The process of fertilization of an egg (conception) is the fusion of two sex cells, female and male. The resulting chorion must reach the uterus within a few days and attach to its wall with the help of special villi. They subsequently form the placenta and umbilical cord, which are vital for ovum.
During an anomalous flow, the necessary villi are not formed, but are transformed into a different substance. This neoplasm is called a hydatidiform mole. It is in the process of continuous growth and has a grape-like shape. The pathology requires surgical treatment, as it poses a danger to the woman’s life.
Etiology and clinical picture of pathology
Apparently invasive hydatidiform mole has a tumor etiology. In advanced situations, the structure can penetrate into the deep layers of the uterine wall and transform into chorionic carcinoma (malignant neoplasm). It is believed that the disease occurs due to chromosomal abnormalities during conception.
In this case, uncharacteristic tissue is formed with numerous bubbles filled with human chorionic gonadotropin - a yellowish liquid. This is the pregnancy hormone (hCG), but due to the lightning-fast growth of the modified tissue, its levels increase sharply. The bubble contents also contain:
- albumins;
- amino acids;
- globulins.
There are two types of neoplasms: partial and complete hydatidiform moles. Their symptoms vary slightly. In the first case, the embryo initially receives a double set of male chromosomes (46) and a normal set of female chromosomes (23). In this case, the fetus develops with multiple anomalies, which subsequently leads to its inevitable death.
With a complete hydatidiform mole, there is no embryo at all. There is an increased proliferation of villi over the entire surface of the chorion. In the photo you can see the modified tissues inherent in the neoplasm. In any case, the situation is critical and requires immediate termination of pregnancy.
A destructive hydatidiform mole penetrates deep into the uterine wall or grows through. However, metastases to the vagina, liver and lungs are rarely diagnosed. Pathological anatomy is a common cause of extensive intra-abdominal blood loss.
Proliferating requires immediate medical attention. Such an invasive structure grows into the myometrium of the reproductive organ and provokes severe blood loss. The only way to save the woman is to remove the uterus with all the structures of the hydatidiform mole.
There are no substantiated reasons for the occurrence of pathological formation. Experts name factors that increase the risk of its occurrence:
- previous abortions and miscarriages;
- age (the age most susceptible to the development of pathology is before 18 and after 45 years);
- history of hydatidiform mole (complete or incomplete);
- ethnicity (statistics show that girls of Asian origin are more likely to be diagnosed with the disease).
Symptoms of hydatidiform mole
Many women are interested in what period of pregnancy the initial stage of hydatidiform mole is diagnosed. At the beginning of gestation, ultrasound examination of the uterine cavity does not always reveal the pathological anatomy of the formation. In this case, symptoms inherent in hydatidiform mole occur:
- minor brown discharge, sometimes blood loss;
- severe toxicosis appearing in the first weeks of gestation;
- rapid enlargement of the uterus, which is typical not for a normal pregnancy, but for a complete pregnancy;
- pain in the lower abdomen;
- increased hCG levels;
- severe gestosis (after 20 weeks).
Consequences and complications
The most severe complication is the degeneration of invasive hydatidiform mole into oncology. As a result, pathological cells penetrate outside the uterus, causing extensive internal bleeding. Loss of blood causes anemia.
If the modified villi grow into capillaries and blood vessels, then the pathological cells of the hydatidiform mole can spread throughout all systems and organs. In this case, metastases form in the internal organs (liver, lungs) and brain.
There are several stages of neoplasm, which differ in etiology and localization. Experts highlight:
- hydatidiform mole within the uterus (has a good prognosis);
- partial proliferation of vesicular tissue in the area adjacent to the placenta (placental bed);
- metastatic tumor (spread of metastases to neighboring organs).
It happens that the disease recurs. Then you will need repeated curettage or chemotherapy. Pathology does not pass without leaving a trace on a woman’s body. Appear frequently Negative consequences:
- infertility (almost 30% of women);
- amenorrhea (absence of menstruation, occurs in 12% of patients);
- thrombosis;
- septic diseases.
Diagnostic measures
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If a partial hydatidiform mole develops and an embryo is present, it is difficult to recognize the pathology. During palpation, the uterus of natural size is felt.
Ultrasound during hydatidiform mole quite often does not detect the disease in the early stages, especially when a small part of the placenta is affected. As a result, such a fetus is still doomed to death, since it does not develop fully. Usually, partial hydatidiform mole is detected at a later stage, and it is the analysis for the hCG hormone that is considered important.
Diagnosis of complete hydatidiform mole is more likely. During the examination, the gynecologist can determine the size of the uterus that is inappropriate for the period (usually it is larger than expected). An ultrasound examination reveals the absence of an embryo in the uterine cavity, and instead a bubble structure.
With this pathology, cysts are diagnosed on both ovaries, about 6 cm in size. For an accurate diagnosis of the disease, the following are important:
- human chorionic gonadotropin content;
- coagulogram;
- x-ray chest;
- liver biochemical tests;
- laparoscopic echography;
- MRI of the brain;
- determination of creatinine.
With insufficient diagnostic tests, hydatidiform mole is mistakenly confused with polyhydramnios, uterine fibroids during pregnancy, or miscarriage. It is important to identify pathology in time to reduce the likelihood of malignant degeneration.
Sometimes a woman may experience symptoms of a neoplasm, and instead doctors discover a dead fertilized egg - a non-hydatidiform mole. This deviation is called non-developing pregnancy.
Treatment of hydatidiform mole
The treatment for hydatidiform mole, regardless of the degree of complexity, is always its removal. If pregnancy is less than a month old, vacuum aspiration is used. This therapy helps preserve the reproductive organs.
At later stages, surgical curettage of the contents of the uterus is considered the most effective method. The operation is always performed under general anesthesia.
Surgical removal
Preparation for surgery includes administering general anesthesia (Oxytocin) to the patient. After this, the surgeon dilates the cervix. This procedure is usually accompanied by severe bleeding. Next, the doctor uses a vacuum apparatus or curettage method to remove the contents of the uterus. At the same time, a procedure called curettage is also performed (removal of modified tissue through a curette).
Sometimes a hydatidiform mole extends into the walls of the uterus so deeply that the surgeon is unable to completely separate the invasive neoplasm from the woman’s reproductive organ. Due to possible extensive bleeding, in this case a decision is made to completely amputate the uterus.
In addition to the above-described methods of treating the disease, other treatment options are used in medicine. They are selected individually for each patient. The method of performing the operation depends on the type of hydatidiform mole:
- vacuum excochleation;
- extription of the uterus (in this case, cysts on the ovaries are not removed; they regress a few months after the eradication of the underlying disease);
- induction of labor (the patient is injected with prostaglandins, which provokes artificial birth, sometimes a woman undergoes a minor caesarean section).
