Lectures of hydatid mole

2021-03-21 12:00 AM

Stillbirth: Easy to mistake in the case of partial pregnancy. Stillbirth usually uterus is smaller than gestational age, engorged breasts may produce lactation, negative biological reaction.

Define

Hydatid mole is due to the abnormal growth of vegetable spikes, the cultured cells grow too fast, so the linkage organization inside the vegetable spikes together with the blood vessels cannot keep up, the vegetable spikes no longer hold links. and there are no blood vessels left, becoming water sacs.

Causes and favorable factors

The cause of hydatid mole is currently unknown, but according to statistics, there is a high incidence of the disease in less developed countries; in Europe 1 / 1,000 - 2,000 cases give birth, while in the Philippines 1/200; in Taiwan 1/82; in Vietnam about 1/500.

The disease can be found at any age during childbirth. According to Fox, Tow, Novak, factors favourable for the development of pregnancy are lack of nutrition, mainly protein deficiency; lay a lot; old age. Park - Tominaga and Page - Carr were found to have chromosomal abnormalities in cells cultured during oocyte and cultured fibroblasts. Most opinions show that cells cultured during ovulation usually have 4 chromosomes, while cultured fibroblasts usually have 2 chromosomes with some abnormalities in the chromosomes.

People also pay attention to the problem of immunity in pregnancy. Ahwood-Park and Douglas have found that in 40% of pregnancies there are cultured cells entering the bloodstream, and this usually occurs in a pregnancy over 18 weeks. Thanks to the immune resistance of the mother's body, these cells do not exist and grow. In case the woman does not have enough resistance, cannot produce antibodies to counteract the growth of cultured cells, pregnancy will appear.

Robinson had given her husband's skin graft to a woman with leukoblastoma and found no skin grafts removed. Thus, in people with leukoblastoma with impaired immune system or immunodeficiency is a favorable factor for the development of cultured cell cancer.

Pathology

General

Vegetable spikes degenerate into pea-sized or grape-sized egg sacs, each with a small stalk sticking together in clusters, in the bag containing clear white water. Usually only 1/3 to 2/3 of vegetable spines degenerate, the fetus dies prematurely and dies. There are roughly three types of pregnancy:

Full pregnancy: most vegetable spikes degenerate into egg sacs.

Partial pregnancy: Most of the spikes turn into a water bag, and a part of normal vegetable thorn, thus the egg bags and also the vegetables.

Pregnant with fetus: A small part of vegetable spines degenerate, and most non-degenerated vegetable spikes are enough to nourish the fetus. Thus in the uterus there is a pregnancy, a vegetable cake and some egg sacs.

 

Micro

Vegetable spikes degenerate into egg sacs, outside are cultured platelets divided into two layers: the outer layer is the inner cytoplasm, the single cell layer, and the Langhans cell layer. The cytoplasm and single cell layer can grow benign or chaotic. Therefore, it is divided into two categories:

Healing of benign eggs: the syncytium layer is not broken down, the single-cell layer does not ingest the uterine lining.

Treatment of malignant eggs: the syncytial layer is thinner and each region is broken, the unicellular layer inside invades, spills into the uterine lining and penetrates the uterine muscular layer, sometimes punctured the myomic layer. the bow causes bleeding in the abdomen.

Cystic gland

When pregnant, hCG increases, stimulates the fetal luteum in the ovary to develop into a glandular follicle. The glandular cyst may or may not be present, and if present, both sides of the ovary are usually present. Cysts can be large or small, in the capsule containing lemon yellow water. After curettage or loss, the cyst will go away on its own if there are no complications.

Symptom

Mechanical symptoms

Bleeding: Is the first important symptom. Early bleeding in the second to fourth month, spontaneous bleeding; black or red; less a little and persistent, patient pale, pale mucous anemia, tired expression haggard.

Abnormal pregnancy: The patient vomits more often than in previous normal pregnancies.

Signs of pregnancy toxicity: Edema, high blood pressure, proteinuria. Sometimes there are signs of jaundice, yellow urine (Robert).

