Why is hydatidiform mole dangerous? Symptoms, causes, treatment of partial and complete hydatidiform mole during pregnancy: what is it and what does it look like? Bubble drift for the second time.

Hydatidiform mole during pregnancy is one of the rarest complications in the process of bearing a child. This deviation occurs due to disturbances in the fertilization process, which causes improper development of the cells that form the placenta.

For hydatidiform mole, see specialist Veronica
risk of pathology pregnant accuracy
the doctor has contractions in clothes

Hydatidiform mole refers to diseases collectively called “trophoblastic tumors.” They are usually non-cancerous. Although there is a possibility of spreading outside the uterus, tumors are treatable.

Stages and signs of the disease

Hydatidiform mole during pregnancy has several varieties, shown in the photo:

• complete hydatidiform mole (usual) – represents pathological changes on the entire chorion;
• partial hydatidiform mole - changes affect only a certain part of the chorion;
• destructive hydatidiform mole - modified villi penetrate the walls of the uterus. This is the most severe form of this disease, as it can lead to the development of dangerous intra-abdominal and external bleeding, and the tumor becomes malignant.

Loss of maternal genes and duplication of paternal chromosomes occurs

A complete hydatidiform mole is characterized by the development of an “interesting situation” at the beginning, within three months. Normal conception involves the presence of 23 paternal and 23 maternal chromosomes in the egg. If a complete hydatidiform mole is observed, the fertilized egg contains only paternal chromosomes and no maternal ones. Since duplication of paternal chromosomes occurs, the egg includes 2 sets of them. As a result, the formation of an embryo does not occur, and natural placental tissue and a fertilized sac are absent.

Partial hydatidiform mole implies triploidity; in other words, the cells contain 69 chromosomes. The additional set is characterized by paternal origin.

The fetus with this form of pathology also has signs of triplodia: intrauterine retardation, as well as various developmental abnormalities, for example, hydrocephalus and syndactyly.

Incomplete hydatidiform mole occurs when the fertilized egg has 23 maternal chromosomes and a double set of paternal chromosomes. This pathology occurs when an egg is fertilized by two sperm at once. For this reason, natural placental tissue and a cystic placental structure are formed. After prescribing the correct treatment and constant medical supervision, the development of any abnormalities associated with trophoblastic disease is unlikely.

Characteristic signs of pathology are:

1. Bleeding caused by separation of the placenta from the decidua.
2. Increased size of the uterus caused by accumulation of blood and chorion growth.
3. Preeclampsia (sometimes eclampsia), which is accompanied by an increase in the size of the uterus.
4. HCG levels during hydatidiform mole are very high.
5. Vomiting in women bearing a child, which is caused by complex disturbances of water and electrolyte balance.
6. Embolism of parts of the pulmonary artery.
7. Very rarely - thyrotoxicosis, which is accompanied by tremor, tachycardia, high body temperature and wetness of the skin.
8. Thecallutein ovarian cyst, caused by high levels of ovarian stimulating hormones, disappears on its own after a few months.

Diagnosis of complications in a woman

During diagnosis, first of all, the doctor takes into account the complaints of the expectant mother. For example, the following may indirectly indicate the presence of pathology:

• bleeding;
• discharge of purulent and serous leucorrhoea;
• painful sensations in the abdomen, chest, lower back;
• severe headache, which leads to vomiting, blurred vision;
• neurological signs.

Obligatory examination by a specialist

An analysis of the anamnesis is no less important. The main pathologies that are characteristic of this disease are:

• preeclampsia in the early stages of pregnancy;
• constant vomiting in the expectant mother;
• thyrotoxicosis;
• embolism of parts of the pulmonary artery.

Another diagnostic tool is ultrasound diagnostics. This disease may include:

• increased size of the uterus;
• absence of embryo;
• lack of heartbeat in the embryo;
• missing parts of the embryo;
• the presence of a homogeneous small cystic substance;
• presence of ovarian thetaluteal cyst.

Other methods for diagnosing this disease include:

• laboratory tests (complete blood count);
• biochemical studies (determination of creatinine level, study of kidney function, coagulogram);
• examination by a gynecologist (examination of the hardness, shape, size of the uterus, vaginal mucosa);
• hysteroscopy, laparoscopy;
• chest x-ray;
• determination of karyotype;
• CT scan;
• Magnetic resonance imaging.