Therapy after removal
After the operation has been performed, the woman is prescribed a course of antibiotics. Over the next two years, she should be observed by a gynecologist. In the first 2 months after removal of an incomplete hydatidiform mole, you must do the following:
- weekly tests for the level of hCG hormone;
- Ultrasound of the abdominal cavity (once every 2 weeks);
- X-rays of light.
A month after therapy, the woman should resume her menstrual cycle. If there is no menstruation for more than 7 weeks or, conversely, they are too heavy, accompanied by an unpleasant odor and at the same time there are severe pain in the abdomen, dizziness and general weakness, you need to consult a gynecologist. Perhaps an infection has entered the body or hormonal imbalance has occurred. Sometimes a relapse is diagnosed.
Treatment for malignant degeneration
If examinations after surgery reveal signs of a destructive hydatidiform mole or chorionepithelioma in the body, intramuscular chemotherapy, in the form of tablets or droppers, is indicated. Typically, specialists prescribe a course of Methotrexate or Dactinomycin. In addition, doctors pay close attention to:
- HCG level in the blood;
- pelvic organs (ultrasound done every 14 days);
- lungs (control of the spread of metastases).
Along with chemotherapy, radiation therapy is an effective method of combating pathology. X-rays are often used. During the treatment period, a new pregnancy is contraindicated. For safety reasons, oral contraceptives are prescribed.
If the level of beta-hCG is low and there are no metastases to the internal organs, the prognosis is considered good. Otherwise, the prognosis is unfavorable.
According to statistics, almost 90% of women who have suffered a hydatidiform mole return to menstruation within 4-5 weeks after treatment. Pregnancy after a hydatidiform mole, occurring without pathologies, is possible in almost 70% of women.
Doctors recommend planning conception no earlier than six months after therapy, and if treatment was carried out using chemotherapy, approximately 2 years should pass. In this case, the woman needs to be thoroughly examined and bring her hormonal levels back to normal. If sexually transmitted diseases are detected, they should be treated before pregnancy to reduce the risk of signs of recurrent hydatidiform mole.
Prognosis and prevention
In 20% of patients, a diagnosed complete hydatidiform mole degenerates into a malignant formation with the appearance of metastasis. Early detection of pathology (up to 4 weeks) gives a chance to be cured without complications. In 1% of women who have a history of this disease, there is a risk of the return of the insidious disease.
As such, there is no prevention of this disease, since the reliable causes of its occurrence are unknown. Before conceiving a child, it is recommended to perform a number of activities.
What provokes / Causes of Hydatidiform Mole:
The cause of hydatidiform mole is the presence in the embryo of a double set of father's chromosomes with an insufficient number or even absence of mother's chromosomes. This anomaly occurs when two sperm simultaneously fertilize an “inferior” egg—one with a delay in the number of chromosomes or one without a nucleus. In this case, in the first case, an incomplete hydatidiform mole develops, and in the second, a complete one.
Incomplete hydatidiform mole caused by triploidy as a result of fertilization of an egg by two sperm (dispermia) with a delay in the haploid set of maternal chromosomes. Conceptus cells contain one haploid set of maternal chromosomes and a diploid set of paternal chromosomes - the karyotype can be 69.XXY, 69.XXX or 69.XYY. The fetus dies at 10 weeks of intrauterine development.
Pathogenesis (what happens?) during Hydatidiform Mole:
In patients with hydatidiform mole, the sperm and egg fuse in the uterus, but no further development of the fetus occurs. Instead, cysts that resemble bunches of grapes form in the uterus. Hydatidiform mole usually does not extend beyond the uterus and does not spread to other organs and tissues.
With choricarcinoma, the tumor begins its development from a hydatidiform mole or develops in other tissues similar in structure to the tissues of the uterus. This often occurs after an abortion or the birth of a child. Choricarcinoma can spread from the uterine cavity to other organs and tissues. Very rarely, trophoblast disease begins at the placenta insertion in the uterus. With this localization, the disease is called trophoblastic tumor of the placenta bed.
Symptoms of Hydatidiform Mole:
Hydatidiform mole is a rare disease (0.05 - 0.25%), more common in elderly multiparous women. There are 4 symptoms that make you think about the disease, each of which is an indication for hospitalization:
2. the size of the uterus is larger than at the corresponding stage of uncomplicated pregnancy;
3. absence of reliable signs of pregnancy - parts of the fetus, heart sounds and fetal movements;
4. frequent occurrence of toxicosis in pregnant women (nausea and excessive vomiting, salivation, symptoms of increasing liver failure, exhaustion, preeclampsia and eclampsia), anemia due to repeated bleeding.
Stages of gestational trophoblastic tumors
If trophoblastic disease is detected, it is necessary to conduct additional studies to determine the extent of the spread of the process to other organs and tissues (staging the disease). Treatment of trophoblastic tumors depends on the stage of the process and the age of the patient, as well as his general condition. In trophoblast disease, the following stages are distinguished:
Hydatidiform mole
The malignant process is limited to the uterine cavity. When tumor cells are found in the muscle layer of the uterus, a hydatidiform mole is called an invasive mole.
Cancer is localized at the placenta insertion and in the muscle layer of the organ.
A malignant process grows into the uterus from tissues of a similar structure after treatment for a hydatidiform mole or after an abortion or recent childbirth. The tumor does not extend beyond the uterus.
Metastatic gestational trophoblastic tumor is considered to have a good prognosis under the following conditions:
1. Your last pregnancy was less than four months ago.
2. Low level of beta-hCG in the blood.
3. Cancer does not spread to the liver and brain.
4. The patient has not yet received chemotherapy.
Metastatic gestational trophoblastic tumors with poor prognosis
Metastatic gestational trophoblastic tumor is considered to have a poor prognosis under the following conditions:
2. High level of beta-hCG in the blood.
Diagnosis of Hydatidiform Mole:
Trophoblast disease is not always easy to detect. On early stages the disease often looks and behaves like a normal pregnancy. You should immediately consult a doctor if you experience bleeding from the vagina (not related to menstruation) or if the baby does not move in the vagina. due date pregnancy.
If there are clinical symptoms to exclude trophoblast disease, the doctor needs to carry out additional diagnostic procedures. The first on this list is usually a vaginal examination. During this procedure, the doctor may feel any swelling or growths in the uterus. In this case, ultrasound is indicated, a diagnostic method that is based on the use of sound waves to detect a tumor. Blood tests are also performed to measure levels of a hormone called beta chorionic gonadotropin (beta-CG). Normally, this hormone is found in the blood during pregnancy. If the woman is not pregnant, the presence of beta chorionic gonadotropin may indicate trophoblast disease.
Treatment of the 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 (examination under a microscope of material obtained from the uterus), the patient should be sent to a specialized oncology institution.
If 8 weeks after evacuation of the hydatidiform mole there is no normalization of CG levels or there is a tendency to increase CG, the patient is prescribed an in-depth examination, since these test results indicate that hydatidiform mole cells remain in the uterus or other organs, which produce HG.
