How often do women look forward to those cherished two stripes on the test, which will turn their lives upside down! But, unfortunately, the joy of pregnancy does not always last as long as we would like. There are a huge number of pathologies, as a result of which this process must be interrupted. Many people know about miscarriage and missed pregnancy . But besides them there is one more deviation, as a result of which a woman fails to enjoy motherhood. This is the so-called cystic drift. So, what is this pathology and why does it arise? We will analyze this question in more detail.
What happens with the disease?
Bubble drift is a chorion disease, during which its villi transform into vesicles, the size of which can reach the size of a large grape berry and even more. They are interconnected by gray tree-like trunks containing a clear liquid with albumin or mucin.
According to statistics, cystic skid occurs in one pregnant woman out of a hundred. The outcome of the disease is almost always the same - either an independent death of the fetus with its subsequent expulsion from the uterine cavity, or artificial termination of pregnancy. The birth of a child, all the more healthy, with this pathology is possible, but this is rather an exception to the rule, which has 1 chance out of a million.
Causes of the disease
The exact factor that provokes the development of the disease has not been identified so far. It was previously believed that cystic drift during pregnancy is the result of pathologies such as syphilis, anemia, chlorosis, nephritis, and so on. But recently, the opinion of doctors has changed significantly. Specialists divided into two camps.
The first assure that the cystic skid arises as a result of inflammation of the uterine wall, and the process of degeneration of the chorionic villi into the vesicles is a secondary phenomenon. This theory even has scientific evidence. For example, in a woman who is pregnant from different men, this pathology occurs during each conception. At the same time, scientists have speculations that not all of the uterine mucosa can be affected, but only part of it. To prove this conjecture, an example is given when, during a double-egg pregnancy, only one fetal egg was reborn, the other remained healthy and was not affected by the disease.
The second camp of doctors and scientists believes that the causes of the pathology are as follows: the primary disease of the egg, which occurs even at the stage of its presence in the ovary, and secondary disorders of its development already outside the ovum. At the same time, confirmation of their theory is that during the disease very often there are cases when there is a fine-grained degeneration of both ovaries. Then such formations will be defined as a sausage or spherical tumor having a tuberous surface.
Another reason that can cause the disease is bladder skidding, it is considered that the fetus has a set of father's chromosomes, while from the mother they are insufficient or even absent. Such a pathology occurs when the simultaneous fertilization of one egg by two sperm.
Several types of disease
A simple cystic skid manifests itself in the first three months of pregnancy. The reason for the development of the deviation is the presence of only paternal chromosomes in the fertilized egg. At the same time, maternal ones are completely absent. Duplication of paternal chromosomes leads to the fact that embryo formation does not occur, there is no placenta and a fertilized bladder. Identify a complete cystic drift by ultrasound. During the procedure, it will be seen that the size of the uterus is significantly different from the expected gestational age (they are enlarged). The formation of a malignant tumor and the appearance of metastases may also be observed.
Partial cystic skidding is characterized by the presence in the fertilized egg of one set of maternal chromosomes and two paternal ones. Such situations occur in cases when there is an insemination of one egg by two sperm. This can also happen when duplicating paternal chromosomes. This type of cystic drift develops after 12 weeks of pregnancy. In this case, the formation of the placental structure of the cystic nature and placental tissue.
There is also an invasive form of the disease, in which the villi grow into the very depths of the myometrium, destroying all tissues. This pathology may be accompanied by the appearance of bleeding.
Risk Factors for Disease
Most often, cystic skidding occurs when:
- repeated pregnancies;
- the presence of many abortions;
- immunodeficiency;
- ectopic pregnancy;
- lack of vitamin A and animal fats in food;
- thyrotoxicosis (thyroid disease);
- early (before 18 years) or late pregnancy (after 40 years);
- closely related intimate relationships.
Bubble drift: symptoms
The most obvious sign of the presence of the disease is the appearance of discharge from the genital tract of a dark red color with an admixture of rejected skid vesicles. They are not very plentiful and irregular. But if this deviation is detected, urgent hospitalization of the pregnant woman is required, since there is a risk of death. If deep growth of the elements of the cystic drift occurred in the myometrium, then intra-abdominal bleeding is possible.
The presence of pathologists may be indicated by the absence of the simplest symptoms of pregnancy: a fetal heartbeat that cannot be heard even with ultrasound, its movement, as well as probing parts of the baby. With all this, a pregnancy test shows a positive result, but the concentration of hCG exceeds the norm. In such a situation, cystic drift is quite obvious.
Signs that may also indicate a pathology:
- toxicosis, accompanied by vomiting;
- increase in liver failure;
- profuse salivation;
- weight loss;
- symptoms of eclamasia and gestosis in the first trimester;
- protein in the urine;
- swelling;
- stomach ache;
- headache;
- increase in blood pressure;
- weakness.
Also, the bladder drift, the symptoms of which, as already mentioned, can occur in both the first and second semester, is characterized by an active increase in the size of the uterus. As a rule, they significantly exceed the norm for the established period.
Bubble drift: consequences
The main complication of the disease is the development of chorionic carcinoma. This is a trophoblastic disease of a malignant form, which is characterized by the germination of pathological tissues in the uterus, liver, lungs and brain. And this is already fatal.
