Moles

The Moles represents a serious complication in pregnancy. Due to a failure in fertilization, the chorionic villi grow vigorously without a full embryo developing. The pregnancy must be terminated with a small surgical procedure.

What is a mole?

An incorrect growth of the chorionic villi of the female placenta is called a mole. The reason for this disorder is an error in fertilization. When the surrounding connective tissue melts, the placental villi are transformed into bubbles. The trophoplast is subject to increased growth.

There are two types of moles. A partial mole develops in 90 percent of the cases and a complete mole in 10 percent of the cases. In the complete form, no embryo is formed, while in the partial moles, beginnings of the development of an embryo can be seen. Moles are cell growths in the placental tissue, but they are usually not cancerous.

However, they can invasively grow into the surrounding space. In rare cases, however, a so-called chorionic carcinoma can develop. Phenomenologically, the transition between an invasive mole and cancerous growth appears to be fluid and has not been described consistently in the literature.

root cause

The cause of a mole of bladder lies in faulty fertilization. In the complete form, the female chromosome set is completely absent. How female genetic information is lost is not yet fully understood. For example, a seedless egg cell can be fertilized with two sperm cells or with a dividing sperm cell. However, it is possible that the female chromosome set is subsequently lost due to an incorrect division of the male chromosome set.

The partial mole of the bladder develops from a triploid fertilized egg cell with a female chromosome set and two male chromosome sets. Here an egg cell is fertilized either with two sperm or with a dividing sperm.

An embryo cannot develop in the case of a complete molar, since the genes of the paternal chromosome set are completely inactivated by imprinting. However, the female homologous chromosome set is missing. As a result, only trophoplastic tissue develops. In the case of partial molars, however, embryonic tissue can form in addition to the trophoplastic tissue.

Symptoms, Signs & Ailments

Mole pregnancy will initially show all of the normal signs of pregnancy. However, bleeding can occur from the sixth week of pregnancy. The bleeding can occur later. If the mole is complete, there is usually an early abortion. However, if this does not happen, additional symptoms include nausea, vomiting and dizziness.

The abdomen swells because the placenta grows quickly and the uterus expands. The values ​​of the pregnancy hormone "human chorionic gonadotropin (hCG)" rise steeply due to the rapidly growing placenta. However, a partial mole is not that easy to spot. The clinical symptoms are not so noticeable and a possible abortion occurs a little later in the period from the fourth to the sixth month of pregnancy.

diagnosis

To diagnose a mole of the bladder, the value of human chorionic gonadotropin (hCG) is first determined. If, in addition to unusual and severe pregnancy symptoms, the hCG values ​​rise rapidly, a mole of bladder is suspected. The strongly swelling belly also indicates this finding.

Imaging procedures such as sonography can support the examination. Complete moles are usually easily identified by ultrasound scans. However, partial moles are not that easy to diagnose. Nothing can be seen here even during an ultrasound examination.

In this case, it is necessary to carry out cytogenetic analyzes. A tissue sample is taken and genetically examined. If only male sets of chromosomes are found, the mole is complete. A triploid cell with one female chromosome set and two male chromosome sets has a partial mole of the bladder.

Complications

A variety of complications can occur as a result of a mole. First of all, the pregnancy must be terminated, which is usually associated with emotional and psychological stress for the women concerned. In a third of cases, a mole will develop into cysts on the ovaries.

This can lead to severe abdominal pain, menstrual disorders and digestive problems. A rupture of a cyst occurs rather rarely, resulting in infections and bleeding in the abdomen or in circulatory shock. If the cysts twist, a so-called twist of style occurs, which can lead to peritonitis and further complications as a result.

Surgical treatment of a mole increases the risk of bleeding and injury to the cervix. In addition, remnants of the moles often remain, which can become inflamed years later and require further scraping. Even with successful therapy, the chance of becoming pregnant is reduced.

If there are serious complications such as polycystic ovary syndrome, fertility is sometimes permanently restricted. A mole of bladder can lead to long-term menstrual disorders or the complete absence of menstruation.

