Pregnancy is a sacrament from its first to its last day, it is a state of anticipation, a growing sense of responsibility. With all the miracles modern diagnostics, capable of predicting multiple births, finding out the sex of the child, talking about his health - the upcoming meeting with the baby excites and pleases.
And suddenly, at this time of hope, like thunder from a clear sky, a diagnosis rings out - hydatidiform mole.
Hydatidiform mole - what is it during pregnancy?
Hydatidiform mole- this is one of the worst complications of pregnancy, which has serious consequences and requires emergency treatment. In the uterus, the development of the outer membrane of the fetus is disrupted with the development of multiple hollow elements filled with protein secretions. They are connected to each other by connective tissue trunks, creating a picture of a bunch of grapes.
The fetus, with the exception of very rare cases, dies, and its outer shell (chorion) grows into an independent tumor.
Some information about the processes occurring in the uterus
A newborn girl has about 400 thousand already formed eggs, some of which, upon reaching puberty, leave the ovary one by one, creating the prerequisites for pregnancy. If it does not occur, then the inner lining of the uterus is shed with menstrual blood, so that after a month the new mucous membrane is ready for pregnancy.
Already on the 5-6th day of pregnancy, 25-150 mU/ml of the specific hormone hCG (human chorionic gonadotropin) is detected in a woman’s blood, the purpose of which is to inform the woman’s body about the onset of a new condition that requires a change in hormonal levels. This hormone is produced by the chorion.
It is on the detection of hCG that tests for determining pregnancy are based on establishing exact date its onset.
HCG reaches its maximum concentration by three months of pregnancy, then its level decreases. A decrease or increase in hCG levels compared to the norm allows doctors to diagnose many problems during pregnancy. With hydatidiform mole hCG level rises.
Causes of hydatidiform mole
Several theories explain the occurrence of this pathology, and each of the assumptions is confirmed in medical practice.
1. Some researchers see the reason in the period of embryonic development of a woman who has a hydatidiform mole.
In their opinion, when the ovaries of a female embryo are laid, some of the eggs do not receive a chromosome set due to improper splitting of the cell nucleus (in germ cells there is a half set of chromosomes - 23 out of 46 - so that when two cells merge, an organism with a full set develops).
If an egg that does not contain chromosomes is fertilized, then a new organism will not develop with only the paternal chromosomes. The unclaimed chorion begins to develop independently inside the uterus.
2. There is an opinion that a hydatidiform mole can also develop in the case when either one sperm with a double set of chromosomes or two sperm penetrate into a normal egg, and then the additional 23 chromosomes turn out to be superfluous, causing the death of the fetus at a later date.
3. Another group of scientists defends the version that the culprit is a defect in the inner lining of the uterus (endometrium), which arose as a result of frequent abortions, diagnostic procedures, genitourinary infections. The chorion, when attached to an unhealthy area of the uterus, begins to develop in the form of a hydatidiform mole.
4. Some clinicians, when examining patients with this pathology, identify altered ovarian tissue, which gives them the right to assume that the development of the egg is disrupted there, and hydatidiform mole is a consequence of changes, first of all, in the ovary.
5. Some see the viral nature of the development of the disease.
6. There are enzymatic and immunological theories that explain the improper development of the chorion by biochemical processes.
Classification
- There are simple and invasive (destructive) hydatidiform moles.
- The simple form is divided into complete and partial.
With a complete hydatidiform mole, the entire chorion is involved in the process, the death of the embryo quickly occurs, and the pathology is revealed on early stages.
Hydatidiform mole is partial - detected at 9-34 weeks, it is characterized by local degeneration of the outer membrane of the fetus.
The most severe form is destructive. With it, the chorionic villi, which normally contain blood vessels to nourish the embryo, grow into the wall of the uterus, causing its thinning, internal bleeding and contamination with pathological cells of other organs.
The signs of hydatidiform mole are quite characteristic and allow one to avoid making mistakes in diagnosis.
A woman at the appointment complains of bloody, abdominal pain, vomiting, increased salivation, palpitations, elevated temperature and deterioration in general condition.
When taking measurements, the doctor notes that the volume of the abdomen and the size of the uterus correspond to a longer period of pregnancy, while the fetal head, its heartbeat and movement are not determined, weight loss and an increase in the level are noted.
Septic complications and thrombosis may develop. The most serious complication is the development of malignant chorionic carcinoma, in which, in addition to the uterus, the tumor also affects the liver, vagina, lungs and brain with a fatal outcome.
In addition, malignant tumors may develop that do not extend beyond the uterus.
If a hydatidiform mole is diagnosed, the woman is admitted to the hospital. First of all, life-threatening complications are treated: eclampsia, anemia, thyrotoxicosis.
Then the hydatidiform mole is removed - in cases of short pregnancy, this is done by curettage of the hydatidiform mole or vacuum aspiration.
In the second half of pregnancy (over 20 weeks), an attempt is made to reject the tumor using drugs that stimulate labor. If unsuccessful, do C-section with curettage of the uterine cavity or complete removal uterus leaving the ovaries.
After discharge from the hospital, the woman is registered with a dispensary.
If regular menstrual cycle has not recovered and is bleeding:
- They do a pelvic ultrasound every two weeks, and after the cycle is restored - once every three months for a year;
- HCG is monitored once a week until its normal level is restored;
- for two years, an hCG test is performed once a month;
- X-rays of the lungs are periodically repeated to identify metastases;
- hormonal contraception for two years to restore ovarian function.
If saved increased level HCG or a further increase is noted, if after the operation an invasive form of hydatidiform mole or its metastases is revealed, if a histological examination of the hydatidiform mole shows malignant degeneration, then the second stage of treatment is carried out - chemotherapy using the drugs Dactinomycin, Methotrexate or Leucovorin, combining both of these means.
With a favorable outcome of treatment for hydatidiform mole, 70% of women can count on the possibility of another pregnancy two years after a course of chemotherapy. Naturally, it will take place under the special supervision of a doctor.
Hydatidiform mole is a rare pathology of pregnancy associated with the defective function of fertilization of the egg, incompatible with the development of pregnancy and the birth of a live fetus.
The result of the pathological process during hydatidiform mole is the formation in the uterus instead of a normal placenta unusual fabric, consisting of cluster-shaped clusters of bubbles filled with liquid. The source of this transformation is the chorionic villi. If pathological growth fills the entire uterine cavity, hydatidiform mole is classified as complete (classic). Partial hydatidiform mole is localized only in a certain area of the fetal membrane.
Sometimes there is another name for hydatidiform mole - chorionadenoma.
There is reliable data on the possible malignant transformation of any form of hydatidiform mole. The malignant, and most severe, form of the disease is called destructive hydatidiform mole.
To understand the pathogenesis of pathology, it is necessary to recall the events following fertilization. Let us recall that two sex cells - an egg and a sperm - merge into one. Moreover, each of the “parental” cells endows the future embryo with chromosomes - female (X) and male (Y), 23 chromosomes from each. Of the 46 chromosomes belonging to the parents, the fertilized egg inherits only 23, and the “male/female” ratio determines the gender of the fetus.