There are several stages of gestational tumors:
- the bladder skid itself, characterized by the presence of malignancy within the uterus;
- the so-called bed of the placenta - the location of the tumor in the muscles of the organ and in the place of attachment of the placenta;
- non-metastatic tumor - germination of similar tissues into the uterus after abortion, childbirth or bladder drift;
- metastatic tumors with a good prognosis - a malignant tumor does not leave the uterine cavity (a positive outcome is possible if the last pregnancy was less than 4 months ago, there is no metastasis in the brain and liver, the patient did not have chemotherapy, the level of beta-CG does not exceed the norm) ;
- metastatic tumors with a poor prognosis - cancer spreads outside the uterus to other organs.
In addition to this pathology, cystic skidding has several more negative consequences. For example:
- Inability to develop subsequent pregnancies (infertility). This consequence is observed in 30% of women who have had the disease.
- Amenorrhea - complete or partial absence of menstruation. This pathology develops in almost 12% of patients.
- Septic diseases.
- Thrombosis.
Diagnosis of the disease. Methods
Detection of pathology in the early stages without ultrasound is almost impossible. After all, the appearance of nausea, fatigue and many other signs of the disease is also characteristic of a normal pregnancy. As a rule, a woman learns about cystic drift either during a planned ultrasound procedure, or only after the appearance of bleeding or the absence of fetal movements in a timely manner.
Methods for diagnosing the disease:
- gynecological examination, during which the doctor can feel the densely elastic consistency of the uterus and determine the increase in its size;
- Ultrasound - shows the presence of ovarian cysts and homogeneous fine-grained tissue;
- phonocardiography - listens to the heartbeat of the fetus, which is not present with the disease;
- studies of chorionic gonadotropin (in rare cases, an analysis of the determination of coagulogram and creatinine is carried out, as well as liver samples are taken);
- hysteroscopy;
- biopsy;
- diagnostic laparoscopy;
- x-rays of the abdominal cavity and chest, brain MRI - are performed to exclude screenings of bladder skidding;
- laparoscopic ultrasound imaging.
Analyzes necessary to identify pathology:
- blood biochemistry;
- general urine and blood tests.
A patient who has been diagnosed with the disease needs to receive the advice of an oncologist, surgeon, endocrinologist and nephrologist.
Solution
After the diagnosis of cystic drift, the treatment of which is aimed at removing the neoplasm from the uterine cavity, is confirmed, the woman is sent to a hospital. If the disease has no complications and the gestational age does not exceed 12 weeks, then the curettage procedure is performed. To do this, the neck is stretched, which provides better access to its cavity, and using the curette (a special tool), the entire uterine contents are removed.
Vacuum aspiration is used even in cases where the uterus has a size corresponding to 20 weeks of pregnancy. This procedure consists in sucking off the contents of the cavity using special equipment. Often it is performed along with curettage.
With an increase in the volume of the uterus to sizes that correspond to 24 weeks of pregnancy, a hysterectomy (removal of the uterus) is performed . Also, indications for the operation are thinning of its walls, perforation with cystic skidding and the presence of metastases in the lungs or vagina. In this case, the ovaries are not removed.
After removing the cystic drift from the uterine cavity, its tissues are sent for histological examination to exclude chorionepithelioma. If this procedure showed malignancy, the level of hCG after bladder drift tends to increase, and foci of metastatic origin are found in the lungs, then the patient is prescribed chemotherapy.
For the treatment of pathology, Methotrexate and Dactinomycin are used, or a drug that combines these two drugs, Leucovorin. The main line of action of these medicines is to destroy cancer cells. Acceptance of these drugs is prescribed until the level of hCG and the menstrual cycle are normalized, 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, it may be necessary to conduct radiation therapy in the form of x-rays and other types of radiation. It is carried out both outside, with the help of devices, and from the inside. In the latter case, the so-called radioisotopes are used, which produce radiation in the area where the malignant cells are located, using thin plastic tubes.
Observation of the patient after treatment
For approximately two years after surgery, the woman is under the close supervision of an oncologist. At this time, she goes through the following procedures:
- Control over the level of hCG every week for 1-2 months until the result is negative 3 times in a row. After this, this analysis is carried out, but much less frequently.
- An X-ray of the lungs is performed once a month to normalize the level of hCG.
- 14 days after the operation to remove the cystic skid, an pelvic ultrasound is done. Then the procedure is performed every month until the hCG level is negative.
Is pregnancy possible after an illness?
Bubble drift, the consequences of which can be very deplorable, is not a disease leading to complete infertility. But it is worth considering that during the entire time the patient is examined by an oncologist, she is not recommended to become pregnant. The main method of contraception at this time is the use of hormonal drugs. This is due to their positive effect on the regulation of ovarian function, impaired as a result of the disease.
It is necessary to plan the next pregnancy no earlier than 2 years after the operation. This is especially true if the patient has undergone chemotherapy. After the onset of conception, a woman should be closely monitored by medical personnel, since there is a high probability of complications during pregnancy and childbirth.
A patient who has had a cystic drift and wants to become pregnant again should not set herself up for a worse outcome and inability to have children. Thanks to modern medicine, almost 70% of women experience the joy of motherhood after overcoming this disease.
Can ailment come back?
As a rule, relapse of the disease manifests itself in the form of a malignant formation in the pancreas, lungs and other organs and tissues.