Bladder mole is a serious complication of pregnancy. Due to a mistake in fertilization, there is a strong growth of the chorionic villi without the development of a complete embryo. The pregnancy must be terminated by means of a minor surgical procedure.
What is a bladder mole?
A bubble mole is a malgrowth of the chorionic villi of the female placenta. The reason for this disorder is an error during fertilization. The placental villi undergo blister-like transformation with melting of the surrounding connective tissue. The trophoplast undergoes increased growth. There are two types of vesicular mole. A partial bladder mole develops in 90 percent of cases and a complete bladder mole in 10 percent of cases. In the complete form, no embryo forms, whereas in the partial bladder mole, rudiments of embryo development can be seen. Bladder moles are cell proliferations of placental tissue, but they usually do not degenerate into cancer. They may, however, invasively grow into the surrounding space. In rare cases, however, a so-called chorionic carcinoma may develop. Phenomenologically, the transitions between an invasive bladder mole and a cancerous growth appear only fluid and are not uniformly described in the literature.
Cause
The cause of a bladder mole is defective fertilization. In the complete form, the female chromosome set is completely missing. How the female genetic information is lost is not yet fully understood. Thus, a nucleus-less egg can be fertilized with two sperm or with one dividing sperm. However, it is possible that the female chromosome set is subsequently lost due to an incorrect division of the male chromosome set. Partial bladder mole develops from a triploid fertilized egg with one set of female chromosomes and two sets of male chromosomes. Here, one egg is fertilized with either two sperm or one dividing sperm. In the case of the complete bladder mole, no embryo can develop because in the case of the double set, the genes of the paternal chromosome set are completely inactivated by imprinting. However, the female homologous chromosome set is absent. As a result, only trophoplast tissue develops. However, in partial bladder mole, embryonic tissue may develop in addition to trophoplast tissue.
Symptoms, signs, and symptoms
A bladder mole pregnancy initially shows all the normal signs of pregnancy. However, bleeding may start to occur after the sixth week of pregnancy. Bleeding may occur even later. If the bladder mole is complete, miscarriage usually takes place early. However, if this does not occur, other symptoms include nausea, vomiting and dizziness. The abdomen swells because the placenta grows rapidly and the uterus expands. The levels of the pregnancy hormone “human chorionic gonadotropin (hCG)” rise steeply due to the rapidly growing placenta. However, a partial bladder mole is not so easy to recognize. The clinical symptoms are not as noticeable, and a possible miscarriage occurs a little later in the period from the fourth to the sixth month of pregnancy.
Diagnosis
To diagnose a bladder mole, the first step is to determine the level of human chorionic gonadotropin (hCG). If, in addition to unusual and severe pregnancy symptoms, hCG levels rise rapidly, a bladder mole is suspected. A strongly swelling abdomen also indicates this finding. Imaging techniques, such as sonography, can support the examination. Complete bladder moles are usually readily detectable by ultrasonography. However, partial bladder moles are not as easy to diagnose. In this case, nothing may be seen even with ultrasonography. In this case, cytogenetic analysis must be performed. In this process, a tissue sample is taken and genetically analyzed. If only male chromosome sets are found, there is a complete bladder mole. In the case of a triploid cell with one female chromosome set and two male chromosome sets, there is a partial bladder mole.
Complications
Several complications can occur as a result of a bladder mole. First, the pregnancy must be terminated, which is usually associated with emotional and psychological stress for the affected women.In one third of cases, cysts on the ovaries develop from a bladder mole. This can lead to severe pain in the abdomen, menstrual disorders and digestive problems. Rather rarely, a cyst ruptures, resulting in infection and bleeding in the abdominal area or circulatory shock. If the cysts twist, a so-called stylet torsion occurs, which can lead to peritonitis and subsequently to further complications. During surgical treatment of a bladder mole, there is an increased risk of bleeding and injury to the cervix. In addition, remnants of the bladder mole often remain, which can become inflamed years later and necessitate another scraping. Even with successful therapy, the chance of becoming pregnant is reduced. If severe complications occur, such as polycystic ovary syndrome, fertility is sometimes permanently limited. As a result of bladder mole, there may be long-term menstrual irregularities or the complete absence of menstruation.