A few hours after fertilization, the egg begins to divide, turning into a multicellular structure, which gradually moves towards the uterine cavity along the fallopian tube. After five days, the beginning of a new life reaches the uterus and is introduced (implanted) into its mucous layer.
Since the embryo will constantly develop and grow, its outer shell must be firmly fixed at the site of implantation. For this purpose, the outer embryonic membrane (chorion) at the site of attachment of the embryo to the uterine wall (future placental site) forms peculiar outgrowths - branched villi, which, like the roots of a tree, are deeply immersed in the mucous membrane and connect with the blood uterine vessels; subsequently, these villi will become a source formation of the placenta. The remaining cells of the outer membrane of the embryo are transformed into the umbilical cord and fetal membranes.
With hydatidiform mole, the villi surrounding the fertilized egg do not form the placenta, but degenerate into a completely non-viable structure - an unusual tissue similar to bubbles. The stroma around the villi swells, they grow to form vesicle-like extensions (cysts). When combined, these extensions become like bunches of grapes. Each cyst is filled with an iridescent yellowish fluid that secretes hCG human chorionic gonadotropin (pregnancy hormone), so the hCG numbers for hydatidiform mole have an important diagnostic meaning.
An embryo that requires oxygen and nutrition to develop normal pregnancy receives what it needs from the placenta, but in the case of hydatidiform mole there is simply no such source, so inevitable degradation and death of the germ cells occurs.
The degenerated tissue is not limited to the place of its primary formation, it begins to grow, and the affected area increases. This behavior of the tissues of a hydatidiform mole allows us to compare it with a tumor.
The causes of hydatidiform mole remain unclear, however, reliable studies have established a connection between the development of pathology and the fertilization process, when during the fusion of germ cells the loss of maternal cells and duplication occurs male chromosomes.
Clinical symptoms of hydatidiform mole are ambiguous and depend on the behavior of the expanding chorion and gestational age. More often, uterine pain, bloody leucorrhoea and discrepancy between the size of the pregnant uterus and the established period are observed. Motor activity (movement) of the fetus, of course, is not observed.
The presence of a hydatidiform mole is clearly visualized during ultrasound scanning, since the modified tissue has characteristic features. Signs of the presence of an embryo in the uterine cavity are not detected during scanning. The final diagnosis is carried out after evacuation of the hydatidiform mole and examination of the resulting tissue in a histological laboratory.
Unfortunately, the treatment of hydatidiform mole does not provide for the preservation of pregnancy, because the non-viability of the fetus in conditions of complete isolation from the elements necessary for development is beyond doubt.
Removal of a hydatidiform mole is the only method of therapy. The unpredictable behavior of growing unusual tissue requires its complete elimination, so exclusively surgical techniques are used. The uniqueness of this disease lies in the fact that, given its aggressiveness, the process can be completely eliminated if detected correctly and in a timely manner, without any consequences.
Pregnancy after a hydatidiform mole is possible, but it is necessary to be examined first to prevent a recurrence of the sad scenario. A clear pattern of relapses of hydatidiform mole has not been established, so the subsequent one can proceed and end properly.
The incidence of hydatidiform mole is very low (less than 1%), but sometimes it appears in the reports of ultrasound diagnostic specialists, which greatly frightens patients. Meanwhile, not a single functionalist conclusion is a diagnosis, because for a correct diagnosis it is necessary to carry out several measures that will clearly indicate a certain pathology. Sometimes hydatidiform mole (especially partial) is simulated by other, less dangerous, pathologies that look very similar on the monitor, and the specialist writes a presumptive, rather than final diagnosis of hydatidiform mole, which, fortunately, is often not confirmed.
What is a hydatidiform mole?
Hydatidiform mole is the result of chromosomal abnormalities. It is part of a special group of pathologies united by the term "trophoblastic disease", which includes several conditions associated with abnormalities of the trophoblast (the outermost membrane of the embryo).
Trophoblastic diseases are always either tumors or conditions similar to them in structure and behavior, which ultimately in most cases provoke a tumor process. They are unique and very rare, as they have a unique development path - they appear from products of conception, that is, they are diagnosed only in pregnant women.
As a result of physiological fertilization, the egg has 46 chromosomes - 23 female and 23 male. Hydatidiform mole can develop in a complete variant, when the fertilized egg is completely devoid of maternal, female, genes, and instead of them there are duplicated father's genes, male in the amount of 46. It can also be caused by a denucleated egg fertilized simultaneously by two sperm. Since the chromosomes of any cell are located in its nucleus, an anucleate egg does not contain them, and a double set of male chromosomes is provided by two sperm.
Complete hydatidiform mole does not imply the development of the embryo, only significant growth of the villi occurs.
Partial hydatidiform mole is formed in a different way: the egg has the necessary nucleus with female chromosomes (there are 23 of them), but the sperm that fertilizes it has a double set of male chromosomes (46). As a result, there are 96 (46+23) chromosomes in the egg, and the fetus nevertheless begins to develop, but has multiple malformations due to the large number of additional chromosomes, so it is also not viable.
Hydatidiform mole tissues behave like a malignant tumor - they not only grow significantly, grow through the uterine wall, but can also “spread” (metastasize) from the uterine cavity to the lungs. The degenerated trophoblast secretes human chorionic gonadotropin, and since the tissue increases its volume excessively, the concentration of the hormone becomes excessive.
There are hypotheses about the influence of infectious processes on the degeneration of chorionic villi; viral infections are also called especially dangerous in this regard.
We cannot reject the arguments of another popular theory of the origin of hydatidiform mole, which associates incorrect fertilization with hormonal dysfunction. As is known, for full development the egg requires a sufficient amount of estrogens, they provide the processes of folliculogenesis and subsequent ovulation. In conditions of estrogen deficiency, according to some experts, the egg may grow defective.
In multipregnant women, as well as women who have had abortions, the chance of developing a hydatidiform mole triples.
Symptoms and signs of hydatidiform mole
Hydatidiform mole is classified into complete and partial. A rarer invasive (destructive) form is distinguished separately.
The main criterion is the degree of degeneration of chorionic villi: if the zone of their pathological transformation covers the entire chorion, the drift is considered complete, and if the chorion is not completely modified - partial. Regardless of the form of hydatidiform mole, the fetus dies, but the pathological process continues. The modified structures of the chorion grow quite quickly, so the uterus also becomes larger. It is the discrepancy between its size and the expected gestational age that suggests an unfavorable development of pregnancy.
The timing of the formation of a hydatidiform mole is very variable: early hydatidiform mole can be detected as early as the 9th week of pregnancy, and sometimes it is detected only by the 34th week.
The more pronounced the clinical picture of hydatidiform mole is, the larger its area, so when different forms Although it has similar symptoms, it is somewhat different.
1. Partial hydatidiform mole - symptoms in the early stages.
Partial hydatidiform moles, as already mentioned, do not affect the entire chorion. In this form, the chromosome set contains both male (Y) and female (X) chromosomes, but their number and ratio do not correspond to the norm: per single female chromosome accounts for double the number of men. The hypertrophied tissue of the expanding chorion contains fragments of an unchanged embryo and placenta, chorionic villi in a state of pronounced edema.