Basic therapy methods

Treatment of the disease can be carried out using different methods. Some approaches are considered standard, while others are being studied in clinical trials. Such research is needed to improve existing therapies as well as to obtain information about the effectiveness of new approaches. Also find out how and why it is dangerous.

Let's consider the main methods of treating the disease presented in the photo.

Traditional methods of treatment

Veronica officinalis is used in the treatment of this pathology

Symptoms of pathology in the early stages of an “interesting situation” are aggravated by the fact that the tumor grows according to the laws of pregnancy, in other words, it increases every day. In this case, the intensity of growth is much greater than during the normal course of pregnancy. That is why, when making decisions about self-treatment of a disease, you are risking your life.

It’s another matter if you combine folk recipes with the remedies your doctor prescribed for you. This will help prevent side effects and new cases of such pregnancies.

Veronica officinalis tincture:

• 2 tbsp. spoons of grass;
• 500 ml water;
• chop the grass;
• to boil water;
• close the lid;
• leave for 2 hours;
• strain.

Application.

1. Take 3 times/day, 150 ml.
2. Duration of the course is 2 months.

Lacfiol baths:

• 4 tbsp. spoons of grass;
• 2 liters of water;
• chop the grass;
• to boil water;
• pour boiling water over the chopped herbs;
• Boil for 15 minutes;
• strain;
• cool to 40 C.

Application.

1. Pour the prepared solution into a basin.
2. Take a sitz bath for about 20 minutes.
3. Duration of therapy – 1 week.

Carrots with cod liver:

• 1 medium carrot;
• 50 g cod liver;
• finely grate the carrots;
• simmer for 5 minutes in a dry frying pan;
• mix with prepared cod liver.

Application.

1. Eat this salad daily.
2. Take a break for a week.
3. Repeat 2 more courses.
4. Carry out therapy 2 times a year.

Developmental hazards and prevention

One of the complications is an increased risk of birth pathology

The main complication of this disease is the development of chorionic carcinoma - a malignant disease that involves the growth of pathological tissues into the uterus, lungs, liver and brain. This, in turn, can be fatal. The following stages of tumors are distinguished.

1. Uterine chorionepithelioma or hydatidiform mole, the main symptom of which is the presence of a tumor within the uterus.
2. The placenta bed is the location of the tumor in the muscle of the organ, as well as the placenta attachment site.
3. Non-metastatic neoplasm - penetration of similar tissues into the uterus after childbirth or abortion.
4. A metastatic neoplasm with a good prognosis is a malignant tumor that does not leave the uterine cavity (positive dynamics are possible if the last pregnancy was less than 4 months ago, there are no metastases in the brain and liver).
5. A metastatic tumor with a poor prognosis—the cancer has spread beyond the uterus to other organs.

Other complications:

• impossibility of subsequent pregnancies (infertility) - this consequence is observed in almost 30% of women who have suffered from this disease;
• amenorrhea – permanent or temporary absence of menstrual bleeding, this pathology is typical for 12% of women;
• thrombosis;
• septic diseases.

Among the methods of preventing this disease are:

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Hydatidiform mole during pregnancy. This is a rare complication, but it can lead to fetal death and a threat to the health of the mother.

Now let's look at this in more detail.

What is a “hydatidiform mole”?

Hydatidiform mole is a deviation in the development of the fertilized egg. If this pathology occurs, the formation of the placenta does not occur. The chorionic villi degenerate into bubbles, inside of which there is liquid. It has a yellowish color and consists of:

• amino acids;
• human chorionic gonadotropin;
• albumin.

The diameter of the bubbles does not exceed 25 ml. Hydatidiform mole occurs in 0.02-0.8% of pregnancies. There are several types of the disease, which include:

1. Complete or simple hydatidiform mole. The disease is characterized by pathological changes throughout the chorion.
2. Partial hydatidiform mole. Pathological changes affect the chorion only partially.
3. Destructive hydatidiform mole. This is the most severe form of the disease. It is malignant in nature.

The first type of pathology appears in a woman during... In the presence of this form of the disease, the fetus dies and then dissolves.