When should you go to the doctor?

In the event of this complaint, a doctor must be consulted in any case. Since the pregnancy is usually terminated due to the undesirable development, in many cases a psychologist must be consulted if the patient and her partner suffer from psychological complaints or depression.

A doctor must be consulted if bleeding occurs despite pregnancy. In most cases, these occur after the sixth week of pregnancy. Persistent dizziness or a general malaise can also indicate the disease, so that an examination by a doctor is necessary.

The expansion and enlargement of the uterus is also a common symptom, so that a visit to a doctor is necessary. In the event of acute pain or emergencies, an emergency doctor should be called or the hospital should be visited. The disease can also be diagnosed by a gynecologist. He can also carry out the corresponding abortion. Successful treatment usually does not result in any particular complications for women.

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Treatment & Therapy

A mole of bladder must be surgically removed using a suction curettage once it has been identified. The cervix is ​​expanded and the tissue is gently suctioned off. Sometimes a second procedure is required because not all of the molar tissue was captured the first time. In addition, drugs are administered that are intended to reject the remaining tissue. These drugs come in the form of tablets, gels, or vaginal suppositories.

Even after the treatment, the development of the moles must be monitored for a long time. If individual cells remain, they can grow again after a certain time. The level of the pregnancy hormone should be examined for up to six months. Low values ​​indicate complete removal of the moles.

However, if the values ​​increase again, another operation may be necessary. Because occasionally the mole grows into the uterine muscle. In this case, the entire tissue cannot be captured by suction curettage. Signs of this are constant bleeding despite treatment. With the invasive forms of moles, only chemotherapy can bring a complete cure.

Since the tissue is usually not malignant, the chances of recovery are very good. However, in rare cases, malignant chorionic carcinoma develops, which requires more intensive treatment and monitoring. However, even with malignant degeneration of the moles, there are good chances of recovery from chemotherapy.

Outlook & forecast

The prognosis of a mole of bladder depends on the individual circumstances. If the progression is optimal and there are no further complications, corrective surgery can result in permanent healing.

If the outcome is less favorable, the expectant mother is at risk of an abortion. In very severe cases, permanent infertility of the woman can subsequently occur. Without medical care, an abortion occurs. The pregnant woman usually loses her baby within the first few weeks of pregnancy and also suffers from severe emotional and psychological problems.

Treatment increases the chances of recovery immensely. The changed tissue is carefully removed in one procedure. This procedure requires the highest level of precision and sensitivity. Complications result in harm to the unborn child or immediate loss of the child. Regular check-ups are then necessary as the pregnancy progresses. The uterus is checked for possible changes.

In some cases, tissue regrowth and mole relapse occurs. In order to ensure the survival of the child, a new intervention is necessary, which is again associated with great challenges and risks for an abortion. If complications and an abortion occur during the procedure, the damage to the uterus can be so immense that infertility occurs.

prevention

A mole prevention is unfortunately not possible because its development is caused by an error in fertilization. Another pregnancy is possible again. However, a new pregnancy should not follow immediately after a mole that has been overcome, but only after it has completely healed.

You can do that yourself

Patients with moles usually undergo surgery soon after the diagnosis of the disease, in which the removal of the malformation by means of suction curettage is in the foreground. The operation is usually associated with loss of the embryo and thus termination of the pregnancy. The women affected are therefore confronted with both physical and emotional problems. Self-help measures are partly possible, but only in consultation with the treating team of doctors.

After the operation, the sick treat themselves to physical rest, avoiding sports and excessive exercise. In some cases, an inpatient stay makes sense. Prescribed medication must always be taken on time, with patients paying more attention to possible side effects. A continuous follow-up check is of great relevance, as further malformations occur in rare cases.

Since the termination of pregnancy associated with the mole in particular is associated with a high level of psychological stress, patients try to avoid further stress and to rest. If possible, the patients treat themselves to a few days off and support body and psyche in regeneration after the surgical procedure. If the emotional impairment is too great, affected women seek help from a psychotherapist. This reduces the risk of long-term psychological damage and depression.