Bumpy drift

A bladder is a proliferation of trophoblast tissue in pregnant women or women who have recently had a pregnancy. Manifestations of the disease can include excessive expansion of the uterus, vomiting, vaginal bleeding and pre-eclampsia, especially in the early stages of pregnancy. Diagnosis is the determination of beta-hCG and pelvic ultrasonography, as well as confirmation of diagnosis by biopsy. Tumors are removed with a separate diagnostic curettage. If the disease persists after removal of the tumor, chemotherapy is prescribed.

What causes a bubble drift?

Gestational trophoblastic disease is a tumor originating from the trophoblast that surrounds the blastocyst and penetrates the chorion and amnion. This disease can occur during or after a uterine or ectopic pregnancy. If the disease occurs during pregnancy, spontaneous abortion, then the presence of eclampsia, intrauterine fetal death, is characteristic; the fetus rarely survives. Some forms of the tumor are malignant, but benign tumors that behave aggressively are noted.

Pathomorphology

Classification of the disease is based on morphological data. Bubble skidding is a pathological pregnancy in which the villi become edematous and the proliferation of trophoblastic tissue occurs. Destructive chorio-adenoma (invasive bladder skidding) is a local invasion of myometrium by a bubble drift. Choriocarcinoma is an invasive, usually widely metastatic tumor, consisting of malignant trophoblast cells and inferior edematous villi; most of these tumors develop after a bubble drift. The placental area of trophoblastic tumors (the rarest) consists of intermediate trophoblastic cells that persist after the termination of pregnancy. They can germinate into adjacent tissues or metastasize.

Bladder skidding is most common among women younger than 17 or older than 35 years. In the US, these tumors are diagnosed at a frequency of 1 in 2000 pregnancies. In Asian countries, for unknown reasons, they are detected at a frequency of 1 in 200 pregnancies. More than 80% of cases of bladder skidding are benign and regress spontaneously. In other cases, tumors can persist, tend to invasive growth; in 23% of cases - to be malignant in the chorionic carcinoma.

Symptoms of bladder skidding

The initial symptoms of bladder skidding are most often seen in early pregnancy, the uterus becomes longer than expected and is increased to 10-16 weeks of pregnancy. This pathology is characterized by bloody discharge, lack of fetal movement, absence of fetal heart sounds and the presence of severe vomiting in the pregnant. By identifying a tissue like grape, you can suspect this disease. There are complications, such as infectious diseases of the uterus, sepsis, hemorrhagic shock and preeclampsia, which can occur in the early stages of pregnancy. The placental area of the trophoblastic tumor can cause bleeding. Choriocarcinoma is symptomatic due to the appearance of metastases. Bubble skidding does not impair fertility, but predisposes to prenatal or perinatal complications (eg, congenital malformations, spontaneous abortions).

If suspicion of a cirrhosis is carried out, determination of hCG in the serum and pelvic ultrasonography. If a high level of hCG is detected, one can assume a diagnosis and confirm it with a biopsy.

Treatment of bladder skidding

A bladder skid, an invasive skid and a placental site of a trophoblastic tumor are evacuated by vacuum curing. If the birth of a child is not planned, you can alternatively perform a hysterectomy. After tumor removal, gestational trophoblastic disease is usually classified clinically to determine the need for additional treatment.

The clinical classification does not correspond to the morphological one. Chest X-ray is performed and the hCG levels in the blood serum are determined. If the level of hCG is not normalized within 10 weeks, the disease is classified as persistent. When the disease is persistent, it is necessary to perform CT of the brain, thorax, abdomen and pelvis. According to the survey, it is necessary to classify the gall bladder as non-metastatic or metastatic. In metastatic disease, the risk of death may be low or high.

The NIH (National Institutes of Health) criteria for the prognosis of metastatic gestational trophoblastic disease

• Urinary excretion of HCG over 100,000 IU for 24 h
• Duration of the disease more than 4 months (from the previous pregnancy)
• Metastases to the brain or liver
• Disease at the end of pregnancy (after childbirth)    
• The content of HCG in the blood serum is more than 40,000 mIU / ml    
• Ineffective prior chemotherapy for more than 8 courses (WHO)

With persistent trophoblastic disease, chemotherapy is usually prescribed. Treatment of bladder skidding is considered successful if in three consecutive results of the study (with a weekly interval), the levels of beta-hCG in the blood serum are normal. Usually appoint acceptable oral contraceptives for 6-12 months; Alternatively, any effective contraceptive method can be used. With nonmetastatic disease, treatment can be given in the form of monochemotherapy with the use of a single chemotherapy (methotrexate or dactinomycin). Alternatively, a hysterectomy can be performed in patients older than 40 years old or patients who want to perform sterilization, as well as in patients with severe infection or uncontrolled bleeding. If monochemotherapy is ineffective, then a hysterectomy or polychemotherapy is prescribed. In fact, 100% of patients with non-metastatic disease may be cured.

In metastatic disease of low risk, mono or polychemotherapy is prescribed. Metastatic disease of high risk requires aggressive polychemotherapy. Treatment comes in 90-95% of patients with a low risk of the disease and 60-80% - with a high-risk disease.

What is the prognosis of bladder skidding?

The bladder recurrence recurs in approximately 1% of subsequent pregnancies. Patients who underwent a bladder drift perform ultrasonography at early stages of subsequent pregnancies.