On initial terms Hydatidiform mole mimics the symptoms of pregnancy, so it is difficult to diagnose it without additional examination.
Since hydatidiform mole does not cover the entire uterine cavity, the growth of the modified tissue occurs more slowly, the uterus remains normal in size for the gestational age or is slightly smaller. Therefore, at the beginning of the development of the pathology, its symptoms may not be obvious, but suspicious changes can be detected during an ultrasound scan.
Incomplete hydatidiform mole does not exclude the development of pregnancy, since the pathological process starts after the third month of gestation and affects only part of the placenta. The fetus can die if the placenta is damaged by more than a third.
2. Complete hydatidiform mole - symptoms in the early stages.
Diagnosed between the 11th and 25th weeks of gestation. All available chromosomes are exclusively male. Signs of development of the embryo and fetus are completely absent, the uterus is filled with modified edematous villi and vesicles. Hydatidiform mole in this form grows quickly, so the uterus becomes large in the early stages.
3. Destructive form of hydatidiform mole. It is even less common than its other two forms. It is characterized by aggressive growth of villi to the entire depth of the uterine wall with subsequent destruction of the surrounding myometrial tissue. Characterized by severe internal bleeding.
Invasive hydatidiform mole is essentially similar to a tumor process. Features of invasive hydatidiform mole are:
- the tumor is usually local, with invasive (inward) growth;
- infrequently (20-40%) metastasizes to the nearby vagina and vulva, less often metastases are “directed” to the lungs;
- much more often than other forms of drift it is transformed into a malignant structure - chorionic carcinoma;
- despite the aggressive course and the likelihood of malignant degeneration, it responds very well to therapy and is cured in 100%.
The size of the uterus, which does not coincide with the term, in case of hydatidiform mole does not allow one to suspect this particular pathology without additional symptoms. It is especially difficult to determine early hydatidiform mole in partial form by this sign. Several other symptoms indicate the presence of chorionadenoma:
- Bleeding. It has specific sign– the presence of typical mole bubbles in the bloody discharge.
When the degenerated chorionic villi grow, excess tissue with bubbles gradually separates from the uterine wall and “falls” into the uterine cavity, and from there is evacuated out along with the blood.
Blood loss provokes typical signs of anemia and worsens the well-being of the pregnant woman.
- Toxicoses. Depending on the period, they have a clinic of early toxicosis (nausea, vomiting, weakness, etc.) or gestosis (and).
- Absence of signs indicating the presence of a fetus. The fetus against the background of hydatidiform mole (if it begins to form at all) dies very early, so all studies conducted indicate its absence. Pregnant women note that they do not feel the fetus move.
Diagnosis of hydatidiform mole
The clinical picture of hydatidiform mole is not always obvious and can simulate other pathologies. Symptoms of hydatidiform mole, namely asymmetrical enlargement of the uterus, must be differentiated from those with polyhydramnios and pregnancy due to fibroids. Bleeding that appears may indicate a spontaneous miscarriage.
The most reliable sign is the appearance of typical vesicles in the vaginal discharge; as a rule, their appearance heralds the “expulsion” of a hydatidiform mole.
External examination does not allow you to feel parts of the fetus and listen to its heart. A vaginal examination helps to palpate areas of softening of the uterus, as well as to determine that its size does not correspond to the gestational age.
An ultrasound scan shows a fairly typical picture for a hydatidiform mole:
- enlargement of the uterus, not comparable with the gestational age;
- absence ovum in the early and late stages of the fetus, with a partial form of drift, preserved parts of the fetus can be visualized;
- the presence of homogeneous tissue of a fine-grained appearance (symptom of a “snow storm”) filling the uterine cavity;
- in every second pregnant woman, against the background of hormonal dysfunction during hydatidiform mole, luteal cysts are recorded in large (more than 8 cm) ovaries, and symmetrically in both ovaries.
As the gestational age increases, the ultrasound picture of hydatidiform mole becomes more and more obvious.
Since hydatidiform mole provokes excessive accumulation of the pregnancy hormone, laboratory determination of its concentration has important diagnostic value. The concentration of hCG during a hydatidiform mole does not change in the same way as during normal pregnancy: it exceeds 100,000 mIU/ml and does not decrease after one week.
The presence of hCG after a hydatidiform mole, or rather its concentration, is also an important indicator in diagnosis. As a rule, after adequate treatment, the amount of hCG after a hydatidiform mole begins to decrease and normalizes by the 8th week. If such dynamics are not observed and the amount of the hormone remains high, there is a possibility dangerous complication– malignant trophoblast tumor.
Hydatidiform mole can cause a number of complications:
- toxicosis in the form of necrotic vomiting;
— early development arterial hypertension and preeclampsia;
- hyperfunction thyroid gland ();
- rupture of formed ovarian cysts;
- infection of the contents of the uterus and subsequent septic process;
- bleeding, especially in the invasive form;
- trophoblastic embolization: penetration of bubbles from the uterine cavity into the pulmonary cavity (through the vessels) and the development of an embolic clinic;
- pronounced disturbances in blood coagulation processes, leading to.
Treatment of hydatidiform mole
Any chosen treatment tactic for hydatidiform mole is based on the need to remove the pathologically overgrown trophoblast. The specialist is faced with the task of choosing the most appropriate way to eliminate the pathology.
The first stage of treatment for hydatidiform mole is similar to abortion by vacuum aspiration. The method is suitable even for significant sizes (up to 20 weeks) of the uterus. After the contents of the uterine cavity are aspirated, additional control curettage is performed to remove those small villi that are too tightly attached to the mucosa. To ensure that the uterus returns to its original state as quickly as possible after the procedure, uterotonics are used - uterine contracting agents (oxytocin, pituitrin).
Mechanical removal of a hydatidiform mole is both a therapeutic and a diagnostic procedure, since the study of the resulting tissue helps clarify the diagnosis and examine in the laboratory the cellular composition of the resulting material. The presence of modified chorionic villi in the material indicates the reliability of the diagnosis of hydatidiform mole.
The presence of a rare and sometimes “dangerous” diagnosis greatly frightens patients, especially if they seek to obtain additional information from sources that are not entirely reliable. In addition, each of them experiences stress from the thought of a failed pregnancy and the death of a child. Therefore, before starting therapy, a detailed conversation is necessary about:
- this pregnancy has begun to develop incorrectly, and it has no chance of becoming “normal”;
- even the most unfavorable course of hydatidiform mole does not exclude complete recovery;
— the next pregnancy after a hydatidiform mole has every chance of being absolutely normal, subject to proper rehabilitation.
It is often possible to independently expel a hydatidiform mole, when, against the background of the administration of contractile agents, the uterus independently evacuates the pathological contents.
The quality of the mole removal procedure is controlled by ultrasound scanning; it is carried out several times at two-week intervals to ensure that the uterus and surrounding tissues are “cleaned”.
Lung X-ray is indicated for all survivors of the hydatidiform mole removal procedure to rule out the presence of metastases.
After removal of a hydatidiform mole, monitoring the dynamics of hCG is also necessary. Laboratory monitoring is carried out weekly for the next two months.
A patient is considered healthy if:
— hCG after a hydatidiform mole two months later does not exceed 15 MME/ml;
— ultrasound control does not detect tumors or metastases;
- X-ray lungs are “clean”;
- menstrual function has been restored.
