Diagnosis and treatment of hydatidiform mole

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  • Methods of diagnosis of hydatidiform mole
  • Treatment of hydatidiform mole



  • Methods of diagnosis of hydatidiform mole

    In connection with the development of ultrasound diagnosisdiagnosis "molar pregnancy" does not cause much difficulty, as is typical for this disease ultrasound picture of a well-known in the art.

    Laboratory diagnosis of pathologicalstate based on the determination of significant increase in the content of human chorionic gonadotropin in serum (500 IU / ml) or a daily excretion (amount of allocation for one day in the blood).

    High-quality pregnancy test in the urine as wellIt can be used for the diagnosis of hydatidiform mole, but the urine should be diluted 20-50 times. A positive result in this case confirms the diagnosis of hydatidiform mole. The diagnostic accuracy of the method is 70-80%, as the disease may be associated with normal or reduced secretion of human chorionic gonadotropin. In these cases, more significant is the determination of the quantitative level of human chorionic gonadotropin in the blood of pregnant - no physiological decrease the secretion of human chorionic gonadotropin after 13-14 weeks of pregnancy, and even more growth hormone content in the mother's blood after this period, with high reliability is confirmed diagnosis of hydatidiform mole.



    Treatment of hydatidiform mole

    Diagnosis and treatment of hydatidiform moleTreatment of benign forms of trophoblasticdisease cystic skidding basically comes down to remove it using a vacuum aspiration - uterine suction using cylindrical metal tip and electric vacuum pump.

    After histological confirmation of the diagnosis (microscopic examination of material obtained from the uterus), the patient should be sent to a specialized agency with cancer.

    Observation for 8 weeks after surgeryincludes the study of human chorionic gonadotropin in serum once a week and ultrasound examination of small pelvis (US) once every two weeks.

    In the absence of signs of illness (normalindex of human chorionic gonadotropin to 15 mIU / mL, no tumor formation by ultrasound and pelvic X-ray study of lung, as well as restoration of the normal menstrual cycle) chemotherapy is not carried out.

    Further study of human chorionicserum gonadotropin held 1 time in two weeks for 3 months, and then - 1 time per month for six months. The optimal time for the onset of desired pregnancy - a year after the evacuation of hydatidiform mole.

    If the 8 weeks after the evacuationhydatidiform mole is observed normalization of human chorionic gonadotropin, or the tendency to increase chorionic gonadotropin, the patient is prescribed a thorough investigation, as these test results indicate that the cells survived hydatidiform mole in the uterus or other organs, which produce hCG.

    According to the data of the pelvic ultrasound can be identifiedpockets of hydatidiform mole in the uterus, and lung X-ray examination - metastases. Therefore patients administered chemotherapy. The most commonly for the treatment of this disease using chemotherapy drugs methotrexate and dactinomycin or a combination thereof in combination with leucovorin. Treatment is carried out before the normalization of human chorionic gonadotropin, recovery of the menstrual cycle, the disappearance of lesions in the uterus and lungs. However, we must remember that fibrotic changes - pockets of connective tissue on the site of lesions in the uterus and lungs - can be stored for quite a long time, in spite of a full recovery.

    After achieving clinical and laboratory remission (a period when no symptoms of the disease and all the tests are normal) is carried out 2-3 preventative course of chemotherapy with the same drugs.

    After the treatment the patient remains underobservation oncologist for 1-1.5 years (during which time the determination is performed every month in chorionic gonadotropin serum). At this time, it recommended abstinence from pregnancy, and the best protection against unwanted pregnancy option is hormonal contraception, which together with the contraceptive effect regulates ovarian function, impaired as a result of this illness and chemotherapy.

    Early diagnosis and proper therapeutictactics allow to maintain the reproductive function of women, and ensure the normal onset of pregnancy and following childbirth. In 90% of patients receiving chemotherapy, menstrual function fully recovered, and 70% became pregnant, which resulted in normal childbirth.

    It is noted that abnormalities inbabies born to women after suffering a hydatidiform mole, there are somewhat more likely than children of healthy women. At the same time, and pathology in childbirth (bleeding, uterine inertia duration, etc.) in patients undergoing trophoblastic disease was slightly higher compared with healthy women. This fact indicates that the disease after this woman needs very careful monitoring by doctors.

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