Bladder drift

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Bladder drift

Cystic drift is a condition accompanied by proliferation of trophoblast (the outer layer of embryonic cells involved in the implantation of the embryo into the uterine wall and the formation of the placenta), which fills the uterine cavity. The clinical picture of hydatidiform mole gives the impression of a normally progressing pregnancy. Vesicular drift can be complete (classic) or incomplete (partial). With complete cystic drift, changes capture the entire chorion, with partial – only part of it. Syncytial endometritis is also referred to as hydatidiform mole. Frequency. In the USA, 1 case of hydatidiform drift occurs in 1200 pregnancies, in the states of the Far East – 1 case in 120 pregnancies. In Russia – 1 case per 820-3000 births

    • Socio-economic conditions. More often, gestational trophoblastic disease occurs in women of low socioeconomic status, as well as in underdeveloped regions (for example, Southeast Asia)
    • The predominant age is up to 30 years. Etiology
    • Complete mole occurs with uniparental disomy, when for unknown reasons there is a loss of maternal genes and duplication of the paternal haploid genome (the zygote has a 46,XX karyotype). Occasionally (5%) a complete mole is caused by the fertilization of an empty (nucleated) egg by two sperm, resulting in a 46,XY or 46,XX karyotype. The embryo dies in the early stages of development, before the establishment of placental circulation
    • Incomplete hydatidiform drift is caused by triploidy as a result of fertilization of the egg by two spermatozoa (dyspermia) 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.

Pathomorphology

    • Complete, or classic, hydatidiform skid
    • Pronounced edema and an increase in villi with transparent contents
    • Disappearance of the blood vessels of the villi
    • Proliferation of the trophoblastic lining of the villi, much less often degeneration
    • Missing fetus, umbilical cord, or amniotic membrane
    • Normal karyotype (usually XX, rarely XY)
    • Incomplete, or partial, hydatidiform mole
    • Severe swelling of the villi with atrophy of trophoblast cells
    • Presence of normal villi
    • Presence of fetus, umbilical cord and amniotic membrane
    • Abnormal karyotype, traditionally triploid or trisomy.

Clinical picture

    • Bleeding, traditionally occurring in the second trimester of pregnancy
    • The uterus is larger than you might expect, given the date in the last day of menstruation,

at this stage of pregnancy

    • Nausea and vomiting, which occurs in about a third of patients
    • Preeclampsia in the second trimester of pregnancy
    • Sometimes hyperthyroidism develops. It is believed that with an excessive increase in HCG levels, this hormone binds to TSH receptors, causing hyperfunction of the thyroid gland.
    • Abdominal pain disturbs 15% of patients. The cause of pain is the formation of tecalyutein cysts under the influence of CHT in 50% of patients.

Diagnosis

    • The main evidence of a hydatidiform mole is the presence of many vesicles with clear contents in the vaginal discharge.
    • An increase in the content of HCG over 100,000 mIU / ml with an increase in the uterus and bleeding
    • On ultrasound, there are no signs of a normal gestational sac or fetus
    • Even after 15 weeks of pregnancy, the abdomen is flat (no fetus).

Treatment:

    • Vacuum aspiration to remove a mole is used more often than other methods, even if the uterus is enlarged to the size corresponding to 20 weeks of pregnancy
    • Previously, when the uterus was enlarged up to 12-14 weeks of pregnancy or more, a hysterotomy was performed when removing the hydatidiform mole.
    • After vacuum aspiration, oxytocin is administered intravenously for better contraction of the myometrium.
    • primary hysterectomy. If a woman does not want to have babies in the future, a hysterectomy can be performed. The ovaries are not removed. If multiple thecalutein cysts are present in the ovaries, their reverse development occurs as a result of a drop in the level of HCG.
    • prophylactic chemotherapy. 80% of patients with hydatidiform mole go into spontaneous remission without additional therapy. Systematic determination of the content of HCG helps to timely identify developing chorionepithelioma; therefore, given the high likelihood of toxic effects, prophylactic chemotherapy is not performed in all patients. observation. The time for complete elimination of HCG (approximately 73 days) depends on the initial concentration of HCG, the amount of viable trophoblast tissue remaining after vacuum aspiration, and the half-life of HCG. Monitoring of patients after removal of the hydatidiform mole includes a number of activities.
    • Determination of the level of HCG with an interval of 1-2 weeks until 2 negative results are obtained. Then the studies are carried out monthly for 2 years. Patients are advised to protect themselves from pregnancy for 2 years with oral contraceptives that reduce LH levels.
    • Physical examination of the pelvic organs after 2 weeks until remission, then after 3 months for 1 year
    • X-ray examination of the chest to rule out lung metastases, if there is no decrease in HCG titer.

Complications

    • Intrauterine infections and septicemia
    • Bleeding
    • Toxicosis of pregnant women (the only condition in which there is true toxicosis in the first half of pregnancy)
    • Development of metastatic trophoblastic disease
    • Infiltration of adjacent tissues, sometimes metastasis to distant organs. Prevention
    • Prophylactic chemotherapy is carried out after the removal of the hydatidiform mole, if the HCG titer increases or remains at a constant level for a long time, as well as when metastases are detected. 80% of patients with hydatidiform mole go into spontaneous remission without additional therapy.
    • Systematic determination of the content of HCG helps to timely identify developing chorionepithelioma, therefore, preventive chemotherapy is not performed for all patients.

Synonyms

    • Chorioadenoma
    • Persistent trophoblastic disease
    • Invasive mole See also Chorionepithelioma

ICD

    • D39.2 Indeterminate neoplasm of placenta
    • 001 Bubble drift

Note. Destructive form of hydatidiform mole

  • The tissue of the hydatidiform mole penetrates the thickness of the uterine wall and metastasizes to the lungs, vagina, and parametric tissue.
  • The clinical picture is ongoing bloody discharge from the uterus after removal of the hydatidiform mole; the uterus does not contract; pain in the lower abdomen, sacrum, lower back persists; thecalutein cysts do not regress, HCG levels are high
  • Surgical treatment – extirpation of the uterus with subsequent measures used to treat chorionepithelioma (choriocarcinoma).