Treatment of Hydatidiform Mole:
There are two standard treatment methods: surgery (removal of the tumor) and chemotherapy (use of drugs to destroy tumor cells). Sometimes, if the process has spread to other organs and tissues, radiation therapy (high-frequency X-rays, the action of which is aimed at destroying malignant cells) is used.
In radiation therapy, X-rays or other types of radiation are used to destroy tumor cells and reduce the size of the tumor. Radiation therapy can be carried out using special apparatus, placed externally (external radiation therapy) or internally using materials that produce radiation (radioisotopes) through thin plastic tubes directly to the area where the malignant cells are located (internal radiation).
For some patients, participation in clinical trials may be best choice method of treatment. Clinical trials are part of the cancer research process. They are conducted to determine whether new tumor treatments are effective and safe, and how they are superior to standard approaches to therapy.
Some studies recruit patients without prior therapy. Other trials are studying the drug's effect in patients who have not responded to previous treatment. There are also studies of new methods of preventing relapses (recurrences) of the disease or reducing the side effects of the drug.
2. Surgical removal of the uterus (hysterectomy), provided that the patient no longer intends to have children.
Metastatic gestational trophoblastic tumor with good prognosis
Treatment methods include:
3. Chemotherapy followed by hysterectomy if the tumor does not disappear during chemotherapy.
Metastatic gestational trophoblastic tumor with poor prognosis
The treatment of choice is chemotherapy.
Prevention of Hydatidiform Mole:
Preventive chemotherapy is carried out after removal of a hydatidiform mole, if the hCG titer increases or remains at a constant level for a long time, as well as when metastases are detected. In 80% of patients with hydatidiform mole, spontaneous remission occurs without additional therapy.
Which doctors should you contact if you have hydatidiform mole:
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Incomplete form
Incomplete hydatidiform mole occurs when the fertilized egg contains the maternal set of chromosomes (23 chromosomes) and double the paternal set of chromosomes.
In this case, instead of 46 chromosomes, the fertilized egg contains 69. The main cause of partial hydatidiform mole occurs when the paternal chromosomes are duplicated, or when the egg is inseminated by two sperm. Because of this, a cystic placental structure and natural placental tissue is formed. Partial hydatidiform mole develops in a woman after the first trimester.
Losing a pregnancy under these circumstances is a serious moral injury. Once the correct treatment is prescribed and the doctor carries out observation, the development of any pathologies associated with trophoblastic disease is unlikely. An ultrasound can determine the size of the uterus if a hydatidiform mole is suspected.
Invasive hydatidiform mole develops at full and incomplete degrees. The bubbles penetrate deep into the falling membrane, but retain the placental structure of the villi.
Symptoms
Diagnosing this disease does not cause any difficulties, because the signs of hydatidiform mole are quite classic.
To detect a disease such as hydatidiform mole, diagnostics must be done. It is done when, during a gynecological examination, a woman has a large uterus, which is abnormal for this period. So, with this pathology, a three-month pregnancy period corresponds in size to five months. The thickness of the uterus is tight-elastic. The gynecologist does not see the exact signs of conception, such as fetal movements and heart sounds.
A diagnostic sign of hydatidiform mole is a woman’s complaints of uterine bleeding. Bleeding begins in the early stages and continues until the due date, or until surgery to remove the egg. Discharge during a hydatidiform mole is dark-colored bleeding that has a liquid consistency. Egg vesicles are released along with the blood. Bleeding is not profuse, but if it is regular, it can lead to the formation iron deficiency anemia.
Characteristic signs of hydatidiform mole are:
In most cases, hydatidiform mole is detected during abortion or suspected miscarriage (due to bleeding). In some cases, symptoms are mild. A more distinct clinical picture is observed with complete hydatidiform mole.
Classification
Hydatidiform mole can be complete or incomplete (classical or partial). They differ in the degree of damage to the fetal membrane: with a complete hydatidiform mole, changes occur throughout membrane, and if incomplete - only in its area. A separate category includes destructive hydatidiform mole, which is considered a malignant pathology.
Most often, a complete hydatidiform mole occurs between 11 and 25 weeks of pregnancy and is characterized by the absence of any signs of embryonic or embryonic development. The first clinical symptom of this type of disease is an enlarged uterus that does not correspond to the gestational age. You can visually verify the presence of vesicles and edematous chorionic villi.
For incomplete hydatidiform moles, the characteristic time of detection is gestational age 9–34 weeks. The main symptom is the size of the uterus, which is smaller than the corresponding current term pregnancy. It is also possible to visually identify fragments of the fetus, placenta and edematous chorionic villi. In some cases, the transition of an incomplete hydatidiform mole to a malignant formation is possible.
Simultaneously with a simple hydatidiform mole, the development of an invasive type of hydatidiform mole is possible. At the same time, this diagnosis can be confirmed only by removing the uterus or the area with metastases (signs of invasion are observed in the villi of the myometrium and other tissues). With this type of hydatidiform mole, there is swelling on the chorionic villi, the absence of embryonic vessels and the invasion of the myometrium by proliferating syncytio- and cytotrophoblast elements. The lesion quickly extends deep into the myometrium and can cause severe intraperitoneal bleeding.
Causes
The main factors that increase the risk of developing hydatidiform mole are:
The likelihood of the formation of this pathology increases significantly in the presence of several risk factors.
Another cause of hydatidiform mole is uniparental disomy, which occurs when the maternal genomes are lost and the paternal genome is duplicated.
In some cases, this pathology develops in full form as a result of fertilization of an anucleated egg by two sperm. Incomplete hydatidiform mole can occur when an egg is fertilized by two sperm, characterized by a single set of maternal and double set of paternal chromosomes. In both of these cases, the fetus dies.
Signs
The main signs of hydatidiform mole are bleeding that occurs in the 1st trimester of pregnancy and an enlarged uterus. The woman is also tortured:
There are also no signs of pregnancy such as parts, heartbeat and movements of the fetus, and with ultrasound, the absence of the fetus and the presence of small cystic tissue are observed in the uterus.
Hydatidiform mole in a malignant form is characterized by the penetration of its tissues into the structure of the uterine wall and further spread with blood into the vagina and lungs. Its signs are bloody discharge from the uterus and pain in the abdomen, lower back and sacrum that continues even after removal of the hydatidiform mole. There is also no uterine contraction.
Treatment
Treatment of a benign form of the disease leads to the removal of the egg using vacuum aspiration. During this process, the contents of the uterus are sucked out with a metal narrow-cylindrical tip and an electric vacuum pump.
HCG during hydatidiform mole exceeds the norm. After egg removal, it is recommended to check your hCG levels every week. It should drop to 100 mIU/ml. After hCG has decreased to this norm, its determination continues every month for 6 months.