Partial hydatidiform mole may appear after. In this situation, the pregnancy is not terminated. There is a possibility that it will end in a live birth of a child. In most cases, birth occurs prematurely. However, the baby may appear on time. If the pathology appears during a multiple pregnancy, it can affect only one placenta or both of them.

What does a hydatidiform mole look like from a photo?

If a woman has developed a hydatidiform mole, the villi of the outer membrane turn into cysts. This is the name given to bubbles containing liquid. Additionally, proliferation of the villous epithelium is observed. Pathology can lead to fetal death. To better understand what a hydatidiform mole looks like, it is recommended that you familiarize yourself with the photo.

If the pathology develops in the first 1-2 weeks of pregnancy, all primary villi of the fetal egg are degenerated. Severe hyperplasia is present in the trophoblast layers. In this situation we are talking about the appearance of 1 form of pathology. Sometimes this type of disease is called early hydatidiform mole. This is explained by the timing of the onset of the pathology. During this period of pregnancy, hydatidiform mole is characterized by:

• proliferation of trophoblasts lining the villi from the inside;
• swelling of the villi and their increase are observed;
• the villous epithelium is not defined or undergoes dystrophic changes;
• there are no blood vessels in the villi;
• the embryo is resorbed.

If the pathology developed between 3 months and up to 34 weeks inclusive, usually only part of the chorionic villi degenerates. In this case, we are talking about the so-called incomplete hydatidiform mole. In this case, the villi that have not degenerated have a normal appearance. Their blood supply is preserved. In this case, the fetus is observed in the uterus. However, pathology can lead to his death.

In case of multiple pregnancy, the problem may affect only one placenta. At the same time, 2 is able to remain in its normal form and continue to function.

Invasive hydatidiform mole can occur against the background of a complete or partial type of pathology. Varieties of the disease have the following symptoms:

• bubbles can grow into the muscular layers of the uterus;
• villi can penetrate blood vessels and the lymphatic network, grow through the serous cover of the uterus and myometrium, spreading throughout the body, and also affect internal organs;
• the placental structure of the villi is preserved.

The destructive form of the disease is the most severe. It occurs in 5-6% of cases.

The first signs of a hydatidiform mole

If a woman has developed a hydatidiform mole, one of the signs of the disease is early toxicosis. It may be accompanied by an increase in temperature, as well as moisture in the skin. The patient often feels nauseous. It occurs against the background of nausea. It appears due to severe disturbances in water and electrolyte balance.

An alarming sign is the appearance of bloody discharge. They occur as a result of uterine bleeding. Bloody discharge may occur in early pregnancy and continue until childbirth or surgery to remove the egg. The discharge is dark in color and liquid-like in thickness. They are not abundant, but appear regularly.

Another sign is an abnormal size of the uterus. So, a three-month period can correspond in size to 5 months.

Symptoms and signs of hydatidiform mole

Symptoms of hydatidiform mole may manifest differently in different women. The fact is that pathology can develop at different stages of pregnancy. The forms of the disease also differ. All this affects the clinical picture of the pathology.

Usually, a woman who is faced with a problem begins to worry about uterine bleeding. The discharge is dark in color. Bleeding ranges from minor to heavy. Symptoms of toxicosis occur. Women often mistake them for signs of pregnancy. The patient is often bothered by nausea and. She may experience increased drooling and dizziness. No appetite. Against this background, exhaustion may occur.

In severe cases, hydatidiform mole can grow into the walls of the uterus. This leads to a violation of its integrity, which in turn provokes intra-abdominal bleeding. Symptoms require immediate hospitalization and adequate therapy. Otherwise, there is a risk of death.

The visual size of the uterus does not correspond to the duration of pregnancy. This can be confirmed by visual examination and ultrasound. A woman suffering from pathology has bilateral fluid ovarian cysts. Their size can reach 10 cm or more. Cysts are easily detected during ultrasound. However, this symptom does not appear in all women who experience hydatidiform mole. There is no treatment in this situation. They will disappear on their own after the uterine cavity is cleared of hydatidiform mole.

In pathology, it is several times higher than normal. During treatment, the doctor will check this indicator without fail until it returns to normal. Even when the level returns to normal, the woman will still have to undergo this test regularly for six months. The action is performed for preventive purposes. Symptoms of hydatidiform mole can appear in the early stages of pregnancy and mimic its symptoms. Therefore, diagnosing the problem during this period is quite problematic.

