Gestational Trophoblastic Disease (H- mole)

HYDATIDIFORM MOLE

Catague, Rizza Palamine

Hyatidiform Mole

Developmental anomaly of the placenta resulting in the conversion of the chorionic villi into a mass of clear vesicles

Hyatidiform Mole

Abnormal proliferation and degeneration of the trophoblastic villi

Hyatidiform Mole

As the cells degenerate, they become filled with fluid and appear as clearfilled, grape-sized vesicles.

Hyatidiform Mole

Unsual chromosomal patterns seen either no genetic material in ovum, or 69 chromosomes .

Types of H-mole

Complete H-mole Partial H-mole

Predisposing Factors.

COMPLETE H-MOLE

Develop from anuclear ovum that contains no maternal genetic material, an (empty egg)
23

DUPLICATION

46

46XX or 46XY
BACK

If embryo forms, it dies early at only 1-2mm, no fetal blood present

PARTIAL H-MOLE

Some of the villi form normally

46
OR

23

69

69XXY or 69XYY
23 23 23 69

BACK

A macerated embryo of approximately 9 wks may be present with fetal blood in the villi

Predisposing Factors

Low protein Woman older than 35 yrs old Women of Asian Heritage
ASSESSMENT FINDINGS: signs and symptoms

DIAGNOSTIC TEST .

ASSESSMENT FINDINGS

Vaginal bleeding (16th wk): brownish like prune juice Uterine enlargement NO fetal heart sounds NO fetal skeleton (ultrasound) Elevated serum level hCG (1M-2M IU (Normal: 400,000 IU) Hyperemesis gravidarum PIH Hyperthyroidism thyrotoxicosis
COMPLICATION

COMPLICATIONS (recall PATCHED )

BACK

P-ulmonary embolus A-nemia T-rophoblastic embolization of the lungs seen after molar evacuation of enlarged uterus C-horiocarcinoma H-yperthyroidism, H-emorrhage E-mbedded infection D-isseminated Intravascular Coagulation (DIC)

DIAGNOSTIC TEST

Radioimmunoassay Histologic examination Ulrasonography Laboratory test (CBC,

Protrombin Time, partial thromboplastin time, fibrinogen levels, hepatic findings) MEDICAL MANAGEMENT .

MEDICAL MANAGEMENT

Suction Curettage D&C Dilatation and Curettage Hysterectomy Anti- metabolite Drugs (Methotrexate, Dactinomycin) Blood Transfusion

NURSING INTERVENTIONS

Provide pre/postoperative care for evaluation of uterus Prepare pt. for surgery Teach contraceptive use Follow up lab work Monitoring 3 mos and periodic follow up for 6-12 mos Pelvic examinations and chest X-ray Teach about risk for future pregnancies

NURSING INTERVENTIONS

Assess pt. V/S for basline Monitor signs of hemorrhage Provide emotional support for loss of pregnancy Help pt. and family develop effective coping strategies