How often women look forward to those cherished two stripes on the test that will turn their lives upside down! But, unfortunately, the joy of pregnancy does not always last as long as we would like. There are a huge number of pathologies, as a result of which this process must be interrupted. Many people know about miscarriage and missed pregnancy. But besides them, there is another deviation, as a result of which a woman fails to enjoy motherhood. This is the so-called bubble skid. So, what is this pathology and why does it occur? Let's analyze this issue in more detail.
What happens when you get sick?
Bubble drift is a disease of the chorion, during which its villi turn into formations from bubbles, the size of which can reach the size of a large grape and even more. They are connected by gray tree-like trunks containing a clear liquid with albumin or mucin.
According to statistics, hydatidiform mole occurs in one out of a hundred pregnant women. Exodusthe disease is almost always the same - either the independent death of the fetus with its subsequent expulsion from the uterine cavity, or artificial termination of pregnancy. The birth of a child, especially a he althy one, is possible with this pathology, but this is rather an exception to the rule, which has 1 chance in a million.
Causes of disease
The exact factor that provokes the development of the disease has not yet been identified. Previously, it was believed that cystic drift during pregnancy is the result of pathologies such as syphilis, anemia, chlorosis, nephritis, and so on. But recently the opinion of doctors has changed significantly. The specialists were divided into two camps.
The first assure that hydatidiform drift occurs as a result of inflammation of the uterine wall, and the process of degeneration of 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 suggestions that not the entire mucous membrane of the uterus, but only part of it, may be affected. To prove this conjecture, an example is given when, during a twin pregnancy, only one fetal egg degenerated, while the other remained he althy and did not become ill.
The second camp of doctors and scientists believes that the causes of the pathology are the following: the primary disease of the egg, which occurs even at the stage of its presence in the ovary, and secondary violations of its development already beyond the redistribution of the egg. Atthis confirmation of their theory is that during the disease very often there are cases when a fine-grained degeneration of both ovaries occurs. Then such formations will be defined as a sausage-shaped or spherical tumor with a bumpy surface.
Another reason that can cause the disease hydatidiform mole is the presence of a set of father's chromosomes in the fetus, while they are absent from the mother in insufficient quantities or not at all. Such a pathology occurs when there is a simultaneous fertilization of one egg by two spermatozoa.
Several types of disease
Simple mole occurs in the first three months of pregnancy. The reason for the development of the deviation is the presence in the fertilized egg of only paternal chromosomes. At the same time, maternal ones are completely absent. Duplication of paternal chromosomes leads to the fact that the formation of the embryo does not occur, there is no placenta and a fertilized bladder. A complete hydatidiform mole can be detected by ultrasound. During the procedure, it will be seen that the size of the uterus is significantly different from the expected gestational age (they are enlarged). The formation of a malignant tumor and the appearance of metastases can also be observed.
Partial hydatidiform mole is characterized by the presence in the fertilized egg of one set of maternal and two paternal chromosomes. Such situations occur when one egg is inseminated by two spermatozoa. It can also happen whenduplication of paternal chromosomes. This type of mole develops after 12 weeks of pregnancy. In this case, the formation of a cystic placental structure and placental tissue occurs.
There is also an invasive form of the disease, in which villi grow into the very depths of the myometrium, destroying all tissues. This pathology may be accompanied by bleeding.
Risk factors for disease development
Most often a hydatidiform mole occurs when:
- repeated pregnancies;
- presence of many abortions;
- immunodeficiency;
- ectopic pregnancy;
- lack of vitamin A and animal fats in food;
- thyrotoxicosis (thyroid disease);
- early (before 18) or late pregnancy (after 40);
- closely related intimate relationship.
Sleep drift: symptoms
The most obvious sign of the presence of the disease is the appearance of discharge from the genital tract of a dark red color with an admixture of rejected mole vesicles. They are not very abundant and irregular. But if this deviation is detected, urgent hospitalization of the pregnant woman is required, since there is a risk of death. If deep growth of elements of cystic drift occurred in the thickness of the myometrium, then intra-abdominal bleeding is possible.
The absence of the simplest symptoms of pregnancy may also indicate the presence of pathologies: the fetal heartbeat, which cannot be heard even with the help of ultrasound, its movement, andalso probing parts of the child. With all this, a pregnancy test shows a positive result, but the concentration of hCG exceeds the normal norm. In such a situation, a hydatidiform drift is quite obvious.
Signs that may also indicate pathology:
- toxicosis accompanied by vomiting;
- increasing liver failure;
- profuse salivation;
- weight loss;
- symptoms of ecclamasia and preeclampsia in the first trimester;
- protein in urine;
- puffiness;
- abdominal pain;
- headaches;
- increased blood pressure;
- weakness.
Also, hydatidiform drift, the symptoms of which, as already mentioned, can occur both in the first and second semester, is characterized by an active increase in the size of the uterus. As a rule, they significantly exceed the norm for the established period.
Bubble drift: consequences
The main complication of the disease is the development of choriocarcinoma. This is a trophoblastic disease of a malignant form, which is characterized by the germination of pathological tissues in the uterus, liver, lungs and brain. And this is already leading to death.