Chemotherapy for hydatidiform mole is also used. The dose of drugs is prescribed by the doctor strictly individually. After treatment, you should protect yourself from pregnancy for one year.
In case of severe hydatidiform mole, it is necessary to first treat complications, such as:
Only after the normal state of the pregnant woman is restored, the uterus is emptied.
With a complete hydatidiform mole, treatment depends on the woman’s desire to have children in the future. If you plan to have a baby in the future, then vacuum aspiration should be used, regardless of the size of the uterus. It is done as follows:
If patients have Rh-negative blood, they are given anti-Rh(D) immunoglobulin during surgery. In less than 10% of cases of hydatidiform mole removal, there is a need for chemotherapy. The probability of developing malignant tumors after the elimination of complete or partial hydatidiform mole is 8% or 0.5%, respectively.
After treatment for hydatidiform mole is completed, pregnancy and childbirth proceed normally, and the risk of re-development of hydatidiform mole does not exceed 1%. For women who fall into this 1%, the following is produced:
Heavy bleeding and enlarged uterus more sizes, corresponding to the 20th week of pregnancy, may become an indication for laparotomy with removal of the uterus (if the woman does not want to have children). The ovaries are not removed.
Diagnostics
When diagnosing a hydatidiform mole, the patient's complaints are taken into account. For example, they indirectly indicate this pathology:
Anamnesis analysis is also very important. Characteristic pathologies accompanying hydatidiform mole are:
An important diagnostic tool is ultrasound. In this case, a hydatidiform mole may be indicated by:
Other methods for diagnosing hydatidiform mole are:
Ultrasound
The size of the uterus during a hydatidiform mole is larger than the size characteristic of the expected period of pregnancy (50% of cases). Ultrasound visualizes many liquid bubbles of various diameters (a picture of a snow storm), which appeared as a result of proliferation of the chorion epithelium with a change in its shape, location and the formation of liquid vacuoles; the fertilized egg turns into a cluster-like conglomerate of heterogeneous ultrasonic density. In half of the cases, cysts can be detected in the ovaries. The doctor must rule out partial hydatidiform mole - a combination of local hydatidiform mole and pregnancy.
Ultrasound is the most exact method diagnosis of hydatidiform mole. In this case, the diagnosis is based on the detection of multiple echo signals in the uterine cavity, creating a picture of a “snow storm”. The longer the pregnancy, the more accurate the diagnosis, which is associated with an increase in the size of the vesicles (the picture becomes more clear).
Also not difficult ultrasound diagnostics partial hydatidiform mole during pregnancy of more than 12 weeks, if the fetus is developing normally. With minor changes in the chorion and/or severe fetal degeneration, identifying this pathology is often difficult.
Differential diagnosis of hydatidiform mole should be carried out with uterine fibroids with secondary changes in the myomatous nodes (edema, necrosis). There may be difficulties in differentiating a hydatidiform mole from a non-developing pregnancy with significant regressive changes.
Consequences
The main complication of the disease is the development of chorionic carcinoma. This is a trophoblastic disease of a malignant form, which is characterized by the proliferation of pathological tissues in the uterus, liver, lungs and brain. And this already leads to death.
There are several stages of gestational tumors:
In addition to this pathology, hydatidiform mole has several other negative consequences. For example:
Chemotherapy treatment
Previously, there was a practice of mandatory chemotherapy for all patients who had a hydatidiform mole. Currently, this procedure is only recommended for women with increased danger development of chorionepithelioma. This danger is detected in women without a certain decrease in chorionic gonadotropin titers after getting rid of hydatidiform mole. If there is no progress within a month, chemotherapy is vital. Except high level HCG indications for chemotherapy are diagnosed choriocarcinoma and detection of metastases.
Treatment of trophoblastic tumors is carried out in clinics prepared for this, and you should choose a clinic with good statistics on the treatment of such diseases. The treatment process begins a course of chemotherapy, depending on the research of the tumor. Chemotherapy is also carried out during bleeding that has not stopped; in this case, the chemotherapy is combined with hemostatic therapy.
Hydatidiform mole is characterized by gynecologists as a serious disease that requires particularly close monitoring. Identifying the causes and undergoing a course of treatment for such a disease is mandatory. Recurrence of hydatidiform mole occurs in almost 20% of cases, but if you strictly follow all the doctor’s recommendations, it is quite possible to avoid a relapse, and the pregnancy will be completely full.
In any case, the patient who has suffered a mole is under the supervision of an oncology gynecologist for a certain time. After the illness, hCG levels are analyzed monthly for 1.5 years. During such a period, a woman needs to protect herself from pregnancy, preferably hormonal contraceptives - they will help restore normal ovarian function.
If the rehabilitation period proceeds normally, after two years the woman receives approval for a new pregnancy. At the same time, monitoring of a pregnant patient who has suffered a hydatidiform mole in the past, for obvious reasons, should be more closely in order to avoid the risk of relapse, severe pregnancy and bleeding.
Modern medicine allows 70% of women faced with the problem of hydatidiform mole to avoid dangerous consequences and fully carry and give birth to a child with next pregnancy. Therefore, the happiness of motherhood with such a complication does not become impossible; it is only slightly delayed.
Pregnancy
When the hydatidiform mole is removed, the woman is registered for another 1-1.5 years. During this control period, you need to carefully monitor to ensure that pregnancy does not occur. The best method of planning pregnancy is hormonal contraceptives, which it is advisable to discuss with your gynecologist. Due to the hormonal effect on the body, this method will positive side regulate the functioning of the ovaries, which could have been disrupted during the operation and complications in general.
The next pregnancy should be under strict control both from the woman and from the medical team. personnel. This is necessary because the likelihood of complicated childbirth and pathologies in the development of pregnancy has now increased.
Conceiving after chemotherapy or surgery should be planned no earlier than a year later!
Solution
After the diagnosis of “hydatidiform mole”, the treatment of which is aimed at removing the tumor from the uterine cavity, is confirmed, the woman is sent to the hospital. If the disease has no 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 all uterine contents are removed using a curette (special instrument).
Vacuum aspiration is used even in cases where the uterus is of a size corresponding to 20 weeks of pregnancy. This procedure involves suctioning out the contents of the cavity using special equipment. It is often performed together with curettage.
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 surgery include thinning of its walls, perforation by hydatidiform 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 tissue is sent for histological examination to exclude chorionepithelioma. If this procedure shows the malignancy of the formation, the level of hCG after a hydatidiform mole tends to increase, and foci of metastatic origin are found in the lungs, then the patient is prescribed chemotherapy.
