Pregnancy ... Most often, a woman is looking forward to it, dreaming of the baby and how to change her life. And then, finally, the long-awaited two strips on the test. Joy, excitement, the first excitement. Tragically, sometimes excitement are not in vain. Missed abortion, spontaneous miscarriage, molar pregnancy.
And if the first two of the complications of normal pregnancy all women are more or less know something about molar pregnancy have heard only a few. That is what has molar pregnancy symptoms, causes and consequences, and will be discussed below.
What happens during a hydatidiform mole? Doctors characterize this process as follows: during the hydatidiform mole trophoblast proliferation occurs. However, having no medical training, a woman is difficult to understand what it means. Trophoblast - is the outer layer of embryonic cells. That it is necessary to ensure that the embryo was successfully transplanted into the uterus, and later formed a complete placenta. And if the trophoblast begins to grow abnormally, filling the cavity of the uterus, doctors say about molar pregnancy.
Doctors are three types of hydatidiform mole:
- Complete molar pregnancy. He also has the name of a simple molar pregnancy. When complete molar pregnancy pathological changes occur in the entire chorion.
- A partial molar pregnancy. In case of partial molar pregnancy, these changes involve only part of the chorion.
- Destruirujushchego molar pregnancy is the most severe form of manifestation of drift, as it is malignant.
Features Simple hydatidiform mole is that it occurs in the first trimester of pregnancy, that is, in the first three months. At this time, the chorion, located across the surface of the ovum has villi. But partial skid develops only after the first trimester. In this case, often the pregnancy continues to develop, and even ends with the birth of a living child. Deliveries may be premature or may occur in time. Sometimes there are cases of hydatidiform mole in multiple pregnancies, reception on both the placenta, and only one of them.
Symptoms of cystic skidding typical and usually diagnosis there is no difficulty. Below are the main clinical manifestations of cystic skidding:
- At gynecological examination indicated the size of the uterus is different from normal for a given gestational age. And change is always in a big way - in the three months of pregnancy uterine size corresponds to five months. The uterus at the same time has tugoelastichnuyu consistency.
- The doctor could not detect such significant signs of pregnancy as fetal heart tones, his movements are not observed.
- Typically, a woman goes to a doctor about uterine bleeding. Bleeding in molar pregnancy - a symptom of a constant. It begins in the first months and continued with varying intensity until the birth or surgical removal of hydatidiform mole. Blood for bleeding due to hydatidiform mole has a dark color and a liquid consistency, with blood periodically stand isolated bubbles drift, but the bleeding is never plentiful.
- Molar pregnancy is almost always accompanied by such pregnancy complications as toxicosis and gestosis - nephropathy, edema, nausea, and vomiting. Due to the constant bleeding in women develop iron-deficiency anemia.
However, in no case can not try to diagnose yourself, only on the basis of the totality of the symptoms, as most of them are also observed in the spontaneous abortion, and threatened abortion. Only a doctor, and on the basis of intravaginal ultrasound, can diagnose.
Those women who have had a molar pregnancy is detected, the causes are often very concerned about - after knowing that the impetus for the development of complications. However, doctors still have not reached a consensus about the nature of occurrence of hydatidiform mole. To date, there are three basic
Theory of hydatidiform mole:
- The infectious nature of the occurrence. Pathological changes chorionic villi is the result of the impact of viruses on the female body, often Toxoplasma.
- Hormone nature arise. In this case, modification of chorionic villi occurs due to insufficient amount of estrogen in the female body.
- The genetic nature of the occurrence. Molar pregnancy is caused by chromosomal abnormalities, leading to abnormal development of the ovum.
As the long-term observation of gynecologists, the most common molar pregnancy in women who have previously given birth or had previous pregnancy
. Sometimes, however, it occurs in early to mature teenagers. Further, the frequency of occurrence of hydatidiform mole follow predklimakterichekogo women age, especially those who already have two or more children. It is women aged 40 - 45 years old account for 45% of all cases of molar pregnancy. In some cases, the same woman may often face a molar pregnancy, resulting in developing infertility. Furthermore, molar pregnancy can occur when an ectopic pregnancy - it develops in the tube.