If the disease becomes malignant, the blisters can spread to other organs, mainly the lungs. The prognosis in this case is unfavorable. Quite often death occurs. For this reason, it is important to detect pathology as early as possible and begin its treatment. This will allow us to count on the fact that the process will regress irrevocably, and the woman’s health will suffer minimally. There are other complications of the disease, which include:

• the occurrence of infertility;
• the appearance of intrauterine infection;
• septicemia;
• the occurrence of thrombosis;

Causes and prevention of signs of hydatidiform mole

Separately, there are categories of women who are at greater risk of developing the disease than others. The risk group includes girls who are not yet ripe for pregnancy. The problem may arise if conception occurred at the age of 14-15 years. The risk of pathology is also present if a woman is over 40 years old. Other reasons that increase the likelihood of a hydatidiform mole are:

• the woman gave birth many times;
• conception occurred between close relatives;
• immunodeficiency is present;
• A woman’s diet lacks some microelements and vitamins.

The phenomenon is quite rare. On average, the pathology is detected in 1 pregnant woman out of a thousand. However, the indicator is quite relative.

As mentioned earlier, the exact causes of the disease have not been established. Therefore, there is no specific prevention of hydatidiform mole. However, experts have identified a number of measures that can reduce the risk of pathology. The list includes:

• timely consultation with a doctor regarding pregnancy. You must register before 12 weeks;
• a woman must completely stop taking drugs, alcohol, and smoking;
• It is necessary to regularly visit an obstetrician-gynecologist. During this period, she should be seen by a doctor once a month. In the second trimester, the number of visits increases to 1 time every 2-3 weeks. In the third trimester, you need to visit a specialist once every 7-10 days;
• pregnancy must be planned consciously. It is recommended that you first undergo all necessary examinations;
• It is recommended to take folic acid for 3 months before planned pregnancy and during the 1st trimester.

Treatment of signs of hydatidiform mole

Treatment of hydatidiform mole during pregnancy depends on the individual characteristics of the course of the pathology, the period of gestation of the child, as well as the type of disease. In some cases, the fetus can be saved. However, the disease often leads to miscarriage or the need to remove the fertilized egg. If an accurate diagnosis is made, the woman is often offered to undergo minor surgery. During this procedure, curettage of the uterus is performed. The action is carried out in order to remove remnants of pathological tissue. Follow-up is then required for 8 weeks after surgery. The woman will have to undergo regular tests and ultrasound examinations every two weeks.

After the hydatidiform mole has been removed from the uterus through surgery, blood levels are monitored. The value of the indicator should gradually fall. This will be the main sign that the pathological processes in the uterus have stopped. If a negative value is received, the analysis must be taken again. Actions are performed to ensure that the disease is truly cured. Additionally, the woman must undergo examination by a gynecologist-oncologist.

If an ultrasound shows that hydatidiform mole activity is observed, and an X-ray examination of the lungs indicates metastatic lesions, chemotherapy is administered. After remission is achieved and laboratory parameters return to normal, 2-3 additional courses are administered. The action is performed for prevention.

A patient experiencing a hydatidiform mole should be monitored by an oncologist for another year. Blood levels are monitored monthly. It is not recommended to plan pregnancy during this period. The best means of preventing its onset are hormonal contraceptives. They allow you to normalize ovarian function after completing a course of chemotherapy and getting rid of the disease. Treatment is applied until the menstrual cycle returns completely to normal.

If there is no need for chemotherapy, and treatment was carried out in other ways, doctors recommend abstaining from pregnancy for a period of time. In other situations, the period is extended to 12 months. If conception occurs during this period, the level will certainly increase. This will lead to the fact that doctors will not be able to reliably determine the cause of the incident. It must be taken into account that hydatidiform mole can recur. The probability of this is 1-2%. However, reoccurrence of the pathology is still possible. In the vast majority of cases, the pathology does not in any way affect the ability to have a child in the future. A mother who has had the disease can give birth to a healthy child. The chance of premature birth also does not increase.

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 the fertilized egg.

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 appears due to chromosomal abnormalities during the process of 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:

• slight 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. Negative consequences often appear:

• infertility (almost 30% of women);
• amenorrhea (absence of menstruation, occurs in 12% of patients);
• thrombosis;
• septic diseases.