If the level of chorionic gonadotropin remains high eight weeks after removal of the mole, there is reason to suspect the presence of trophoblast cells remaining after the operation (in the uterus or other organs) that continue to secrete gonadotropin, or a malignant trophoblast tumor, so additional diagnostic measures are carried out: examination, ultrasound diagnostics and chest radiography. In such a situation, further treatment with chemotherapy is necessary; methotrexate and dactinomycin are used separately or in combination with leukoverin. Treatment is continued until complete diagnostic well-being, the criterion of which is the absence of pathological foci and recovery normal indicators HCG. In order to prevent relapses, chemotherapy drugs in a course dose are taken in two more courses.
Chemotherapy can cure 100% (all) of patients with trophoblast pathology, and in 90% menstrual function returns to normal and does not require additional correction.
In cases where hydatidiform mole is complicated by threatening bleeding, preeclampsia or other dangerous conditions, the treatment tactics change: first they compensate for the threatening condition, and then eliminate the hydatidiform mole.
It is impossible to eliminate a destructive hydatidiform mole using the aspiration method, because it literally grows into the uterine wall and vagina. The high probability of dangerous bleeding and uterine rupture is the basis for the use of a more radical surgical technique - a hysterectomy is performed along with pathological tissues.
If the hydatidiform mole is successfully cured, the patient is still seen by a specialist for at least another year, and then must undergo a re-examination. A subsequent pregnancy, if necessary, should be planned with your doctor. As a rule, pregnancy after a hydatidiform mole is recommended after the final follow-up examination, that is, a year or more later, provided the results are good. This recommendation is explained by the fact that if, within a year after treatment, when the woman is under observation and undergoes control tests, pregnancy occurs, the level of human chorionic gonadotropin begins to rise, and it becomes impossible to understand whether the reason for its growth is a returning tumor or a real pregnancy.
Prevention of hydatidiform mole
Like any pathology, hydatidiform mole leaves negative consequences. Sometimes a woman who has survived an episode of hydatidiform mole has problems with subsequent conception, menstrual dysfunction occurs, or the risk of a pathological course of subsequent births increases. In children born in pregnancies after hydatidiform mole, pathologies are recorded more often. The risk of pathology during childbirth also increases for those who give birth after a hydatidiform mole.
It should be remembered that after healing, at the site of the foci of hydatidiform mole, wherever they are (uterus, vagina, lungs), small scars remain - areas connective tissue. They persist for a long time even after complete recovery, but they resolve over time, so they are not considered complications.
And finally, the most unfavorable consequence of hydatidiform mole is the formation of malignant degeneration (up to 20%).
Hydatidiform mole is a rare and still poorly understood pathology. His main feature there is a clear connection with pregnancy, so we can say that the absence of pregnancy is the only reliable measure for preventing the disease. However, such a measure, for obvious reasons, can only be recommended for those women who are not planning a desired pregnancy.
However, the lack of effective preventive measures does not prevent the elimination of factors that, according to experts, may increase the risk of developing hydatidiform mole. These can be roughly classified into those that are necessary for women planning a pregnancy, and those that are suitable for already pregnant women.
When planning a pregnancy, women should first examine their health status and find out how ready they are for a difficult and long period of pregnancy, as well as for childbirth. Since there is evidence of a higher risk of hydatidiform mole in patients with infectious diseases and hormonal dysfunction, it is necessary to eliminate the source of infection and restore normal menstrual rhythm.
If pregnancy has already taken place and is accompanied by a hydatidiform mole, a diagnosis must be made as early as possible. In addition to timely diagnosis, the patient’s attentive attitude to pregnancy and compliance with all recommendations given by the doctor help.
Hydatidiform mole refers to the pathology of the fetal egg, which is characterized by the transformation of chorionic villi (outer embryonic membrane) into cysts - vesicles containing fluid, proliferation of the villi 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.
Hydatidiform mole is detected using ultrasound, vaginal examination, determination of the content of β-hCG, and fetal fetal PCG.
Treatment consists of removing the mole by curettage of the uterine cavity, vacuum aspiration, in rare cases– performing a hysterectomy.
This pathological condition develops in 0.02 - 0.8% of all pregnancy cases. With this disease, there is swelling of the stroma (membrane) and proliferation of chorionic villi with the formation of specific bubble-like expansions that resemble bunches of grapes.
Cysts (vesicles) reach a size of twenty-five millimeters and contain a yellowish or opalescent liquid, which includes globulins, amino acids, human chorionic gonadotropin, and albumin. Cysts, as a rule, do not have vessels; rarely single capillaries can be identified in them.
Classification of hydatidiform mole
There are several classifications of hydatidiform mole. They are based on histological and morphological features. Based on the degree of degeneration of the chorionic villi, partial and complete drift are distinguished. In the complete form, all chorionic villi are transformed, in the partial form, only a certain part of them is transformed.
In all cases, the fetus dies, but 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 hydatidiform mole, which is characterized by the growth of villi into the thickness of the muscular lining of the uterus and subsequent tissue destruction.
This condition can be worsened by the development of severe intraperitoneal (intra-abdominal) bleeding. According to the histological type, depending on the ratio of trophoblast structures, syncytial, mixed, and cytotrophoblastic hydatidiform moles are distinguished.
Causes and risk factors of the disease
Hydatidiform mole develops as a result of chromosomal abnormalities during gestation. Full version This pathology occurs when maternal genes are lost and a set of (haploid) paternal genes is duplicated, or when an anucleate egg is fertilized simultaneously by two sperm.
Partial hydatidiform mole also develops as a consequence of genetic disorders: fertilization of an egg with a sperm that has a diploid set of chromosomes. Similar condition often accompanied by the development of multiple malformations (syndactyly, hydrocephalus, etc.).
Hydatidiform mole develops three times more often when repeat pregnancies, in young patients, as well as pregnant women over thirty-five to forty years old. This pathology may be a complication ectopic pregnancy and therefore localized in the fallopian tube.
Multiple births, abortions, immunodeficiencies, thyrotoxicosis, dietary deficiency of vitamin A and animal fats, consanguineous marriages are factors that several times increase the likelihood of developing a hydatidiform mole.
Symptoms that accompany the pathology
One of the most characteristic signs of this pathological condition is the discharge of dark liquid blood from the genital tract, which contains rejected mole vesicles.
Such bleeding can lead to significant anemia and in some cases become life-threatening.
The growth of elements of a hydatidiform mole into the thickness of the muscular lining of the uterus can be accompanied by its perforation and massive intra-abdominal bleeding.
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.
Hydatidiform mole is often accompanied by the development of toxicosis. In this case, nausea, repeated vomiting, salivation, exhaustion, increasing liver failure, symptoms of gestosis, eclampsia and preeclampsia are observed already in the first trimester of pregnancy.
Since with hydatidiform mole the fetus dies in the early stages, then reliable signs there are no pregnancies - parts of the fetus are not detected by palpation and by ultrasound, the heartbeat is not audible and is not recorded by various hardware methods, there are no fetal movements.