To treat the pathology, the drugs “Methotrexate” and “Dactinomycin” or a drug combining these two drugs – “Leucovorin” - are used. The main direction of action of these medications is to destroy cancer cells. Receiving data medicines is prescribed until the level of hCG and the menstrual cycle are normalized, and pathological foci in the lungs and uterus disappear. After getting rid of these symptoms, the patient is prescribed several more preventive courses of chemotherapy 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 externally, using devices, and from the inside. In the latter case, so-called radioisotopes are used, which produce radiation into the area where the malignant cells are located using thin plastic tubes.
Prevention
There is no specific prevention of hydatidiform mole; it has not been established real reasons of this disease.
Indirect measures to prevent hydatidiform mole can be considered:
Hydatidiform mole is an extremely rare, no more than 0.02 percent, abnormal development of the fertilized egg, which manifests itself in the pathological structure of the trophoblast - the tissue of a temporary organ that acts as an attachment of the embryo to the wall of the uterus. After the formation of the placenta, the trophoblast differentiates into extraembryonic tissue, which in turn forms the fetal septum, separating the embryo and the mother and providing the fetus with all the necessary components for healthy development. The development of hydatidiform mole consists of the formation of multiple vesicles in the villous layer of the chorion epithelium. In other words, the villi are transformed into vesicles filled with a yellowish liquid, which includes albumin, amino acids and human chorionic gonadotropin (hCG), and resemble a bunch of grapes in their shape.
There are complete, destructive and partial hydatidiform moles. In the full form of hydatidiform mole, the pathology spreads to the entire chorion, appearing in the first months of pregnancy. In this case, the embryo dies and subsequently dissolves, transforming into additional vesicles. Partial hydatidiform mole develops in the second trimester, which gives a chance to save the life of the baby and, despite the fact that labor under conditions of hydatidiform mole most often begins prematurely, with qualified management of pregnancy, as well as labor, a woman can give birth to a completely viable And healthy child. When a hydatidiform mole forms in a multiple pregnancy, the pathology affects both one and both fertilized eggs. The destructive form of mole is the most threatening to a woman’s life, since it develops into a cancerous tumor.
The mechanism of occurrence of hydatidiform mole in pathological fertilization of the egg, in which the presence of two sets of male chromosomes is noted, with a deficiency, and in some cases the absolute absence of the mother’s chronosome set. Today, there are several causes of hydatidiform mole. The presence of viral and infectious diseases in a woman’s body: vulvar condylomas. infections acquired during laparoscopy of paraovarian ovarian cyst. development of infectious parametritis. with possible transformation into pelvioperitonitis, they create favorable conditions for the occurrence and development of hydatidiform mole. Hormonal imbalances, with estrogen deficiency, also cause pathological development of chorionic villi. In addition, the genetic dependence of chromosomal disorders and abnormalities of the fetal egg is noted. Against the background of chronic hereditary diseases, such as heterozygous thalassemia. Gilbert's disease. There may also be a risk of hydatidiform mole. In addition, it was noted that hydatidiform mole is much more common in second and subsequent pregnancies. Women in the age group of forty to forty-five years make up more than forty-five percent of all cases of hydatidiform mole, but the anomaly also threatens those who started early. sex life teenagers
The symptoms of hydatidiform mole are quite characteristic, and this easily suggests an anomaly. A significant, inappropriate increase in the size of the uterus (at three months of pregnancy, the size of the uterus corresponds to the fifth month), tight elasticity of the uterus, difficulty in listening to the baby’s heartbeat and observing its movements are the first signs of hydatidiform mole. The anomaly is accompanied by severe toxicosis, nausea and vomiting, tissue swelling, and the development of iron deficiency anemia associated with constant uterine bleeding, which accompany a pregnant woman with partial hydatidiform mole throughout the entire pregnancy.
Diagnosis of hydatidiform mole is carried out on the basis of a carefully collected medical history, gynecological examination, as well as laboratory and instrumental studies. A blood test during hydatidiform mole will indicate a significant increase in hCG content, sometimes tens of times higher than normal, as well as a decrease in oxytocinase activity. On ultrasound, a hydatidiform mole will look like many bubbles forming a bunch of grapes in the uterine cavity.
Treatment of hydatidiform mole is reduced to curettage of the formation from the uterine cavity, followed by the administration of drugs that stimulate the contractile function of the uterus. The extracted tissue is sent for histological examination to determine the type of cells and exclude an oncological factor. If the destructive form of the disease (malignant formation) is confirmed, the woman is referred to a doctor specializing in oncological pathologies. As a rule, a course of chemotherapy is prescribed. After which a repeat test is carried out to determine the level of hCG and oxytocinase activity. In some cases, several courses of chemotherapy and long-term observation by an oncologist are required. It should be noted that Israeli oncologists are known throughout the world for their highest qualifications and progressive treatment methods.
Treatment of hydatidiform mole in Israel is carried out using the latest generation drugs Dactinomycin and Methotrexate - drugs intended for chemotherapy are used in combination with Leucovorin, according to the regimen and in dosages recommended by the doctor in accordance with the condition of each woman’s body individually. Therapy is carried out until blood counts are completely normalized and stabilized menstrual cycle. At the end of the therapeutic period, the woman remains registered with a gynecological oncologist for another year and a half, with constant monitoring of significant blood parameters.
Such measures are necessary because of the dangerous consequences that hydatidiform mole can have. Complications of hydatidiform mole manifest themselves in the development of a trophoblastic tumor, in the presence of which some cells do not leave the uterine cavity and begin active division. The greatest danger of such a comb is that these cells have the ability to move to neighboring organs, involving the liver, lungs and even the brain in the malignant process. The occurrence of choriocarcinoma, an incurable form of cancer, is a fairly rare occurrence, and yet it would be extremely imprudent to neglect such a danger.
With timely provision of qualified medical care, after the hCG level reaches zero and complete remission is achieved, pregnancy after a hydatidiform mole is quite likely, and the chances of its healthy resolution are high. However, a woman must be under constant medical supervision to avoid complications and give birth to a healthy baby.
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, of unusual tissue consisting of grape-shaped clusters of bubbles filled with fluid. 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. In this case, 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 mucosa 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.
The embryo, which requires oxygen and nutrition for development, during a 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, but reliable studies have established a connection between the development of pathology and the process of fertilization, when during the fusion of germ cells the loss of maternal chromosomes and doubling of male chromosomes occurs.
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 genes of the father, male in the amount of 46. It can also be caused by a denucleated egg fertilized simultaneously by two spermatozoa. 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, the egg contains 96 (46+23) chromosomes, and the fetus nevertheless begins to develop, but has multiple malformations due to large quantity extra 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 the full development of the egg, a sufficient amount of estrogens is required; 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 clinical picture of hydatidiform mole is more pronounced the larger its area, so in different forms it, although it has similar symptoms, 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: for a single female chromosome there is twice the number of male chromosomes. 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 a specific feature - 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 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.