Diagnostic measures

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;
• chest x-ray;
• 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 a 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 labor, sometimes the 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 you have not had your period for more than 7 weeks or, conversely, it is too heavy, accompanied by an unpleasant odor, and you experience severe abdominal pain, dizziness and general weakness, you should 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 the presence 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:

• pass all the necessary tests (for STDs, herpes virus, human papillomavirus, HIV infection);
• take folic acid for 3 months before conception;
• systematically visit a gynecologist;
• do not consume alcohol, drugs and nicotine.

If pregnancy has already taken place, it is important to register with an obstetrician-gynecologist on time and undergo all necessary tests and examinations on time. In this case, the gynecologist sends the pregnant woman for an ultrasound examination not at 12 weeks, as usual during pregnancy, but somewhat earlier. You will also need to do a biochemical blood test and hCG.

Hydatidiform mole is a trophoblast pathology in which the villi of the outer embryonic membrane (chorion) degenerate into cysts - a huge number of small bubbles filled with liquid and gradually occupying the entire uterine cavity. Cysts tend to grow very quickly. A distinction is made between complete hydatidiform mole, when there are no signs of the embryo, and incomplete, when the body of the embryo or some of its parts are present.

There are cases when a pregnant woman notices blood discharge from the vagina in the early stages. Unfortunately, many are in no hurry to see a doctor, considering this to be normal. In fact, this can be a sign of serious pathology. Hydatidiform mole occurs due to abnormalities of the trophoblast (the primary organ that attaches the embryo to the walls of the uterus). Ideally, it should become the placenta. The trophoblast begins to rebuild in the early stages of pregnancy, and with the appearance of the placenta it becomes extra-embryonic tissue that forms partitions between the embryo and the mother’s body and provides nutrition to the fetus.

Trophoblast abnormalities are tumors or pretumor formations. Their peculiarity is that they appear as a result of conception, are formed from its products and tend to pass into the body of the mother’s uterus. During a hydatidiform mole, the trophoblast fills the entire uterine cavity with bubbles, which can result in metastasis (transition of the tumor to other organs). An embryo with this diagnosis dies in the very first days of development.

Since this disease is associated with the pathology of pregnancy, it mainly affects women of reproductive age (the average age of women susceptible to hydatidiform mole is 25 years).

Pathogenesis

When the villi are completely filled with fluid, the trophoblast vessels atrophy. The layer covering the vesicles tends to grow and penetrate into the muscular layer of the uterus, bringing with it destructive force. It can even lead to complete destruction of the walls of the uterus and the disease spreading into the abdominal cavity, which can provoke internal bleeding.

With a complete hydatidiform mole, the fetus dies immediately, but the uterus continues to enlarge due to the progression of the disease. With an incomplete hydatidiform mole, there is a low probability that the fetus will be born.

Trophoblastic tumor is a very serious malignancy. At the first stage of a hydatidiform mole, conception occurs in the uterus, but the fetus does not develop or dies. Instead, formations resembling a bunch of grapes appear on the walls of the uterus. In this case, growth beyond the uterus does not occur. But if the disease was not diagnosed in time, then choriocarcinoma occurs - a tumor that begins to develop in other organs, outside the uterus (mainly in the lungs). It can also occur as a result of an abortion or after childbirth.

Causes

Hydatidiform mole in women occurs when there is a sharp loss of maternal genes and a double predominance of paternal ones. In fact, paternal genes seem to replace maternal ones. The reasons for this replacement have not yet been studied. In several cases (5%), the occurrence of hydatidiform mole was observed when an empty egg or a normal egg but two sperm were fertilized.

Fortunately, this disease is not so common: it occurs in 1 case out of 1000. However, the frequency of its occurrence varies in different regions. For example, in the USA, cases of hydatidiform mole are 0.6-1.1 per 1000 pregnant women. The situation is completely different in South America and some areas of Asia: there this disease occurs 10 times more often, affecting 1 woman out of 120. In Russia, the situation is not so depressing: 1 case of this pathology occurs in 820-3000 pregnancies.

Symptoms

Hydatidiform mole exhibits quite pronounced symptoms, and every pregnant woman can identify the first signs of this disease.