At the same time, immunological and biological tests for pregnancy give positive results. In thirty to forty percent of cases, patients are diagnosed with bilateral cysts (theca lutein cysts), which regress on their own after removal of the hydatidiform mole.
This pathological condition poses the greatest danger due to the possibility the appearance of dangerous malignant tumors, which subsequently metastasize to the walls of the vagina, vulva, brain, lungs, and abdominal organs.
Complete (simple) hydatidiform mole
This pathological condition is the most common form of trophoblastic disease. It occurs in 1/1000 – 1/1500 pregnancies (in Western countries). The greatest risk of developing a complete hydatidiform mole is in women under fifteen years of age and over forty years of age.
Other risk factors are a history of miscarriages, termination of pregnancy, errors in diet (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 manifests itself as delayed menstruation. Symptoms of pregnancy such as vomiting and nausea are more pronounced than normal due to the high content of hCG, which is synthesized by the abnormal trophoblast. Some patients may develop hyperthyroidism due to the fact that hCG has a weak stimulating effect on thyroid tissue.
Partial hydatidiform mole
This pathological condition is diagnosed when the fetus is found along with proliferating villi with hydropic type degeneration.
The fetus usually dies at the end of the first or at the beginning of the second trimester, and analysis of the placenta is needed to make a diagnosis, since hydropic villi are not expressed to the same extent as with a complete hydatidiform mole.
The age of the patients is slightly older than with complete hydatidiform mole. This condition is associated with a lesser risk of subsequent malignancy.
How to get pregnant without consequences
After removal of a hydatidiform mole, the woman must be registered with a gynecologist for another one to one and a half years.
During this control period, it is necessary to carefully ensure that pregnancy does not occur, since there is a risk of re-development of this pathological condition.
The most optimal method of pregnancy planning is hormonal contraceptives, which should be taken after consultation with a gynecologist.
Thanks to specific hormonal effects, the work of the ovaries will be regulated in better side, since during the operation and in the presence of complications it could be disrupted.
The next pregnancy should be under strict control, both from the medical staff and 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 should be planned on time, no earlier than in a year.
Modern methods for diagnosing hydatidiform mole
When diagnosing, this disease is differentiated from polyhydramnios, multiple pregnancies, spontaneous miscarriage, pregnancy due to uterine fibroids. Distinctive Features This pathology is the presence of bubbles in the bloody discharge, which is usually observed before the expulsion of a hydatidiform mole.
A gynecological examination allows us to determine a change in the consistency of the uterus to a dense 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 age.
An ultrasound examination can confirm an enlarged uterus and the absence of a fetus, while detecting a “snow storm” symptom (the presence of homogeneous fine-grained tissue), thecal lutein ovarian cysts with a diameter of over six centimeters.
When performing phonocardiography, the fetal heartbeat is not recorded. According to indications, hysteroscopy, diagnostic laparoscopy, laparoscopic echography, and ultrasound hysterosalpingoscopy can be performed.
If the development of a hydatidiform mole is suspected, the content of human chorionic gonadotropin (HCG) must be examined; if necessary, biochemical liver tests are performed, the level of creatinine and a coagulogram are determined.
In order to exclude metastatic screenings of a hydatidiform mole, a survey radiography of the abdominal organs is performed, chest, MRI or CT scan of the brain. After removal of the pathological tissue, a special histological examination is performed, as well as determination of the karyotype.
Methods for treating hydatidiform mole
The main method of treating hydatidiform mole is removal of this formation. For this purpose, methods of vacuum aspiration with control curettage are used after preliminary dilatation (dilation) of the cervix. To improve the contraction of this organ, pituitrin or oxytocin is prescribed. In rare cases, spontaneous expulsion of a hydatidiform mole from the uterine cavity may occur.
When the reproductive function is completed or threatening bleeding develops, the uterus is removed (extirpation) without appendages. The removed tissue is subject to special histological study.
After removal of the hydatidiform mole, over the next two months, the patient undergoes weekly determination of the level of hCG in the blood serum, once every two weeks - pelvic ultrasound, as well as chest X-ray. If there are no signs of developing chorionepithelioma, then subsequent chemotherapy is not indicated.
Chemotherapy and radiation therapy
Used for chemotherapy 
drugs that act on cancer cells. It can be administered intramuscularly, intravenously, or in the form of tablets.
Chemotherapy is a systemic treatment method, since all drugs enter the bloodstream and are distributed 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 and reduce the size of tumors.
The causes of hydatidiform mole lie in abnormal development of the embryo. When examining a partial hydatidiform mole, it was discovered that it contains a maternal and two paternal chromosomes.
Thus, the egg is fertilized by 2 sperm at once, as a result of which the embryo contains extra chromosomes, and the embryo itself is not viable. This type of pathology degenerates into cancer in 5% of cases.
The causes of complete hydatidiform mole are the fertilization of an inferior female reproductive cell, which does not have a set of chromosomes. As the embryo develops, the father's chromosomes double, but instead of the development of the fertilized egg, a bubble-like transformation of the chorionic villi is observed.
During diagnosis, two X chromosomes are detected, which are paternal. Occasionally, paternal chromosomes form a 46XY karyotype (no more than 13% of cases).
Malignant degeneration of the disease is diagnosed much more often (up to 20% of pathologies).
Causes and risk factors of the disease
Placenta previa
Premature
detachment of a normally located
placenta (PONRP)
Uterine rupture.
Currently,
after the appearance of ultrasound, and they began to put
diagnosis of placenta previa before presentation
bleeding, then the main group
maternal mortality rate is
women with PONRP.
Cervical rupture
Uterine rupture
Uterine rupture
If there is a gap
uterus, it develops very quickly
serious condition of a woman associated
with traumatic and hemorrhagic
shock, intrapartum death occurs
fetus, and then the diagnosis is clear. But maybe
erased symptoms.
Make a diagnosis of PONRP
very difficult, because contractions
attempts are added, uterine tone
significantly increased, and most often the diagnosis
placed after the birth of the fetus, on
basis of discharge following the fetus
dark bloody clots.
If it has
place of uterine rupture in the second period and
the head is on the pelvic floor, then
obstetric forceps are required
or removing the fetus by the pelvic end.
With PONRP - shortening of the expulsion period
perineotomy or obstetric placement
forceps.
Associated with disruption of separation and
placenta discharge.
Tight attachment
True increment (only with partial
true increment or partial
tight attachment possible
bleeding).
Infringement of the placenta in the internal area
pharynx (spasm of pharynx).
Remains of placental tissue in the uterus
Bleeding may be very heavy.
Risk group:
Women with burdened
obstetric and gynecological history
Pregnancy, complicated
gestosis
Childbirth with a large fetus
Polyhydramnios
Multiple pregnancy
Experts do not single out certain reasons, which contribute to the emergence of female body hydatidiform mole. It is reliably known that the disease is a consequence of chromosomal disorders during the gestational period: loss of the mother’s genes, duplication of the father’s genes and fertilization of an egg that does not have a nucleus by two sperm.
With an ectopic pregnancy, bubbles may appear on the walls of the fallopian tubes.
Not so long ago in medicine, a hypothesis was put forward that infectious diseases and reduced level estrogen production.
