As early as B.C., there were records of women giving birth to 600 children, which were called “strange fetuses” or “blister-like fetal masses” at that time. It was later known that this so-called freak fetus is due to the proliferation of placental chorionic trophoblast and interstitial edema after pregnancy, forming blisters of different sizes, which are connected to each other in bunches and look like bunches of grapes, hence the name gravida. Staphyloma is a benign trophoblastic disease characterized by complete confinement to the uterus, without invasion of blister-like tissue into the muscle wall or metastasis to other organs, hence the name benign staphyloma. There are two types, complete and partial gravidity, with complete gravidity being more common.
Why do staphs occur in pregnancy?
Staphyloma occurs in women of childbearing age and the exact cause of its occurrence is not known, but the following factors are associated with the occurrence of staphyloma.
1, racial factors: gravida is mostly seen in Asian countries, especially in Southeast Asian countries, while it is relatively rare in Europe and America, which some people think may be related to race. The epidemiological survey in China found that gravida occurs once in every 1290 pregnancies, and the incidence of gravida is higher among Zhuang and Mongolian than Han Chinese.
2, nutritional factors: according to the geographical distribution of staph, it mostly occurs in rice eating countries, and some people think it may be related to the eating habits of residents. Studies have shown that if the food is not cooked properly, the loss of large amounts of protein and vitamin A, as well as the lack of precursor carotene and animal fat in food can easily lead to an increased incidence of staphylococytes.
3.Infection factor: It is believed that the occurrence of staph is related to infection. It is not clear whether there is a causal relationship between the gene and the gravida.
The incidence of staphyloma after pregnancy increases exponentially when the mother is older than 35 years old. Conversely, the incidence of staph in women younger than 20 years of age is also significantly higher.
5. The previous pregnancy was a gravida: the chance of having a gravida again this time is also significantly higher.
6, genetic factors: cytogenetic examination of normal pregnancy are 46 chromosomes (i.e. diploidy), of which 23 are from the father and 23 from the mother. The results of cytogenetic examination of gravida reveal that although most of the complete gravida have 46 chromosomes, all of them are from the father and there is no maternal component; partial gravida are found to have 69 chromosomes, of which 46 are from the father and 23 are from the mother, i.e. excessive paternal component contributes to the abnormal proliferation of placental villi and leads to the occurrence of gravida.
What are the manifestations of gravidity?
Gravida is also a kind of pregnancy, which also has menopause and early pregnancy reaction, and should be alerted to gravida when the following conditions occur
1, abnormal enlargement of the uterus: due to the rapid growth of the gravida and intrauterine bleeding, the uterus often increases rapidly and the uterus is larger than the corresponding menopause month of normal pregnancy.
2, lower abdominal pain: due to the rapid growth of the gravida, the uterus is rapidly dilated, for paroxysmal lower abdominal pain, usually not severe, can be tolerated. But occasionally there is acute lower abdominal pain, mostly seen when the ovarian flavinized cysts are twisted.
3, pregnancy vomiting: due to the excessive proliferation of trophoblast cells producing large amounts of human chorionic gonadotropin (HCG), the vomiting in patients with hyperemesis gravidarum appears earlier than in normal pregnancies, and the symptoms are heavy and long-lasting.
4, gestational hypertension syndrome manifestations: a few patients may develop hypertension, edema and proteinuria before 24 weeks of pregnancy, and in severe cases, convulsions, coma and heart failure.
5. Ovarian flavinized cysts: Due to the large amount of HCG produced by patients with gravida, the ovaries are stimulated to change into multi-housed cysts. These cysts mostly disappear naturally 1 to 3 months after the expulsion of the gravida, sometimes it takes 6 months, and have no effect on ovarian function after disappearing.
6. Symptoms of hyperthyroidism: A few patients show mild manifestations of hyperthyroidism, such as tachycardia, moist skin and tremor. Therefore, once the above symptoms appear after menopause, you should seek medical attention and undergo human chorionic gonadotropin measurement and ultrasound examination to confirm the diagnosis.
7. Vaginal bleeding after menopause: It is the most common symptom. Irregular vaginal bleeding often starts at 8 to 12 weeks after menopause, and the amount is variable.
How to treat after the diagnosis of staph?
1, timely clearance: after the diagnosis of staph, the uterine cavity contents should be removed immediately, generally choose aspiration. The second scraping of the uterus can be done after a week. Ovarian flavinized cysts will disappear on their own after clearance of the gravida and usually do not require treatment. The vast majority of staphylococci can be cured after clearance and do not require chemotherapy.
2.Prophylactic chemotherapy: single drug prophylactic chemotherapy should be considered for the following high-risk factors: age > 40 years; blood HCG level > 1000000 IU/l; uterine volume significantly larger than the month of menopause; ovarian flavinized cyst > 6 cm; pathology dominated by small grape-shaped blisters (diameter less than 0.4 cm); recurrent staphyloma.
3. Hysterectomy: total hysterectomy is feasible for those who are older than 40 years old, without fertility requirements and with high-risk factors, but bilateral ovaries should be preserved.
Staphyloma is a benign lesion, why do I need to follow up after treatment?
Although staph is a benign condition, unlike a normal early abortion, it does not go away after clearing the uterus. As an abnormal pregnancy, most staph can be cured by clearing the uterus, but still 20% or more of patients can develop further into malignant staph or choriocarcinoma, which is a trophoblastic tumor that can threaten the patient’s life. Therefore, all patients with staphyloma should be closely monitored, and once abnormalities are detected, then chemotherapy should be administered immediately. The follow-up includes: blood HCG measurement, gynecological examination, regular review of ultrasound, X-ray chest or CT examination. The return of menstruation, abnormal vaginal bleeding, cough, hemoptysis and other symptoms of metastases should also be noted. Strict contraception during the follow-up period, i.e., two years of contraception, with condoms preferred and intrauterine devices avoided.
What manifestations suggest possible malignancy?
When symptoms such as vaginal bleeding, hemoptysis, abdominal pain, severe headache, etc. are found during the follow-up; when the blood HCG level does not decrease or increases again after decreasing for 2 months after cystectomy; when abnormal echogenicity, especially in the myometrium, is found during ultrasound examination, the diagnosis of staphylococcal malignancy is confirmed. The diagnosis of staphylococcal malignancy should be followed by timely chemotherapy. It is usually not life-threatening.
Can staph be repeated?
It is generally accepted that the risk of recurrent staph after one staph is 1%, while the risk of recurrent staph after two staph is up to 20%. Some studies have shown that the chance of malignancy will increase 3 to 4 times for repeat staph. Therefore, prophylactic chemotherapy should be given immediately after clearance of repeat staph to prevent its occurrence. Although the chance of recurrent staph after cure is greater than normal, the majority of them can obtain normal babies, therefore, it is not necessary to worry too much when pregnant again.
What should I pay attention to in my life?
Patients with staph should eat food high in protein, vitamins and easy to digest, be properly active and ensure sufficient sleep. Sexual intercourse should be prohibited for one month after curettage to keep the vulva clean to prevent infection. Regular follow-up and strict contraception for two years.