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 of fertilized egg in the early stages and absence of the fetus in the later stages; with a partial form of pregnancy, 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 of 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 began to develop incorrectly, and she 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 introduction 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 recommended 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 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 chorionic gonadotropin levels remain high eight weeks after molar removal, there is reason to suspect the presence of residual trophoblast cells (in the uterus or other organs) that continue to secrete gonadotropin, or a malignant trophoblast tumor, so further investigations are performed. diagnostic measures: examination, ultrasound diagnostics and radiography of the lungs. 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 the restoration of normal hCG levels. 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 of 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. Its main feature 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 is a very rare form of pathological development of the placenta during pregnancy (only 0.02 - 0.8% of cases). The disorder is based on a chromosomal “breakage” of the conception process, which causes the degradation of cells on the basis of which the child’s place subsequently appears. The affected chorionic villi are modified into bubbles with liquid inside. At the same time, there are no conditions for the growth of the embryo and its existence in general, because the fertilized egg acquires the structure of a bunch of grapes. Read more about the disease and methods of its treatment below.
Hydatidiform mole belongs to the group of trophoblastic tumors, which most often occur in young women ( average age 18 - 35 years old) and are not malignant. The internal space of the uterus is filled with numerous small cysts, inside of which there is a liquid substance. There are no clear boundaries for the period of appearance of vesicles: pathology can be detected both at 7-8 weeks of gestation and at later stages of its development. With a hydatidiform mole in the early stages of pregnancy, the fetus will not survive, since the mutilated placenta cannot provide it with sufficient oxygen and vitality. necessary substances. It is extremely rare for a vesicular neoplasm to grow outside the uterus.
Causes of hydatidiform mole during pregnancy
Most cases of hydatidiform mole are recorded during repeated pregnancies. Sometimes women who celebrate their 40th birthday face this problem. What exactly does it develop from? this pathology currently not known for certain. First of all, scientists' suspicions concern chromosomal breakdowns, when a sperm fertilizes an empty egg that lacks a nucleus. Without finding the necessary cellular material from the woman, the potential father's chromosomes are duplicated, while the mother's genetic heritage is completely lost. Hydatidiform mole also occurs when a normal egg is fertilized by two sperm at once.
Among other suspected causes of the disorder, we note diseases of viral and infectious etiology, as well as hormonal imbalances provoked by an insufficient amount of estrogen in a woman’s body. All this contributes to the pathological transformation of chorionic villi.
The likelihood of developing a serious pathology increases against the background of such disorders in the female body:
- ectopic pregnancy. In this case, the hydatidiform mole “occupies” the fallopian tube;
- repeated abortions, as well as spontaneous miscarriages;
- extremely weak immunity;
- poor nutrition, as a result of which the body experiences an extreme deficiency of retinol and animal fats.
Scientists consider marriages between close relatives to be another provoking factor for this dangerous disorder. Hydatidiform mole is a truly dangerous disorder, because if it happens more than once, the woman will most likely become infertile.
In medical practice, cases have been recorded when hydatidiform mole developed in the vicinity of a normally growing fetus. This is possible if the pregnancy is dizygotic, that is, when one fertilized egg has grown from a full-fledged egg, and the second is affected by a complete hydatidiform mole. If no more than a third of the uterus is affected, the woman still has a chance to give birth to a healthy child.
Stages of hydatidiform mole during pregnancy
According to the extent of damage to the chorion, hydatidiform moles are classified into several types:
- normal or complete hydatidiform mole. The entire chorion is subject to pathological deformation. The embryo is endowed exclusively with the paternal chromosomes. When it dies, the cysts continue to grow (some are the size of a match head, others look like large grapes), and the uterus increases in size. With this form of the disease, numerous cases of degeneration of neoplasms into a malignant tumor with the subsequent development of metastases are recorded;
- partial hydatidiform mole. Pathological changes chorion are fragmentary. An embryo that has received one female chromosome and two male chromosomes dies at approximately 8–10 weeks of intrauterine life;
- simple hydatidiform mole. Cysts fill exclusively the inner space of the uterus;
- destructive hydatidiform mole. With this form of pathology, the destructive process spreads to the tissue of the walls of the uterus, due to which they begin to collapse, causing internal bleeding.
Photo 1 and photo 2 show complete and partial hydatidiform mole during pregnancy, respectively:
Photo 1 
Photo 2 Clinical symptoms of hydatidiform mole during pregnancy
The biggest danger with hydatidiform mole in early pregnancy is that the disease may not manifest itself in any way during the first two months. This makes it very difficult to diagnose.
We list the signs of pathology in the early stages of gestation:
- large size of the uterus (due to the accumulation of cysts and blood);
- elevated levels of human chorionic gonadotropin;
- bleeding from the genital tract, which becomes more intense when the mole is expelled. Anemia develops due to blood loss;
- there are white bubbles in the blood that is released from the vagina;
- formation of cysts in the ovaries;
- high blood pressure;
- pregnant woman's urine contains protein;
- a woman often suffers from nausea, vomiting, general weakness and fatigue;
- There are no obvious signs of pregnancy (fetal heart rate, movements and kicks).
Most often, the uterus during a hydatidiform mole looks excessively large for the stage of pregnancy at which the woman is. However, in some cases, the size of the reproductive organ does not exceed the normative limits, so hydatidiform mole is confirmed on the basis of some other symptom.
It is extremely rare for a fetus to be saved with this pathology. It is a great success if a spontaneous miscarriage occurs without any complications, and the woman still has the opportunity to have children in the future. Unfavorable development of the pathological process entails serious consequences.
Consequences of hydatidiform mole during pregnancy
Due to hydatidiform mole, a woman develops complications that significantly overshadow her future life:
- regular disruptions or complete cessation of the menstrual cycle (in more than 13% of cases);
- After an illness, doctors pronounce about a third of their patients a sentence of infertility;
- there is a high probability that during the next pregnancy the fetus will be diagnosed with developmental anomalies, and the birth will be difficult;
- the risk of developing malignant tumors increases several times;
- development of a malignant tumor of trophoblastic nature - chorionic carcinoma. If treatment is untimely or absent, the woman is doomed to death.
Hydatidiform mole during pregnancy: specific definition of pathology
The clinical picture of hydatidiform mole is very diverse and largely depends on the form of the disease and the degree of its development.
Partial hydatidiform mole during pregnancy is quite difficult to diagnose, since the uterus often retains its natural volume, and due to incomplete damage to the baby's place, the pregnancy continues to develop. Nevertheless, the outcome is the same: in one case, the fetus dies in the womb, in the other, a stillborn child is born.
If the hydatidiform mole has completely covered the uterus, the correct diagnosis will be determined in time. Everything is obvious: there are no symptoms of embryo development in the uterus, but the size of the organ is significantly larger than normal. The body of the uterus contains cystic cysts and villi with signs of edema.