The reasons for the development of pathology are different and depend on the type of disorder. Thus, a complete hydatidiform mole during pregnancy develops with uniparental disomy - the embryo does not receive a maternal set of genes, but gets two from the father at once.
In some cases, this hydatidiform mole may be caused by the fertilization of an anucleated egg by two sperm at the same time. As a result, the fetus dies at an early stage of its development.
An incomplete pregnancy develops when an egg is fertilized by two sperm, and the set of maternal chromosomes is delayed. As a result, at one of the stages of division, the embryo receives one set of maternal and double sets of paternal genes.
Through for a short time the embryo dies. Among the factors contributing to the development of these disorders, doctors name:
- the age of the expectant mother is less than 20 and more than 35 years;
- a history of hydatidiform mole;
- early miscarriage in the past;
- severe deficiency in the diet of vitamin A.
Clinical picture: how to identify hydatidiform mole
Classification of hydatidiform mole
There are such types of pathology:
- complete hydatidiform mole;
- incomplete hydatidiform mole (partial).
Complete hydatidiform mole is a disease in which embryonic tissue is completely absent, that is, the degeneration of chorionic villi covers their entire area. As a rule, this type of disease is detected at 11-25 weeks of pregnancy.
Partial hydatidiform mole manifests itself with the same clinical signs, but it contains individual elements of the fertilized egg. Pathological changes affect only part of the chorionic villi.
Partial hydatidiform mole is usually diagnosed 9-34 weeks after conception, that is, at almost any stage of gestation.
According to the degree of invasion, the disease can be:
- Simple hydatidiform mole. The chorionic villi are large, edematous, located inside the uterine cavity.
- Proliferating hydatidiform mole (destructive). In this case, chorionic villi grow deep into the muscular layer of the uterus, destroying its tissue. This type of disease often leads to bleeding that threatens the life of the pregnant woman.
There are several classifications of hydatidiform mole. They are based on histological and morphological features. Based on the degree of degeneration of the chorionic villi, partial and complete drift are distinguished. In the complete form, all chorionic villi are transformed, in the partial form, only a certain part of them is transformed.
In all cases, the fetus dies, but 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 hydatidiform mole, which is characterized by the growth of villi into the thickness of the muscular lining of the uterus and subsequent tissue destruction.
This condition can be worsened by the development of severe intraperitoneal (intra-abdominal) bleeding. According to the histological type, depending on the ratio of trophoblast structures, syncytial, mixed, and cytotrophoblastic hydatidiform moles are distinguished.
Pregnancy after hydatidiform mole
If the diagnosis of the disease was timely and the treatment was adequate, this will help preserve the woman’s reproductive function in the future. If chemotherapy is not required, the hCG hormone will normally disappear from the blood within 5-6 months.
The fact is that human chorionic gonadotropin increases in pregnant women, and it will be unclear whether such an increase caused a relapse of hydatidiform mole (this happens in 2% of cases).
Fortunately, if the organs of the reproductive system were not removed, the disease does not affect future conception. More than 70% of women can have children after eliminating the pathology.
To further exclude such problems, a woman is recommended to carefully plan her pregnancy, as well as be monitored by ultrasound from the first weeks of gestation and evaluate the level of hCG.
Pregnancy is usually normal, but there is evidence of slightly more frequent weakness labor activity, bleeding during childbirth in women who have previously suffered from trophoblast pathologies.
After removal of a hydatidiform mole, the woman must be registered with a gynecologist for another one to one and a half years.
During this control period, it is necessary to carefully ensure that pregnancy does not occur, since there is a risk of re-development of this pathological condition.
The most optimal method of pregnancy planning is hormonal contraceptives, which should be taken after consultation with a gynecologist.
Hydatidiform mole - symptoms
One of the most characteristic signs of this pathological condition is the discharge of dark liquid blood from the genital tract, which contains rejected mole vesicles.
Such bleeding can lead to significant anemia and in some cases become life-threatening.
The growth of elements of a hydatidiform mole into the thickness of the muscular lining of the uterus can be accompanied by its perforation and massive intra-abdominal bleeding.
The following symptoms indicate that a pregnant woman may have a hydatidiform mole:
- severe bleeding and the appearance of blisters;
- an increase in the size of the uterus, which is not typical for certain period pregnancy;
- absence of the main signs of fetal development: heartbeat and mobility;
- strong manifestation toxicosis in a pregnant woman: frequent bouts of vomiting, repeated bleeding.
Considering the fact that when a hydatidiform mole develops, the fetus dies, the presence of abnormalities can only be determined using an ultrasound examination; pregnancy tests will have positive result.
During gestation, pathology can be assumed by the presence of characteristic symptoms. Doctors call one of the first signs the discharge of liquid dark blood from the genital tract, which contains expelled blisters.
Discharge during hydatidiform mole is always abundant and prolonged, which can lead to the development of anemia, becoming threatening to the health and life of the pregnant woman.
Diagnosis of hydatidiform mole
Usually, when the disease develops, the fetus dies in the first weeks of pregnancy, and therefore heartbeat and other signs of normal gestation are not detected by ultrasound.
But due to the production of hydatidiform hormone hCG test always gives a positive result for pregnancy. Without a medical examination, pathology can be suspected by the presence of bleeding or lack of physical activity of the child according to the timing.
When diagnosing, this disease is differentiated from polyhydramnios, multiple pregnancies, spontaneous miscarriage, pregnancy due to uterine fibroids. Distinctive features of this pathology are the presence of bubbles in the bloody discharge, which is usually observed before the expulsion of a hydatidiform mole.
A gynecological examination allows us to determine a change in the consistency of the uterus to a dense 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 age.
Diagnosis of hydatidiform mole is very difficult. Development of the disease on early stages does not manifest itself at all, pregnancy proceeds without complications.
However, at the first appearances bleeding from the vagina, which a pregnant woman should not have, it is necessary to urgently contact an antenatal clinic.
The doctor initially conducts a vaginal examination, examining neoplasms in the uterine cavity, which makes it possible to determine the presence of trophoblast diseases.
The nature of the formations can be determined in detail using ultrasound. To confirm the diagnosis, the patient's blood is taken to analyze hormonal levels.
Throughout pregnancy, beta chorionic gonadotropin does not exceed the norm, but if this hormone is detected in a woman who is not expecting a child, this may indicate the development of hydatidiform mole.
Hydatidiform mole: the ultrasound photo resembles a bunch of grapes, so a specialist can easily recognize the presence of a neoplasm.
.
Regardless of the stage of development of the disease, disease blisters must be removed. The material obtained from the uterine cavity is subject to further study by specialists, and the patient must undergo a course of treatment in an oncological institution.
Additional measures to strengthen a woman’s general condition will help prevent the formation of malignant tumors. Rehabilitation period after the operation is at least two months, during which changes in the level of human chorionic gonadotropin are regularly examined, and a full examination of the pelvic organs is carried out using ultrasound equipment.
Eight weeks after removal of the vesicles, normalization of all processes should occur; if no improvement is observed, then the patient is prescribed an additional course of examinations, since hydatidiform mole cells could remain in the body, preventing completion of treatment.