Hyperthyroidism with an enlarged thyroid gland, tachycardia, warm hands, tremors ... accounts for about 10% of cases. Often seen in the severe form when the uterus height is over 16 cm, the concentration of hCG in the urine is over 1,000,000 international units / 24 hours.

Physical symptoms

Uterus: The density of the uterus is soft, with no palpable parts of the fetus (except for those with the fetus). The uterus is larger than gestational age (except for degenerative pregnancy, the uterus is not larger than gestational age).

Heart-fetal hearing: The fetal heart cannot be heard.

Vaginal soft, with visible fingertip metastatic nucleus, purple easily bleed. The metastatic nucleus usually appears in the anterior vaginal wall.

Appendices: Bilateral glandular cysts can be palpable, easy to move.

Test

Single reaction: The amount of hCG (human chorionic gonadotropin) in pregnancy is usually highest in late second and early third months, but below 20,000 frog units. During egg pregnancy, hCG will increase by over 20,000 frog units.

ßhCG: The concentration of ßhCG increases very high during pregnancy, usually above 500,000 international units within 24 hours. However, the diagnosis can be erroneous if it is based on a single ßhCG measurement for the following reasons:

In some cases of pregnancy usually around 10 weeks gestation or in some cases of multiple pregnancies, the amount of ßhCG may exceed 500,000 international units / 24 hours.

Conversely, sometimes pregnant women can also have low blood concentrations of ßhCG.

Estrogen: Estradiol or estriol in the urine are lower in estron, estradiol or estriol than normal fetuses due to a disorder of the secretion of the placenta and no conversion of estradiol to estriol occurs in the adrenal glands of the fetus. This difference in estrogen levels is evident when gestational age is more than 14 weeks.

hPL (human placental lactogen): the hPL is usually high in normal fetus but very low in pregnancy, because the oocyte cultured in pregnancy cannot synthesize the hPL normally. If the hPL is low and ßhCG is high, pregnancy can be accurately diagnosed. During pregnancy typically 25 weeks onwards, serum hPL levels are> 10 mcg / ml.

Supersonic

Doppler cannot hear the fetal heartbeat.

Ultrasound does not show embryonic images, but only spots are like snow images, pictures of grapes.

X-ray

Uterine is not prepared for patients with uterine height over 14 cm, if fetal bone is not visible, pregnancy is highly doubtful.

An amniocentesis 5 minutes after injecting the contrast material into the uterus (water-soluble type) will show a honeycomb pattern that is a relatively sure sign of pregnancy. According to Kistener, the correct diagnosis of this method is 100%. Amniocentesis is no longer in use due to the effectiveness and harmlessness of diagnostic ultrasound.

Diagnose

Implementing the quadrants

Usually easy for typical cases:

Persistent bleeding.

The uterus is larger than gestational age.

The amount of hCG increased.

Sometimes difficult to diagnose, need a combination of symptoms and many laboratory tests to diagnose.

Differential diagnosis

Pregnancy can be mistaken for:

Threatened miscarriage: The uterus is not larger than gestational age, the hCG content is less than 20,000 frog units.

Stillbirth: Easy to mistake in the case of partial pregnancy. Stillbirth usually uterus is smaller than gestational age, engorged breasts may produce lactation, negative biological reaction.

Uterine fibroids: There may be symptoms of hemorrhage, no symptoms of pregnancy, negative biological reaction.

Severe pregnancy in normal pregnancy: The uterus is not larger than gestational age, the amount of hCG is less than 20,000 frog units, fetal ultrasound, fetal heart activity.

. Ectopic pregnancy: History of pregnancy, low hCG, uterus much smaller than gestational age. It is necessary to combine with ultrasound to diagnose, in conditional settings laparoscopy can be used to early diagnose ectopic pregnancy in difficult cases.

Progression and complications

if not diagnosed early and treated promptly, often a spontaneous miscarriage causes heavy bleeding.

Progressing well

After abortion, about 80 - 90% of cases:

Vaginal bleeding out.