1. A sharp jump in the level of hCG (chorionic gonadotropin - the pregnancy hormone in a woman’s body). The level is several times higher than normal during normal pregnancy.
2. The appearance of bloody discharge, which intensifies towards the middle of pregnancy. It is at this time that the uterus expels the mole.
3. The size of the uterus exceeds the norm during a normal pregnancy at the same stage by almost a month. However, there are cases when the size of the uterus is within the normal range (corresponds to the expected period of pregnancy) or may even be less than normal (such a deviation with hydatidiform mole sometimes occurs in the early stages of pregnancy).
4. Absence of obvious signs of the existence of the fetus (movements, tremors, heartbeat).
5. Increased toxicosis. Although this fact is inherent in pregnant women, excessive nausea and vomiting, fatigue and weakness can indicate serious abnormalities in your body. Anemia may also occur due to recurrent bleeding.
6. Increased blood pressure.
7. The appearance of protein in the urine in early pregnancy.
8. The presence of white bubbles filled with liquid on the underwear along with discharge (they are quite difficult to notice).
9. It is also possible for a bilateral ovarian cyst to appear (a cavity formation with liquid contents), which sometimes grows up to 15 cm in diameter.

The above symptoms are quite difficult to ignore, so a pregnant woman, having discovered at least some of them, should immediately contact her doctor.

Diagnostics

To determine the presence of a hydatidiform mole, qualified diagnosis is very important. Experienced specialists and modern equipment are able to make an accurate diagnosis.

First of all, a general examination by a gynecologist is required. This is a rather unpleasant procedure in which the doctor feels the uterus with both hands through the vagina to determine its size and condition. To the touch, the uterus becomes compacted, areas of softening are felt. During a normal pregnancy, the uterus is dough-like and homogeneous to the touch.

Next, the doctor prescribes an ultrasound examination of the pelvic organs. In this case, instead of a normal embryo, heterogeneous and lumpy walls of the uterus are noticed, a symptom of a “snow storm” (the presence of fine-grained tissue), and cysts are found in the ovaries.

For an accurate diagnosis, it may be necessary to determine the level of hCG in the body; with hydatidiform mole, it can be several times higher than normal. If necessary, liver biochemical tests are performed, creatinine levels are measured, and a coagulogram (blood clotting test) is performed.

Having diagnosed a hydatidiform mole in a woman, in order to exclude metastasis, many other studies are carried out: general radiography of the abdominal organs, chest, nuclear MRI or CT scan of the brain.

Treatment

To eliminate a hydatidiform mole, surgery must be performed. After preliminary dilatation of the cervix, the doctor uses a vacuum method followed by curettage. The doctor then prescribes a number of medications to improve uterine contractions. However, it happens that the uterus gets rid of the mole on its own.

If the disease has become widespread, there is a high probability of removal of the uterus. After this, the removed organ should become a source of histology study.

After the operation, the woman must be observed by a doctor: donate blood to determine the level of hCG every week, and undergo an X-ray of the lungs once every 14 days. If deviations and complications were not noticed, then subsequent treatment can be canceled.

If tumors appear in the uterine cavity after surgery or tests do not give encouraging results, then radiation or chemotherapy is necessary.

Chemotherapy uses drugs that kill cancer cells. The course can be in the form of tablets or injections. This procedure is a system-wide treatment, since medicinal substances, entering the woman’s blood, destroy all harmful bacteria in their path.

Radiation therapy is aimed at eliminating the tumor or reducing its size. For this, X-rays or other types of rays are used. It is performed using special equipment using materials that conduct rays through plastic tubes aimed at the affected area.

Consequences of eliminating hydatidiform mole

After diagnosis and treatment of hydatidiform mole, a woman needs to be under medical supervision for about 6 months. It is not necessary to spend this time in a hospital. A weekly visit to the clinic is sufficient. Otherwise, there may be a risk of the disease returning or the appearance of a trophoblastic tumor, which occurs if infected cells remain in the uterus.

Subsequently, the cells of this tumor begin intensive division. At the same time, there is a great danger of spreading the disease with blood flow to various organs (lungs, liver, brain). Therefore, observation by a gynecologist should last until all indicators return to normal.

