Hydatidiform mole - a condition accompanied by proliferation of trophoblast (outer layer embryo cells) filling the uterine cavity. It may be complete (classical) or incomplete (partial). At full molar pregnancy changes captures all the membranes, with partial - only part of it. Further, a malignant form of the disease is isolated - destruirujushchego hydatidiform mole.
Complete molar pregnancy occurs when uniparental disomy, when for unknown reasons, is a loss of maternal genes and paternal genome duplication. Sometimes it is called fertilization "empty" (nuclear-free) egg by two sperm. Embryos die in the early stages of development.
A partial molar pregnancy is caused by the fertilized egg by two sperm delayed set of maternal chromosomes. embryonic cells contain a single set of maternal chromosomes and a double set of paternal chromosomes. Fetus dies.
Manifestations of hydatidiform mole
- Bleed typically occurs in I trimester of pregnancy;
- The uterus is larger than you might think, given the date of the last menstrual period at this stage of pregnancy;
- Nausea and vomiting, occurring in approximately one third of patients;
- evidence preeclampsia I trimester of pregnancy;
- No significant signs of pregnancy in the form of parts determining fetal heart, fetal movements ultrasound in the uterus reveals only fine-cystic tissue in the absence of the fetus;
- Abdominal pain disturb 15% of patients.
Malignant form: cloth hydatidiform mole penetrates the thickness of the uterine wall and spreads through the bloodstream to the lungs, vagina. Manifestations of malignant form - continued bleeding from the uterus after removal of hydatidiform mole; the uterus does not contract; stored pain in the abdomen, rump, loin.
- Important evidence of disease - the presence of the plurality of bubbles with clear content in secretions from the vagina.
- Increasing content hCG (Horiogonadotropina) with hydatidiform mole - more than 100,000 mIU / ml and with increasing uterine bleeding.
- Ultrasonography - signs of normal gestational sac or fetal absent.
Treatment of hydatidiform mole
- Vacuum aspiration. To remove a hydatidiform mole is used more often than other methods, even if the uterus is enlarged to a size corresponding to 20 weeks of pregnancy. After vacuum aspiration intravenously administered oxytocin to better uterine contractions. When significant bleeding and uterine large size (more than 20 weeks of pregnancy) can be made by laparotomy with removal of the uterus.
- Uterus removal. If a woman does not want to have children in the future, it is possible to carry out removal of the uterus. The ovaries are not removed. If present in the ovaries multiple cystsAfter hCG levels drop occurs their reverse development.
- Preventive chemotherapy. Preventive chemotherapy is carried out after the removal of hydatidiform mole if hCG titer increases or long is at a constant level, as well as the detection of metastases. In 80% of patients self-healing occurs without additional therapy. The systematic definition of the content of the HCG helps to quickly identify developing horionepiteliomu; therefore, given the high probability of toxic effects, preventive chemotherapy for all patients is not carried out.
Observation of the patient after the removal of hydatidiform mole includes a number of activities:
- Determination of hCG levels from 1-2 week intervals until 2 negative results. Then, studies were carried out on a monthly basis for 2 years. Recommend patients avoid pregnancy during the 2 years of oral contraceptives.
- A physical examination of the pelvic organs every 2 weeks until remission.
In 20% of cases of complete hydatidiform mole subsequently observing the development of malignant tumors.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Epidural anesthesia during childbirth.