The uterus rapidly contracts within 5 - 6 days.

Cystic gland if present will shrink and disappear.

The hCG concentration decreased rapidly in the first week after curettage. According to Kistner, 80% of patients have hCG in their urine return to normal within 30-60 days after being curettage.

Going bad

Hemorrhage: if left untreated, the egg will break spontaneously; when the miscarriage causes heavy bleeding and easy to miss eggs and vegetables.

Perforation of the uterus: If a malignant egg is ingrained in the uterine muscular layer, it can cause a perforation of the uterus, causing dangerous bleeding to fill the abdomen.

Bacterial infection: Inflammation of the lining of the uterus that causes hemorrhage.

Cultured fibroblast cancer: Pregnant eggs are very easy to turn into cultured fibroblast cancer, the rate of complications is 15 -17%. Therefore, pregnancy must be diagnosed early, closely monitored to detect and promptly manage complications of cultured fibroblasts.

To solve

While pregnant

Once the diagnosis has been confirmed as pregnancy, it must be treated early to avoid complications.

If you have a vacuum, you should smoke eggs in all cases. During curettage, a 500ml isotonic sweet serum drip infusion with 5 units oxytocin. Cervical angioplasty to 12, usually dilates easily because the cervix is ​​soft. Use a vacuum to pull the eggs out until the uterus shrinks, use heart-shaped pliers in the direction of the uterus to pick up the egg sacs. Scrape the uterus with a large, blunt spoon. After 2-3 days, curettage will be done again. After curettage, the patient must use antibiotics to prevent infection.

Preventive hysterectomy for the whole mass: Due to the high rate of complications into cultured leukoblastoma, for those over 35 years old and many times laying, management can curate the eggs and prevent hysterectomy or mass hysterectomy. without curettage.

Be very careful during the first curettage because it is prone to perforation of the uterus. Samples with curettage must be sent for pathological examination. All egg sacs, placenta, fetuses (if any), curettage tissue close to the uterine lining must be examined for pathological anatomy; Each type should be kept separately in a patient vial.

Treatment of malignant eggs with metastatic nuclei: The management principle is complete hysterectomy, take the metastatic nucleus (if the metastatic site can be operated), and at the same time treatment with anti-cancer chemicals. Only in the case of a young patient, who is pregnant for the first time, desperately wanting to have a baby, a few vaginal metastases do we put the problem of curettage and metastatic treatment of uterus; But close monitoring is required. If conservative treatment does not work, hysterectomy and combined chemical treatment must be performed.

Follow-up after curettage

Immediately after a few days the eggs were subjected to a pathological examination to see if a benign or invasive (malignant) pregnancy.

Prevent infection after curettage by giving 5-day prophylactic antibiotics and uterotonic drugs.

Clinical monitoring: After 3 to 4 weeks of curettage, the anatomical and physiological features of the genitals return to normal. After that time, if the uterus is still large, still bleeding, and the follicle does not disappear, it is necessary to think about complications of cultured fibroblastoma. If there is a metastatic nucleus, it is more certain.

Follow-up by microbiological reaction: After curettage, hCG should be measured once a week until hCG is negative. Once negative, test hCG every two weeks for the first three months. For the next 6 months, quantify hCG once a month, if all previous results are negative. During the following year, hCG is quantified every two months.

If the hCG level remains abnormally high, a chest X-ray must be taken to find metastases of cultured leukemia.

It is advised that after two years to get pregnant again, because if the patient becomes pregnant again soon, the risk of pregnancy as well as neoplastic cancers, on the other hand, makes it difficult to monitor the disease. The recommended contraceptive method is a condom or vaginal ejaculation. Do not use oral contraceptives or intrauterine devices during follow-up after abortion.

Prevention

Because the cause of pregnancy is not yet known, the best prevention is to improve living standards, carry out a planned birth, early diagnosis for timely treatment, monitoring vegetables and eggs. After curettage, it is necessary to closely monitor pressure prevention and early detection of complications into cultured fibroblast cancer.