Destructive hydatidiform mole is detected due to severe internal bleeding. In this case, the woman is bothered by a severe headache, bloating, heaviness in the lower abdomen, dull and nagging pain that spreads to the sacrum and lumbar region. This symptomatic picture is due to the painful growth of degrading villi into the body of the uterus.
Since hydatidiform mole is quite rare, doctors do not always make the correct diagnosis right away. The pathology can be mistaken for spontaneous abortion, polyhydramnios and uterine fibroids accompanying pregnancy. The main distinguishing feature of a hydatidiform mole is the bubbles that are released from the vagina along with blood, as well as the rapid growth of the uterus in combination with a modified consistency.
In the case of the development of a malignant tumor of chorionic carcinoma, the woman’s vagina, lungs and brain are affected by metastases, which is externally manifested by coughing, expectoration of blood, nausea, dizziness and painful headaches.
To confirm a pregnant woman has a hydatidiform mole, doctors use the following diagnostic methods:
- Ultrasound to assess the size of the uterus;
- fetal phonocardiography to check if the fetus is showing signs of life;
- determination of hCG level;
- examination of the uterine cavity and fallopian tube patency;
- CT and MRI;
- biochemistry of liver tests;
- X-ray of the lungs and brain.
The patient is regularly tested for hCG - its indicators are used to judge the tendency of a hydatidiform mole to degenerate into a malignant tumor. If increased level specific hormone is consistently elevated, this may be evidence of the formation of metastases.
Treatment of hydatidiform mole during pregnancy
Considering the versatile capabilities of modern medicine, treatment of hydatidiform mole can be done in several ways. If the cysts are benign, the fertilized egg is removed through vacuum aspiration. Gentle surgery does not threaten a woman’s reproductive health.
Most often, with this disease, a spontaneous miscarriage occurs, along with which the pregnancy is removed from the uterus. However, in this case, vacuum aspiration is indicated for thorough cleansing of the organ cavity from fragments of the pathological formation. It is not possible to expel them from the uterus without surgical intervention. Afterwards, the woman must donate blood for an analysis of hCG levels. Elevated levels of the hormone indicate incomplete curettage. This means that disease-causing growths are still present in the uterus. In this case, the patient is sent for repeated cleaning.
Biological material extracted by vacuum aspiration is examined for the presence of malignantly degenerated cells.
Treatment continues for 3 to 7 days after surgery: the woman is prescribed stimulants for rapid contraction of the uterus, antibacterial drugs, and is recommended to apply cold to the lower abdomen. For patients with Rh negative blood, especially after incomplete hydatidiform mole during pregnancy, Immunoglobulin is prescribed.
The prognosis of treatment in most cases is favorable - relapses of hydatidiform mole occur in isolated cases.
If, as a result of the pathology, a woman began to experience massive bleeding and the uterus was enlarged to the volume characteristic of the 20th week of pregnancy, specialists will most likely decide on laparotomy with resection of the uterus and preservation of the ovaries.
After the operation, the second, rehabilitation, stage of therapy begins. During this period, doctors closely monitor the level of hCG in the patient’s blood. If the risk of developing chorionic carcinoma remains high, the woman is recommended to undergo chemotherapy to prevent cancer.
Provided that the recovery process goes according to plan, on average 1 month after cleansing, menstruation resumes. The quantitative and qualitative characteristics of these periods are no different from the menstruation that a woman had before conception. If your period does not occur within 7-8 weeks after the removal of a hydatidiform mole, you should make an appointment with a gynecologist. The reason for the absence of a menstrual cycle may be internal inflammation, infection or hormonal imbalance. You should also contact medical care with too heavy periods with an unpleasant odor, during which there is weakness throughout the body, dizziness and abdominal pain.
Treatment of a malignant tumor with hydatidiform mole
When the high concentration of hCG does not decrease after surgical expulsion of a hydatidiform mole, the patient is examined for neoplasms and metastases in the uterus. If the doctors’ fears are confirmed, the treatment is continued: the woman is prescribed chemotherapy.
Diagnosis of malignant degeneration of hydatidiform mole requires an integrated approach:
- strict control of hCG levels;
- ultrasound examination pelvic organs with a frequency of 1 time in 10 - 14 days;
- X-ray of the lungs.
At the stage of diagnosing the pathology, the patient is immediately prescribed hormonal contraceptives, since a new pregnancy during this period is extremely undesirable.
The doctor selects the procedure for administering chemotherapy and medications based on the general health indicators of the patient and the specifics of her disease. The choice of specialists most often falls on pharmaceuticals such as Dactinomycin or Methotrexate. The course of treatment lasts until the level of human chorionic gonadotropin in the blood normalizes and the normal monthly cycle resumes.
The following indicators contribute to a favorable prognosis for the treatment of trophoblastic neoplasms:
- low beta-hCG levels;
- brain and liver without metastases;
- deadlines last pregnancy do not exceed 4 months.
The treatment prognosis is considered unfavorable in the following cases:
- elevated levels of beta-hCG;
- the presence of metastases outside the uterus;
- lack of positive dynamics after chemotherapy;
- the appearance of a neoplasm after a normal pregnancy.
Pregnancy after hydatidiform mole
After getting rid of the tumor, doctors recommend that the patient be registered with the LCD for about 12 to 18 months. According to gynecologists, pregnancy after a hydatidiform mole, eliminated without complications, is possible in 70% of women within a few months. Nevertheless, it is better to postpone thoughts about conception for a while, since, unfortunately, there is no guarantee that a new hormonal surge will not become an impetus for a relapse of the pathology.
During this period, a woman should turn to hormonal contraception, the selection of which is best entrusted to a competent specialist. Oral contraceptives will not only protect against unnecessary pregnancy, but will also have a beneficial effect on the activity of the ovaries, balance the hormonal levels, which will further contribute to the birth of a healthy baby.
Ideally, pregnancy after a hydatidiform mole can be planned only 2 years after completion of therapy. If conception occurs earlier, there remains a high risk of developing intrauterine fetal anomalies and difficult labor. This is especially true for women who have been treated for a malignant tumor.
After pregnancy future mom must enlist reliable support from specialists, which is expressed in the following:
- regular medical supervision;
- Ultrasound of the uterus once every 3 months;
- histology of the fetal egg or placenta (depending on how the pregnancy ends).
The likelihood of developing a hydatidiform mole during IVF
A complete hydatidiform mole develops on the basis of a “defective” egg that has no chromosomes, which an embryologist, of course, cannot correct. But the development of incomplete hydatidiform mole during IVF is excluded, since during the procedure the doctor will make sure that female cage was fertilized by strictly one sperm. The likelihood of developing a hydatidiform mole during IVF is generally small and does not exceed the risks of a natural pregnancy.
Prevention of hydatidiform mole during pregnancy
Unfortunately, there are no special preventive measures, since hydatidiform mole does not occur often, therefore, it has been little studied by representatives of medicine. The main prevention for women who have had this disease before is to abstain from pregnancy for 2 years after treatment of the pathology.
