Gestational Trophoblastic Disease (Hydatidiform mole)

Notes

Description
  1. Hydatidiform mole is an alteration of early embryonic growth causing placental disruption, rapid proliferation of abnormal cells, and destruction of the embryo.
  2. There are two distinct types of hydatidiform moles-complete and partial.
    • In a complete mole, the chromosomes are either 46XX or 46XY but are contributed by only one parent and the chromosome material duplicated. This type usually leads to choriocarcinoma.
    • A partial mole has 69 chromosomes. There are three chromosomes for every pair instead of two. This type of mole rarely leads to choriocarcinoma.
Etiology
  • The etiology of hydatidiform moles is unknown. Genetic, ovular, or nutritional abnormalities could possibility be responsible for trophoblastic disease.
Pathophysiology
  1. A hydatidiform mole is a placental tumor that develops after pregnancy has occurred; it may be benign or malignant. The risk of malignancy is greater with a complete mole.
  2. The embryo dies and the trophoblastic cells continue to grow, forming an invasive tumor.
  3. It is characterized by ploriferation of placental villi that become edematous and form grapelike clusters. The fluid- filled vesicles grow rapidly, causing the uterus to be larger than expected for the duration of pregnancy.
  4. Blood Vessels are absent, as are a fetus and an amniotic sac.
Assessment Findings

1. Clinical manifestation

  1. Vaginal bleeding (may contain some of the edematous villi)
  2. Uterus larger than expected for the duration of the pregnancy.
  3. Abdominal cramping from uterine distention.
  4. Signs and symptoms of preeclampsia before 20 weeks gestation
  5. Severe nausea and vomiting

2. Laboratory and diagnostic study findings

  1. hCG serum levels are abnormally high.
  2. Ultrasound reveals characteristics appearance of molar growth.
Nursing Management

1. Ensure physical well being of the client through accurate assessment and interventions.

  • Review pertinent history and history of this pregnancy.
  • Prepare for suction curettage evacuation of the uterus (induction of labor with oxytocic agents or prostaglandins is not recommended because of the increased risk of hemorrhage).
  • Administer intravenous fluids as prescribed.

2. Provide client and family teaching.

  • Ensure appropriate follow-up and self-care by explaining that frequent possibility of recurrence of the problem or progression to choriocarcinoma. Also explain that hCG levels should be monitored for 1 year.
  • Discuss the need to prevent pregnancy for at least 1 year after diagnosis and treatment.
  • Inform the client that oral birth control agents are not recommended because they suppress pituitary luteinizing hormone, which may interfere with serum hCG measurement.
  • Describe and emphasize signs and symptoms that must be reported (i.e., irregular vaginal bleeding, persistent secretion from the breast, hemoptysis, and severe persistent headaches). These symptoms may indicate spread of the disease to other organs.

3. Address emotional and psychosocial needs.

Exam

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