electric vacuum pump.

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

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

In the absence of signs of illness ( normal rate CG up to 15 MIU/ml, no tumor formations according to pelvic ultrasound and X-ray examination of the lungs, as well as the restoration of a normal menstrual cycle), chemotherapy is not performed.

A further study of hCG in the blood serum is carried out once every two weeks for 3 months, and then once a month for six months. Optimal time for the offensive desired pregnancy- one year after the evacuation of the mole.

If, 8 weeks after the evacuation of the hydatidiform mole, there is no normalization of hCG indicators or there is a tendency to increase hCG, the patient is prescribed an in-depth examination, since these test results indicate that the cells of the hydatidiform mole are preserved in the uterus or other organs, which produce HG.

According to the ultrasound of the small pelvis, foci of hydatidiform mole in the uterus can be detected, and an x-ray examination of the lungs can reveal a metastatic lesion. These patients are treated with chemotherapy. The most common treatment for this disease is chemotherapy. METHOTREXATE And dactinomycin or a combination of them in combination with LEUCOVORIN. Treatment is carried out until the normalization of hCG indicators, the restoration of the menstrual cycle, the disappearance of pathological foci in the uterus and lungs. However, it must be remembered that fibrotic changes - foci of connective tissue at the site of pathological foci in the uterus and lungs - can persist for quite a long time, despite complete recovery.

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

After the treatment, the patient remains under the supervision of an oncologist for 1-1.5 years (during this time, serum hCG is determined every month). At this time, abstinence from pregnancy is recommended, while the best option protection against unwanted pregnancy is hormonal contraception, which simultaneously with the contraceptive effect regulates ovarian function, impaired due to the disease and ongoing chemotherapy.

Timely diagnosis and correct treatment tactics can preserve the reproductive function of a woman and guarantee the onset of a normal pregnancy and subsequent childbirth.

According to RONTS them. N.N. Blokhin, thanks to the success of chemotherapy, it was possible to cure almost 100% of patients suffering from PD. In 90% of patients receiving chemotherapy, menstrual function was completely restored, and in 70% pregnancy occurred, which ended in normal delivery.

It should be noted that pathological changes in children born to women after hydatidiform mole are somewhat more common than in children of healthy women. At the same time, pathology in childbirth (bleeding, weakness generic duration etc.) in patients with trophoblastic disease was slightly higher compared to healthy women. This fact indicates that after this disease, a woman needs especially careful monitoring by doctors.