If a woman has no signs of pregnancy and no cancer is detected, chemotherapy is usually not given. Subsequent pregnancies should proceed under constant monitoring the doctors.
Timely diagnosis of the disease will help you choose the right course of treatment, prevent possible complications and guarantee the onset of next pregnancies, and normal gestation fetus
The diagnosis of “hydatidiform mole” is made based on the results of the studies. Initially, the doctor examines the woman in a gynecological chair.
When performing this procedure, the gynecologist determines the densely elastic consistency of the uterus, in which there are areas of excessive softening. At the same time, the actual dimensions of the organ in practice exceed those that should be expected.
In order to completely exclude metastatic screenings of hydatidiform moles, doctors may prescribe additional examinations:
- chest x-ray;
- abdominal examination;
- MRI of the brain.
Hydatidiform mole – hCG
The hCG level during hydatidiform mole is one of the indicators of the disorder. With this pathology, there is a sharp increase in the concentration of the hormone in the bloodstream.
On average, it exceeds 10,0000 mmU/ml. The simultaneous increase in the size of the reproductive organ, which does not correspond to the period, prompts gynecologists to think that this may be a sign of a hydatidiform mole (hydatidiform mole).
Hydatidiform mole - ultrasound
How to treat hydatidiform mole?
The disease is now being treated surgically, supplementing it with chemotherapy if necessary. At the same time, new tests are being carried out, which are aimed at improving existing methods.
Most often, in the absence of cancerous tissue in the hydatidiform mole, curettage is performed by step-by-step curettage. The uterine tissue is stretched, after which drugs are injected to contract its walls (pituitrin, oxytocin) and the entire contents of the organ are vacuum pumped out.
The walls of the uterus are then scraped out to remove any debris from the mole. After it's over surgery hydatidiform mole, chemotherapy is prescribed (if necessary).
It is aimed at destroying individual cancer cells that are not visualized by a specialist during surgery.
The main method of treating hydatidiform mole is removal of this formation. For this purpose, methods of vacuum aspiration with control curettage are used after preliminary dilatation (dilation) of the cervix.
To improve the contraction of this organ, pituitrin or oxytocin is prescribed. In rare cases, spontaneous expulsion of a hydatidiform mole from the uterine cavity may occur.
When the reproductive function is completed or threatening bleeding develops, the uterus is removed (extirpation) without appendages. The removed tissue is subject to special histological study.
After removal of the hydatidiform mole, over the next two months, the patient undergoes weekly determination of the level of hCG in the blood serum, once every two weeks - pelvic ultrasound, as well as chest X-ray.
If there are no signs of developing chorionepithelioma, then subsequent chemotherapy is not indicated.
Chemotherapy and radiation therapy
Chemotherapy uses drugs that attack cancer cells. It can be administered intramuscularly, intravenously, or in the form of tablets.
Chemotherapy is a systemic treatment method, since all drugs enter the bloodstream and are distributed 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 and reduce the size of tumors.
It can be carried out using special devices located externally or internally using radiation-producing materials through thin plastic tubes directly to the area where the malignant cells are located (internal irradiation).
Information for expectant mothers, find out how toxicosis is diagnosed in pregnant women in order to alleviate the condition and be sure that it is not another dangerous disease.
What are the reasons for the appearance of bartholinitis and options for the development of this disease, read here. Why is glandular fibrous polyp of the cervical canal dangerous, read the article https://womensmed/bolezni/polipy/cervikalnogo-kanala.
html there you will learn how modern medicine fights this disease.
Treatment of hydatidiform mole is aimed at preventing possible complications and preserving the life of a woman. Pregnancy with such a disorder requires urgent termination.
In some cases, the body independently cleanses the uterine cavity of a large number of bubbles, which come out along with bloody discharge.
If this does not happen, surgery is prescribed.
It is performed under general anesthesia. If possible, doctors choose the laparoscopic method.
To completely cleanse the uterine cavity from the existing embryonic membranes, curettage using a curette is used. Doctors often use vacuum aspiration to exclude the presence of residual material.
In this way, complications can be prevented.
Removing a hydatidiform mole
How to get pregnant without consequences
If the pathology is invasive in nature, its complication may be perforation of the uterine wall and massive hemorrhage into the peritoneum. As a result of severe eclampsia, embolism of a branch of the pulmonary artery with respiratory failure and pulmonary edema is possible.
Sometimes hydatidiform mole is complicated by vascular thrombosis, intrauterine infections, and even after removal it can cause infertility.
Serious consequences of hydatidiform mole include the development of choriocarcinoma, a malignant gestational trophoblastic tumor. This tumor quickly metastasizes to the vaginal area, vulva, as well as to distant organs (brain, lungs, liver, kidneys).
Without surgical and chemotherapy treatment, this type of cancer can be fatal.
The consequences of hydatidiform mole can negatively affect the condition of the female reproductive system and health in general. A threatening complication of this disorder is the formation of chorionepithelioma (chorionic carcinoma) - a malignant form of trophoblast disease.
It is characterized by invasive growths of the uterus, numerous metastases of areas of affected tissue to the lungs, liver, and brain. Often the pathology leads to death.
Hydatidiform mole during pregnancy. This is a rare complication, but it can lead to fetal death and a threat to the health of the mother.
Now let's look at this in more detail.
What is a “hydatidiform mole”?
Hydatidiform mole is a deviation in the development of the fertilized egg. If this pathology occurs, the formation of the placenta does not occur. The chorionic villi degenerate into bubbles, inside of which there is liquid. She has yellowish color and consists of:
- amino acids;
- human chorionic gonadotropin;
- albumin.
The diameter of the bubbles does not exceed 25 ml. Hydatidiform mole occurs in 0.02-0.8% of pregnancies. There are several types of the disease, which include:
- Complete or simple hydatidiform mole. The disease is characterized by pathological changes throughout the chorion.
- Partial hydatidiform mole. Pathological changes affect the chorion only partially.
- Destructive hydatidiform mole. This is the most severe form of the disease. It is malignant in nature.
The first type of pathology appears in a woman during... In the presence of this form of the disease, the fetus dies and then dissolves.
Partial hydatidiform mole may appear after. In this situation, the pregnancy is not terminated. There is a possibility that it will end in a live birth of a child. In most cases, birth occurs prematurely. However, the baby may appear on time. If the pathology appears during a multiple pregnancy, it can affect only one placenta or both of them.
What does a hydatidiform mole look like from a photo?
If a woman has developed a hydatidiform mole, the villi of the outer membrane turn into cysts. This is the name given to bubbles containing liquid. Additionally, proliferation of the villous epithelium is observed. Pathology can lead to fetal death. To better understand what a hydatidiform mole looks like, it is recommended that you familiarize yourself with the photo.
If the pathology develops in the first 1-2 weeks of pregnancy, all primary villi of the fetal egg are degenerated. Severe hyperplasia is present in the trophoblast layers. In this situation we are talking about the appearance of 1 form of pathology. Sometimes this type of disease is called early hydatidiform mole. This is explained by the timing of the onset of the pathology. During this period of pregnancy, hydatidiform mole is characterized by:
- proliferation of trophoblasts lining the villi from the inside;
- swelling of the villi and their increase are observed;
- the villous epithelium is not defined or undergoes dystrophic changes;
- there are no blood vessels in the villi;
- the embryo is resorbed.