When should you see a doctor?
In any case, a doctor must be consulted for this complaint. Since the pregnancy is usually terminated by the abnormal development, a psychologist must also be consulted in many cases if the patient and her partner are suffering from psychological complaints or depression. A doctor must be consulted if bleeding occurs despite pregnancy. In most cases, this occurs after the sixth week of pregnancy. Furthermore, permanent dizziness or a general feeling of 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 also necessary in this case. In case of acute pain or emergency, an emergency doctor should be called or the hospital should be visited. Furthermore, the disease can also be diagnosed by a gynecologist. The latter can also perform the appropriate abortion. For the woman, successful treatment usually does not result in any particular complications.
Treatment and therapy
Once detected, a bladder mole must be surgically removed via suction curettage. This involves dilating the cervix and gently suctioning out the tissue. Sometimes a second procedure is required because not all bladder mole tissue was captured the first time. Further, medications are administered to repel the remaining tissue. These medications come in the form of tablets, gels, or vaginal suppositories. Even after treatment, the development of the bladder mole must be monitored for a long time. This is because if individual cells remain, they may start to grow again after a certain period of time. Up to six months, the level of the pregnancy hormone should be examined. Low values indicate the complete removal of the bladder mole. However, if the values rise again, another operation may be necessary. This is because occasionally the bladder mole grows into the uterine muscle. In this case, suction curettage cannot capture all of the tissue. Signs of this are constant bleeding despite treatment. In the invasive forms of bladder mole, only chemotherapy can bring complete cure. Since the tissue is usually not malignantly degenerated, there is a very good chance of cure. However, in rare cases, malignant chorionic carcinoma develops, which requires more intensive treatment and monitoring. However, even in cases of malignant degeneration of the bladder mole, there is a good chance of cure with chemotherapy.
Prospect and prognosis
The prognosis of bladder mole depends on the individual circumstances. With an optimal course and no further complications, a permanent cure can be achieved with corrective surgery. With a less favorable course, the expectant mother is threatened with termination of pregnancy. In very severe cases, the woman may subsequently become permanently infertile. Without medical care, an abortion will occur. In most cases, the pregnant woman loses her baby within the first weeks of pregnancy and also suffers severe emotional and psychological problems. With treatment, the chances of recovery increase immensely. In one procedure, the altered tissue is carefully removed. This procedure requires the utmost precision and tact.Complications lead to damage to the unborn child or the immediate loss of the child. Subsequently, regular check-ups are necessary during the further course of pregnancy. This involves checking the uterus for possible changes. In some cases, the tissue grows again and a relapse of the bladder mole 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 termination of pregnancy. If complications and an abortion occur during the procedure, the damage to the uterus can be so immense that infertility occurs.
Prevention
Unfortunately, prevention from bladder mole is not possible because its development is caused by a mistake during fertilization. Another pregnancy is possible again. However, another pregnancy should not follow immediately after a survived bladder mole, but only after its complete healing.
What you can do yourself
Patients with bladder mole usually undergo surgery quickly after diagnosis of the condition, which focuses on removal of the malformation by suction curettage. The operation is usually accompanied by embryo loss and consequent termination of the pregnancy. The affected women are therefore confronted with both physical and psychological problems. Self-help measures are partially possible, but only in consultation with the treating medical team. After the operation, the patients allow themselves physical rest and refrain from sports and excessive exercise. In some cases, an inpatient stay is advisable. Prescribed medication must always be taken on time, with patients paying increased attention to possible side effects. Continuous follow-up is highly relevant, as in rare cases further malformations may occur. Since the termination of pregnancy associated with bladder mole in particular is associated with a high level of psychological stress, patients try to avoid further stress and rest. If possible, patients allow themselves some time off for a few days and help their body and psyche to regenerate after the surgical procedure. If the emotional impact is too great, affected women seek help from a psychotherapist. This reduces the risk of long-term psychological sequelae and depression.
