trophoblastic disease

Trophoblastic disease - disease of the trophoblast (part of the ovum), which forms the placenta. The development of trophoblastic disease may not only during pregnancy but also after delivery and abortion. There are simple molar pregnancy (a non-invasive form), molar pregnancy - an invasive form, or destruirujushchego molar pregnancy , and horionepiteliomu, or choriocarcinoma. It is believed that these forms of trophoblastic disease - this is the stage of the disease.

Molar pregnancy (a non-invasive form): chorionic villi are swollen, have the form of bubbles, trophoblast hypertrophied. When complete molar pregnancy reborn every nap, with partial - of the villi. The fruit usually die, but can survive in the partial drift. When invasive molar pregnancy chorionic villi penetrate deeply into the myometrium and to be, but the fabric was not destroyed and does not metastasize. When a malignant form - horionepitelioma - note the rapid invasive growth with destruction of the myometrium, hemorrhage, necrosis, and rapid metastasis to the lungs, brain and liver.

Clinically molar pregnancy is characterized by a rapid increase in the size of the uterus, is not an appropriate term of pregnancy, often bloody discharge with an admixture of bubbles, pain in the abdomen. When an invasive form and horionepitelioma these symptoms more pronounced, accompanied by abdominal pain, bleeding, weakness.

Diagnosis is based on the value of non-compliance of the uterus in pregnancy results of ultrasound, in which there is a characteristic pattern of "blizzard" in the absence of the fetus and increase bilateral ovarian cysts to form a corpus luteum - the so-called tekalyuteinovyh cysts. Pathognomonic signs is also a sharp increase in the level of human chorionic gonadotropin (hCG) in urine and blood. In a simple molar pregnancy hCG levels are lower than for invasive and horionepitelioma. In the presence of choriocarcinoma (or suspected it) requires radiography and computed tomography of the brain in order to eliminate metastases.

Treatment. Patients in need of hospitalization, careful curettage of the uterine cavity or vacuum aspiration. After a thorough histological examination of the material obtained decide on further management of patients. In the case of a simple form of hydatidiform mole patient is being closely monitored, which is crucial to determine the level of hCG in the blood or urine. High levels of the hormone for 4 - 5 weeks after the removal of hydatidiform mole or increased hormone levels at three study for 1 month after the removal of an indication for chemotherapy. If there is a chorionepithelioma hysterectomy followed by chemotherapy under the supervision of hCG levels in urine and blood within 2 years.

The prognosis for timely treatment of cystic skidding favorable; when horionepitelioma without metastases, and the short duration of the disease (at least 4 months after pregnancy) and effective chemotherapy - satisfactory; when horionepitelioma with metastases and disease duration of more than 4 months - unfavorable.

Repeated pregnancies after the bubble drift is not recommended earlier than 2 years. During this time, in the 1st year a monthly determination of hCG, in the 2nd year - every 3 months.