There have also been cases (fortunately, they are quite rare) of the occurrence of choriocarcinoma after suffering a hydatidiform mole - this is an oncological disease that can turn placental tissue into malignant. In the early stages, this disease is eliminated completely and is not so terrible for a woman’s health. This pathology is seen in 1 out of 30,000 cases. Chemotherapy drugs are used for treatment.

After removal of the hydatidiform mole, doctors administer preventive chemotherapy if the hCG level does not decrease. The occurrence of metastases also entails this procedure. Most women experience remission after surgery, after which the need for additional treatment disappears on its own.

An analysis of hCG levels can give a clear picture of what is happening, so chemotherapy is not prescribed to all patients who have undergone surgery to remove a hydatidiform mole.

Sometimes, after treatment, a woman must be observed by a gynecologist for a year and a half, donating blood monthly to determine the level of hCG. During this period, the onset of a new pregnancy is strictly not recommended; hormonal contraception is indicated (which, while protecting against pregnancy, at the same time regulates ovarian function, impaired as a result of the disease and the course of chemotherapy carried out after it).

According to statistics, almost 100% of women who have suffered from hydatidiform mole recover after treatment. At the same time, in 90% of them, menstrual function is completely restored, and in approximately 70%, a new pregnancy subsequently occurs.

Unfortunately, after women have suffered a hydatidiform mole, the children born to them may have pathological changes. At the same time, a new pregnancy itself most often has a number of pathologies and during childbirth may be accompanied by weakness of labor and bleeding. This suggests that after suffering from an illness, women need careful monitoring by doctors for quite a long time. If control is carried out properly, women have every chance of maintaining reproductive function, achieving a normal pregnancy and the absence of pathologies during childbirth.

Hydatidiform mole is a pathological condition in which, instead of a long-awaited pregnancy, the trophoblast (a temporary organ necessary for attaching the fertilized egg to the walls) degenerates into a huge number of small bubbles in a woman’s uterus. With this pathology, the appearance of the fertilized egg resembles a bunch of grapes. With this pathology, the embryo dies in the early stages of pregnancy.

Classification

In medical practice, there are several types of pathology such as hydatidiform mole. The primary classification divides this disease into two forms: simple and invasive. When we talk about a simple form, we mean the formation of a hydatidiform mole in the uterine cavity, which has a specific localization and does not affect the tissues of the organ located nearby. In the invasive form, hydatidiform mole grows into the walls of the uterus, which leads to tissue destruction and possible perforation, with the development of massive intra-abdominal bleeding.

Another classification divides this pathology into two forms: partial and complete. Most often, a complete hydatidiform mole occurs, in which it contains a diploid set of chromosomes, both of which belong to the father. If we talk about partial hydatidiform mole, it occurs when the transformation does not affect all villous layers of the chorion. Sometimes, with this form of the disease, a triploid set of chromosomes may occur, of which one chromosome is maternal and two are paternal.

The diploid set of chromosomes in full-form hydatidiform moles is observed mainly in cases where it was formed in the early stages of pregnancy. Triploids occur if a partial hydatidiform mole develops between 9 and 30 gestational weeks. In this case, in both cases, the fetus dies in the mother’s womb, but if a complete hydatidiform mole occurs at an early stage, the embryo is not detected at all in the fertilized egg. With a disorder such as a partial hydatidiform mole, unchanged particles of the fetus and placenta may be found in the fertilized egg, while with a complete mole they are completely absent.

There is also a classification of such a pathology as hydatidiform mole, in accordance with the gestotype, that is, depending on which trophoblast cells undergo degeneration. According to this classification, three types of pathology are distinguished: cytotrophoblastic, syncytial and mixed.

Reasons for development

Since hydatidiform mole is a chromosomal pathology that occurs during gestation, it is impossible to determine exactly what leads to the development of such disorders. At the same time, the reasons for hydatidiform mole lie in the fact that during the process of fertilization, maternal genes are lost, and paternal genes, replacing them, are duplicated.

In addition, pathology can occur if an egg that does not have a nucleus is fertilized by two sperm.

If we talk about risk factors, then this disease occurs several times more often in women who are either not ripe for pregnancy (14–15 years old) or are already over 40 years old. Multiple births, abortions, lack of certain microelements and vitamins in the diet, immunodeficiency, as well as the creation of families between close relatives - all these factors can cause the development of this serious pathology in a woman during pregnancy. Fortunately, this phenomenon is quite rare - on average it occurs in 1 out of 1000 pregnant women, although these figures are relative.