Otherwise, you need to plan motherhood wisely and follow general preventive measures:
- visit a gynecologist twice a year (even if nothing bothers you);
- regularly donate blood for analysis in order to eliminate the risk of developing anemia in time;
- consult a doctor in a timely manner and responsibly treat diseases of infectious and viral etiology;
- do not have abortions;
- “be friends” with sports;
- Healthy food;
- lead an emotionally stable lifestyle.
Hydatidiform mole is one of the most unpredictable diseases in terms of complications. In order to detect the problem in time, a pregnant woman should register on time, take all the necessary tests on time and consult a doctor in case of any, even the most minor, ailment.
Every woman planning a desired pregnancy with all her soul wants the successful gestation and development of the fetus and is afraid of any deviations in this process. This, unfortunately, happens, although not so often. One of the serious diseases that occurs during pregnancy is hydatidiform mole.
This pathology is rare - less than 1% of women who are preparing to become mothers. It is associated with disturbances during the fertilization stage, can have serious consequences, and requires rapid diagnosis and treatment.
What is the disease?
Hydatidiform mole is an irreversible change in the tissue of the chorion - the temporary membrane of the embryo. Attaching to the wall of the uterus, its villi mutate and begin to grow into a special tissue that resembles clusters with bubbles filled with a yellowish liquid. A hydatidiform mole can be in a specific area, can fill the entire uterus, or even penetrate other organs (in particular, the lungs).
The mechanism of 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 its existence.
During fertilization, a sperm unites with an egg. The maternal and paternal cells endow the product of their fusion with 23 chromosomes each. That is, the embryo receives 46 chromosomes, but normally it still has 23. The ratio of male to female determines the sex of the future person.
The cell that appears as a result of fertilization begins to actively divide and move along the fallopian tube to the uterus. There it must attach to its wall, receive nutrition, develop and grow for 9 months, gradually preparing to enter the big world.
The embryo needs nutrition, and it is important for it to attach securely. Therefore, its outer shell - the chorion - is equipped with special villi, which, like the branchy roots of a tree, sink into the mucous membrane of the uterine wall, attach to its blood vessels and begin to form the placenta. The rest of the chorion is transformed - it becomes the umbilical cord and fetal membranes.
Hydatidiform mole is characterized by the fact that the chorionic villi begin to mutate, turning into tissue similar to bubbles. They grow, causing swelling of the surface of the uterus, and resemble grapes. Inside each vesicle is a liquid that contains the pregnancy hormone, hCG.
The tissue affected by the pathology increases in size. By the nature of its growth, it resembles a tumor. In the most severe cases, a malignant neoplasm actually appears, and sometimes the blisters metastasize into the vagina or upward into the lungs.
Is pregnancy compatible with this pathology?
Unfortunately no. The fetus needs nutrition, which the modified tissue cannot provide it with. The placenta does not form, a lack of necessary substances occurs, 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 the pathology?
- Absence of female X chromosomes at all or doubling the number of 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 total (23 maternal and 46 paternal).
- One of the reasons, according to a group of scientists, is estrogen deficiency, which is caused by general hormonal dysfunction. The predominance of the male hormone in the early stages of pregnancy causes various problems, including hydatidiform mole.
- Infectious diseases, especially those suffered at the time of conception.
Signs and symptoms
Early diagnosis is usually difficult. The pathology imitates the symptoms of pregnancy, so it is sometimes detected at a serious period - from 25 to 34 weeks. The signs by which you can identify the problem and sometimes its causes boil down to the following:
- Enlargement of the uterus that does not correspond to the gestational age. This is one of the most important signs that characterize a complete hydatidiform mole, in which all chromosomes are male. The growing chorion tissue stretches the walls of the organ, which a specialist can determine by manual examination. However, an incomplete form of the disease may not have this sign for a long time.
- Signs of a hydatidiform mole are usually clearly visible during an ultrasound examination. Overgrown, non-viable tissue with clusters of bubbles can be easily distinguished from the normal course of pregnancy. Ultrasound allows us to identify the nature of the pathology - partial damage to the uterus, complete or destructive (invasive), when mutating tissue grows inside the organ. In this case, we can talk about a malignant tumor formation.
- Bleeding. This is an ominous sign in any pregnancy, including normal ones.
- A distinctive feature that characterizes a hydatidiform mole is vaginal discharge with bubbles - particles of affected tissue.
- Toxicosis, characterized by severe vomiting, weakness and general malaise.
- Lack of fetus or its death. Most often it does not even begin to form. With partial implantation, lack of nutrition leads to the absence of signs of life of the embryo. An ultrasound specialist can determine this during diagnosis (the heartbeat cannot be heard, the fetus cannot be seen), the woman herself does not feel the baby’s movements.
- The volume of the hCG hormone exceeds the norm by tens of times, and does not decrease during pregnancy.
Diagnostics
Hydatidiform mole, the symptoms of which not every doctor can identify (since the disease is poorly studied), is diagnosed based on a combination of factors. The clinical picture is often similar to other conditions. For example, an enlarged uterus in the early stages may indicate that a woman is carrying a multiple pregnancy, and bleeding occurs due to placental abruption and spontaneous miscarriage.
Most sure sign, by which you can determine chorionadenoma - the presence of bubbles in vaginal discharge. External examination does not reveal a heartbeat, the uterus is soft in places.
Ultrasound examination makes it possible to make a diagnosis if the following clinical picture is visible:
- enlarged uterus;
- there is no fertilized egg or fetus, sometimes parts of it are visualized;
- the presence in the uterus of a characteristic type of tissue with many bubbles;
- 50% of pregnant women diagnosed with hydatidiform mole have large symmetrical luteal cysts in both ovaries simultaneously.
Treatment
By and large, therapy consists of expelling diseased tissue from the uterus. In case of an incomplete form of drift, special preparations can be used to provoke spontaneous cleansing of the cavity. In other cases, this is a surgical intervention: vacuum aspiration and subsequent curettage, that is, cleaning the organ with a special instrument. This is necessary in order to remove 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 monitored regularly checking the following indicators:
- hCG level in urine;
- indications obtained during ultrasound examination;
- X-ray of the lungs (needed to exclude the appearance of metastases - penetration of bubbles into the alveoli themselves).
What to do next?
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 them to despair. However, medicine has established three factors associated with drift:
- The fetus could not develop in such conditions, which means that it was not viable to begin with.
- Even with the most unfavorable results of pathology studies, it is 100% curable.
- A normal pregnancy after a hydatidiform mole is possible.
Having undergone the necessary rehabilitation, which includes monitoring the condition, normalizing hormonal levels and restoring the menstrual cycle, a woman can carry and give birth to a healthy baby. This unpleasant and frightening disease is not a death sentence, and modern medicine is able to cope with it.