Horionepitelioma uterus or molar pregnancy is diagnosed only after a study will be conducted on blood hormone levels. This need is due to the fact that the molar pregnancy should be differentiated from uterine fibroids. When hysteromyoma pregnancy related titer chorionic gonadotropin significantly reduced not only in comparison with the hydatidiform mole, but even in comparison with conventional pregnancy. But if a woman molar pregnancy, hCG in urine will be significantly higher than normal. In normal pregnancy, the highest concentration of the HCG hormone is observed in the range from 7 to 12 weeks of pregnancy and is about 20000L. E in 1 liter of urine. In the same case, if a woman develops molar pregnancy, this figure increases to 25 - 30,000 LE
It is rare, but there are cases in which there is necrotic tissue hydatidiform mole, which remains in the uterus. In this case analysis for a hormone may be negative. In particularly difficult cases, doctors use a much more sophisticated immunological method for the determination of levels of chorionic gonadotropin.
Another method of diagnosis is the enzymatic method of diagnosis. Its essence is as follows: by determine the biochemical level of oksitotsinazy. In that case, if a woman hydatidiform mole, oksitotsinazy much lower activity. Depending on the results of the study further treatment strategy will depend on the size of the uterus.
Molar pregnancy - treatment and consequences
In the event that the patient diagnosed with molar pregnancy, treatment is necessary. If you suspect a molar pregnancy ultrasound can help determine the size of the uterus. In that case, if the size of the uterus does not exceed the size corresponding to the size of the uterus at 12 weeks, the removal of hydatidiform mole made blunt curette, after the pre-expansion of the cervical canal. That is, to put it simply, there is a mechanical cleaning of the uterus. After cleaning the woman's uterus, usually appointed by the pharmacological agents that stimulate contraction of the uterus, such as oxytocin or pituitrin.
In some cases, at the discretion of the doctor, waiting for spontaneous birth of hydatidiform mole. If you use heavy bleeding tamponade (insertion of tampons into the vaginal cavity) and injections of drugs that increase the motility of the uterus for the speedy expulsion of hydatidiform mole. In the event that this method does not bring the expected results, performed curettage curette.
In the same case, if a woman has heavy bleeding, held an immediate expansion of the cervix and the removal of hydatidiform mole is produced either by finger or by the same surgical curettage. If the size of the uterus large, and massive bleeding, in order to avoid the negative consequences of the physician may decide to hold a so-called small caesarean section. In some cases, after the partial removal of hydatidiform mole, the expulsion of residues occurs through careful pressure on the body of the uterus.
In the same case, if after a certain time (usually after one - two weeks) bleeding resumes, there is a need to re-curettage. Often the molar pregnancy is accompanied by a significant rise in temperature - it speaks about the need for immediate surgery in the female body.
Molar pregnancy has a variety of consequences, but not always. The most dangerous complication of hydatidiform mole - the development chorionepithelioma - a malignant tumor. It develops it is relatively rare - only 4% of cases. The main complication of this insidious is the fact that women undergoing molar pregnancy, its development can begin after a very long latency period - up to 20 years.
At the present time, with timely treatment for qualified medical help, the threat of death due to uterine bleeding practically nonexistent. More often there are complications with the infectious nature of the disease and a variety of septic thrombosis.
Approximately 30% of women who underwent molar pregnancy develops infertility. Amenorrhea occurs in approximately 12% of women who underwent molar pregnancy. Relapse hydatidiform mole in the basics of the above increases the chances of complications.
Previously, all women after hydatidiform mole, without exception, are undergoing chemotherapy. Now, in the light of the latest scientific data, methotrexate is assigned only to those women who are at risk of chorionepithelioma. This group includes those women in whom there is no progressive reduction of human chorionic gonadotropin titers already after the molar pregnancy has been removed. In the event that this does not happen within a month, chemotherapy is a must.
Gynecology molar pregnancy characterized as sufficiently serious disease that requires close attention to the state of health of the woman. It is imperative to find out the causes of the disease, to undergo treatment. If a woman has already been molar pregnancy, hydatidiform mole recurrence occurs in about 20% of cases. And if the woman will comply with all recommendations of your doctor, pregnancy after hydatidiform mole is possible.
In addition, in any case, a woman also needs some time to be on the account at the gynecologist - oncologist. Somewhere in the year and a half month the woman should be screened for levels of hCG. During this period the woman should avoid pregnancy, most preferably hormones. They not only reliably will protect a woman against pregnancy, but also help to adjust the full function of the ovaries.
After about two years, a woman usually receives from the doctor agreed to a new pregnancy. However, the pregnancy must take place under very strict control, since pregnancy in women faced with molar pregnancy, sometimes more severe, and may be complicated delivery was weak labor and bleeding.
However, one should not get upset and configure itself for the worst outcome. The level of modern medicine is so high that allows you to experience the joy of motherhood 70% of women. And if you are faced with such a disaster as molar pregnancy, it does not mean that the stork ever forgot your address. He's just a little delayed in transit.