There are several stages of gestational tumors:
- mole itself, characterized by the presence of malignancy within the uterus;
- the so-called placental bed - the localization of the tumor in the muscles of the organ and at the placenta attachment;
- non-metastatic tumor - germination in the uterus similar to ittissues after abortion, childbirth or hydatidiform mole;
- metastatic tumors with a good prognosis - a malignant tumor 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 - the cancer spreads outside the uterus to other organs.
In addition to this pathology, hydatidiform mole has several other negative consequences. For example:
- Inability to develop subsequent pregnancies (infertility). This consequence is observed in 30% of women who have had the disease.
- Amenorrhoea is the complete or partial absence of menstruation. This pathology develops in almost 12% of patients.
- Septic diseases.
- Thrombosis.
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 illness is also characteristic of a normal pregnancy. As a rule, a woman learns about a hydatidiform mole either during a planned ultrasound procedure, or only after the appearance of bleeding or the absence of fetal movements in due time.
Methods of diagnosing the disease:
- gynecological examination, during which the doctor can feel the densely elastic consistency of the uterus and determine the increaseher size;
- Ultrasound - shows the presence of ovarian cysts and homogeneous fine-grained tissue;
- phonocardiography - listens to the heartbeat of the fetus, which is absent during the disease;
- studies of chorionic gonadotropin (in rare cases, analysis of the determination of coagulogram and creatinine is performed, and liver samples are also taken);
- hysteroscopy;
- biopsy;
- diagnostic laparoscopy;
- X-ray of the abdominal cavity and chest, MRI of the brain - carried out in order to exclude screenings of hydatidiform mole;
- laparoscopic ultrasound.
Tests required to detect pathology:
- blood biochemistry;
- general urine and blood tests.
A patient diagnosed with a disease should consult an oncologist, surgeon, endocrinologist and nephrologist.
Problem Solving
After the diagnosis of "hydatidiform mole", the treatment of which is aimed at removing the neoplasm from the uterine cavity, is confirmed, the woman is sent to the hospital. If the disease does not have complications and the gestational age does not exceed 12 weeks, then a curettage procedure is performed. To do this, the cervix is stretched, which provides better access to its cavity, and with the help of a curette (a special tool), all uterine contents are removed.
Vacuum aspiration is used even when the uterus is 20 weeks pregnant. This procedure consists in suctioning the contents of the cavity with the help of a specialequipment. It is often performed along with scraping.
When the volume of the uterus increases to a size that corresponds to 24 weeks of pregnancy, a hysterectomy (removal of the uterus) is performed. Also indications for the operation are the thinning of its walls, perforation with a mole and the presence of metastases in the lungs or vagina. In this case, the ovaries are not removed.
After removing the hydatidiform mole from the uterine cavity, its tissues are sent for histological examination to exclude chorionepithelioma. If this procedure showed malignancy of the formation, the level of hCG after hydatidiform mole tends to increase, and foci of metastatic origin are found in the lungs, then the patient is prescribed chemotherapy.
For the treatment of pathology, Methotrexate and Dactinomycin are used, or a drug that combines these two drugs - Leucovorin. The main direction of action of these medicines is to destroy cancer cells. The intake of these drugs is prescribed until the level of hCG and the menstrual cycle normalize, pathological foci in the lungs and uterus disappear. After getting rid of these symptoms, the patient is prescribed several more prophylactic chemotherapy courses with the same drugs.
In some cases, radiation therapy in the form of x-rays and other types of radiation may be necessary. It is carried out both outside, with the help of devices, and from the inside. In the latter case, the so-calledradioisotopes that produce radiation to the area where malignant cells are located, using thin plastic tubes.
Patient follow-up after treatment
Approximately for two years after the operation, the woman is under the close supervision of an oncologist. At this time, she undergoes the following procedures:
- Control hCG levels every week for 1-2 months until the result is negative 3 times in a row. After that, this analysis is carried out, but much less frequently.
- X-ray of the lungs is performed once a month until the hCG level normalizes.
- 14 days after the operation to remove the mole, an ultrasound of the pelvic organs is done. Then the procedure is performed every month until the hCG levels are negative.
Is pregnancy possible after illness?
A mole, the consequences of which can be very deplorable, is not a disease leading to complete infertility. But it is worth considering that throughout the entire time of observation of the patient by the oncologist, she is not recommended to become pregnant. The main method of contraception at this time is the use of hormonal drugs. This is due to their positive effect on the regulation of ovarian function, impaired as a result of the disease.
Planning for the next pregnancy should be no earlier than 2 years after the operation. This is especially true if the patient was undergoing chemotherapy. After the onset of conception, a woman should be under close supervision.control of medical personnel, as there is a high probability of complications during pregnancy and childbirth.
A patient who has had a hydatidiform mole and wants to get pregnant again should not set herself up for a worse outcome and the inability to have children. Thanks to modern medicine, almost 70% of women experience the joy of motherhood after overcoming this disease.
Can the ailment return?
As a rule, a relapse of the disease manifests itself in the form of a malignant tumor in the pancreas, lungs and other organs and tissues.