If the pathology develops from 3 months to 34 weeks inclusive, usually only part of the chorionic villi is degenerated. In this case, we are talking about the so-called incomplete hydatidiform mole. In this case, the villi that have not degenerated have a normal appearance. Their blood supply is preserved. In this case, the fetus is observed in the uterus. However, pathology can lead to his death.
In the case of multiple pregnancies, the problem may affect only one placenta. At the same time, 2 is able to remain in its normal form and continue to function.
Invasive hydatidiform mole can occur against the background of a complete or partial type of pathology. Varieties of the disease have the following symptoms:
- bubbles can grow into the muscular layers of the uterus;
- villi can penetrate blood vessels and the lymphatic network, grow through the serous cover of the uterus and myometrium, spreading throughout the body, and also affect internal organs;
- the placental structure of the villi is preserved.
The destructive form of the disease is the most severe. It occurs in 5-6% of cases.
The first signs of a hydatidiform mole
If a woman has developed a hydatidiform mole, one of the signs of the disease is early toxicosis. It may be accompanied by increased temperature and humidity skin. The patient often feels nauseous. It occurs against the background of nausea. It appears due to severe disturbances in water and electrolyte balance.
An alarming sign is the appearance of bloody discharge. They occur as a result of uterine bleeding. Bloody issues may occur in early pregnancy and continue until childbirth or surgery to remove the egg. Discharges have dark color and liquid density. They are not abundant, but appear regularly.
Another sign is an abnormal size of the uterus. So, a three-month period can correspond in size to 5 months.
Symptoms and signs of hydatidiform mole
Symptoms of hydatidiform mole in different women may manifest themselves in different ways. The fact is that pathology can form on different dates carrying a child. The forms of the disease also differ. All this affects clinical picture pathology.
Usually, a woman who is faced with a problem begins to worry about uterine bleeding. The discharge is dark in color. Bleeding ranges from minor to heavy. Symptoms of toxicosis occur. Women often mistake them for signs of pregnancy. The patient is often bothered by nausea and. She may experience increased drooling and dizziness. No appetite. Against this background, exhaustion may occur.
In severe cases, hydatidiform mole can grow into the walls of the uterus. This leads to a violation of its integrity, which in turn provokes intra-abdominal bleeding. Symptoms require immediate hospitalization and adequate therapy. Otherwise, there is a risk of death.
The visual size of the uterus does not correspond to the duration of pregnancy. This can be confirmed by visual examination and ultrasound. A woman suffering from pathology has bilateral fluid ovarian cysts. Their size can reach 10 cm or more. Cysts are easily detected during ultrasound. However, this symptom does not appear in all women who experience hydatidiform mole. There is no treatment in this situation. They will disappear on their own after the uterine cavity is cleared of hydatidiform mole.
In pathology, it is several times higher than normal. During treatment, the doctor will check this indicator without fail until it returns to normal. Even when the level returns to normal, the woman will still have to undergo this test regularly for six months. The action is performed for preventive purposes. Symptoms of hydatidiform mole can appear in the early stages of pregnancy and mimic its symptoms. Therefore, diagnosing the problem during this period is quite problematic.
If the disease becomes malignant, the blisters can spread to other organs, mainly the lungs. The prognosis in this case is unfavorable. Quite often death occurs. For this reason, it is important to detect pathology as early as possible and begin its treatment. This will allow us to count on the fact that the process will regress irrevocably, and the woman’s health will suffer minimally. There are other complications of the disease, which include:
- the occurrence of infertility;
- the appearance of intrauterine infection;
- septicemia;
- the occurrence of thrombosis;
Causes and prevention of signs of hydatidiform mole
Separately, there are categories of women who are at greater risk of developing the disease than others. The risk group includes girls who are not yet ripe for pregnancy. The problem may arise if conception occurred at the age of 14-15 years. The risk of pathology is also present if a woman is over 40 years old. Other reasons that increase the likelihood of a hydatidiform mole are:
- the woman gave birth many times;
- conception occurred between close relatives;
- immunodeficiency is present;
- A woman’s diet lacks some microelements and vitamins.
The phenomenon is quite rare. On average, the pathology is detected in 1 pregnant woman out of a thousand. However, the indicator is quite relative.
As mentioned earlier, the exact causes of the disease have not been established. Because specific prevention There is no such thing as a hydatidiform mole. However, experts have identified a number of measures that can reduce the risk of pathology. The list includes:
- timely consultation with a doctor in case of pregnancy. You must register before 12 weeks;
- a woman must completely stop taking drugs, alcohol, and smoking;
- It is necessary to regularly visit an obstetrician-gynecologist. During this period, she should be seen by a doctor once a month. In the second trimester, the number of visits increases to 1 time every 2-3 weeks. In the third trimester, you need to visit a specialist once every 7-10 days;
- pregnancy must be planned consciously. It is recommended that you first undergo all necessary examinations;
- It is recommended to take folic acid for 3 months before planned pregnancy and during the 1st trimester.
Treatment of signs of hydatidiform mole
Treatment of hydatidiform mole during pregnancy depends on the individual characteristics of the course of the pathology, the period of gestation of the child, as well as the type of disease. In some cases, the fetus can be saved. However, the disease often leads to miscarriage or the need to remove the fertilized egg. If an accurate diagnosis is made, the woman is often offered to undergo minor surgery. During this procedure, curettage of the uterus is performed. The action is carried out in order to remove remnants of pathological tissue. Follow-up is then required for 8 weeks after surgery. The woman will have to undergo regular tests and ultrasound examinations every two weeks.
After the hydatidiform mole has been removed from the uterus using surgical intervention, blood levels are monitored. The value of the indicator should gradually fall. This will be the main sign that the pathological processes in the uterus have stopped. If a negative value is received, the analysis must be taken again. Actions are performed to ensure that the disease is truly cured. Additionally, the woman must undergo examination by a gynecologist-oncologist.
If an ultrasound shows that hydatidiform mole activity is observed, and an X-ray examination of the lungs indicates metastatic lesions, chemotherapy is administered. After remission is achieved and laboratory parameters return to normal, 2-3 additional courses are administered. The action is performed for prevention.
A patient experiencing a hydatidiform mole should be monitored by an oncologist for another year. Blood levels are monitored monthly. It is not recommended to plan pregnancy during this period. By the best means Hormonal contraceptives protect against its occurrence. They allow you to normalize ovarian function after completing a course of chemotherapy and getting rid of the disease. Treatment is applied until the menstrual cycle returns completely to normal.
If there is no need for chemotherapy, and treatment was carried out in other ways, doctors recommend abstaining from pregnancy for a period of time. In other situations, the period is extended to 12 months. If conception occurs during this period, the level will certainly increase. This will lead to the fact that doctors will not be able to reliably determine the cause of the incident. It must be taken into account that hydatidiform mole can recur. The probability of this is 1-2%. However, reoccurrence of the pathology is still possible. In the vast majority of cases, the pathology does not in any way affect the ability to have a child in the future. A mother who has had the disease can give birth to a healthy child. The chance of premature birth also does not increase.