Clinical manifestations

The symptoms of this pathology are ambiguous - they can manifest differently in different women. Since mole forms at different stages of pregnancy and can take different forms, this is the determining criterion for the clinical picture.

However, the main symptoms that may bother a woman with this disorder are:

• after a long period of delayed menstruation, she experiences uterine bleeding with dark blood, which can be from slight to heavy;
• which many women mistakenly mistake for symptoms of pregnancy are nausea and vomiting, lack of appetite and exhaustion, drooling and dizziness.

In severe cases, when a hydatidiform mole grows into the walls of the uterus, causing their destruction, intraperitoneal bleeding may occur, and if the woman does not receive immediate treatment, the likelihood of death is very high. Also, one of the indicative symptoms of a complete hydatidiform mole is the discrepancy between the size of the uterus and the gestational age of pregnancy, which is confirmed by both visual examination and ultrasound.

Another characteristic symptom of this pathological condition is the presence of bilateral liquid ovarian cysts, which can reach 10 cm or more in size. They are easy to detect on ultrasound, but not all women with hydatidiform moles develop them. Treatment of such cysts is not carried out, since they disappear on their own after the uterine cavity is cleaned of hydatidiform mole.

Separately, it should be said about hCG during hydatidiform mole - its level is several times higher than normal. Therefore, during treatment, it is mandatory to check it before the period when it returns to normal. At the same time, after treatment, when the hCG level returns to normal, the woman will still have to undergo this test regularly for six months for preventive purposes. Signs of partial hydatidiform mole can imitate its symptoms in the early stages of pregnancy, so diagnosing the disorder during this period is problematic.

Separately, it should be said about the most severe complication caused by hydatidiform mole - its transition to a malignant form, due to the spread of bubbles to various organs, mainly to the lungs. Very often, women with this pathology are faced with the development of chorionepithelioma (choriocarcinoma) after removal of a hydatidiform mole. The prognosis for the course of the disease in this case is extremely unfavorable - in most cases death occurs. Therefore, the earlier the pathology is detected and its treatment is started, the higher the likelihood that the process will regress irrevocably, and the woman’s health will suffer minimally.

Other complications of the pathology include:

• septicemia;
• intrauterine infection.

Diagnosis and treatment

Diagnosis of the disease is based on a gynecological examination of the patient and palpation of her uterus, establishing the size, consistency and density of the organ. An ultrasound is also mandatory. Moreover, ultrasound is the most informative method that allows you to see a hydatidiform mole.

Ultrasound can be either external or vaginal. During an ultrasound, bilateral fluid ovarian cysts may be detected, and, in addition, the absence of a fetus in the uterus can be seen. Phonocardiography shows the absence of a heartbeat in the fetus, which is also a diagnostic sign. Also, to differentiate this pathology from others, hysteroscopy, CT and nuclear MRI may be required.

Laboratory tests are required - the hCG level is determined, biochemical liver samples are taken and a coagulogram is prescribed.

As for treatment, it is exclusively surgical. For this purpose, vacuum aspiration devices are used, followed by cleaning out the uterine cavity using curettage. With a pathology such as a simple hydatidiform mole, spontaneous removal from the uterus sometimes occurs. In this case, vacuum aspiration is still performed to ensure that nothing is left in the uterus. And the material extracted from the uterus is sent for research to confirm or refute the malignant degeneration of cells. With the invasive form, there is a high risk of bleeding, and having discovered this form on ultrasound, the doctor must urgently hospitalize the woman in a hospital and prescribe her surgical treatment with removal of the uterus and preservation of the ovaries (if possible).

In cases where the disease has a malignant course, chemotherapy is indicated, the regimen and drugs for which are selected individually for each patient. After treatment, patients are also advised to undergo a diagnostic ultrasound to examine the uterine cavity.

Many representatives of the fair sex are interested in whether pregnancy is possible after a hydatidiform mole. There is no definite answer to this question, since much depends on the woman’s age, her state of health and complications caused by the pathology. According to research, 30% of women suffer from infertility after this pathology, but if it was detected in a timely manner and the treatment was carried out efficiently, then the woman’s chances of becoming a mother are quite good.

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