11/5/2020

Hydatidiform mole

Hydatidiform mole:
hadatidiform mole(molar pregnancy):-is a gestational
trophoblastic neoplasm that arise from chorion.

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There are two types of molar growth:-

1-the complete mole:-is characterized by large amount of edematous
enlarged villi without fetus or fetal membranes. The mole ha a grapelike
appearance with clusters of vesicles on all or part of the lining of the
uterus.
2-the partial mole:-is characterized by normal villi intermingled with
hydropic (swollen) villi & some fetal material or an amniotic sac.

2 sperm and one ovum

Complete moles Partial moles

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Manifestation and causes:

1- a hadatidiform is placental tumor that develops once pregnancy has
occurred for unknown reason, the embryo dies in utero, but the placenta
continues to develop.
2-in the early stages of disease, the manifestations are difficult to
distinguish from those of a normal pregnancy. Genetic abnormalities
occurring at the time of fertilization appear to be responsible for the
disease.

Clinical picture:
1-the pregnancy appears to be normal at first.
2-the uterus is larger than expected for gestational.
3-bleeding is a common symptoms and may vary from brownish-red
spotting to heavy, bright red bleeding, vomiting in a rather severe from
may appear early.
4-fetal heart tones(FHT) are absent in the presence of other signs of
pregnancy.
5-pre-eclampsia may appear before the 20 wks. of gestation.

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6-woman with partial moles typically have a clinical diagnosis of

spontaneous abortion or missed abortion.
7-vesicles may be evident in the vaginal discharge of the abortus.
8-client with complete Hydatidiform mole have a higher incidence of
choriocarcinoma.
9- a blood of B-HCg level will be strongly positive(highly elevated when
compare with those levels of a normal pregnancy).

HCG -more then 25 pregnancy

Less than 5 is non pregnancy
Molor 100000

Medical management:
1- the 1st phase of medical management for Hydatidiform mole consist of
emptying the uterus.
-D & C is usual procedure in almost all client.
-primary hysterectomy is an alternative treatment in client who has
complete childbearing.

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2-the 2nd phase of medical management is B-hcG level surveillance by

radioimmunoassay to detect any change that suggest trophoblastic
malignancy.
-negative B-hcG level should be evident within 6 wks. after evacuation.
-physical examination are performed at 2 wks.

Nursing assessment:
1- a through history and physical examination.
2-fundel height provides data about expected gestational age, which is
beyond that expected by menstrual history.
3-careful auscultation for fetal heart sounds reveals no finding.
4-pregnancy test remain highly positive.
5-vital signs especially BP, which may reveals hypertension before 20
wks. of gestation.
6-bleeding which often develop during the 2nd trimester, should be assest
for clear.

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Nursing diagnosis:
1-fluid volume deficit related to uterine bleeding.
2-anticipating grieving related to loss of pregnancy.
3-altered nutrition: less than body requirement related to nausea &
vomiting.
4-knowledge deficit related to the need for follow-up.
5-fear related to the possibility of malignancy.

Nursing intervention:
1-assist the client for preparation of uterine evacuation.
2-render appropriate pre-operative & postoperative nursing care.
3-teach the client the need for follow-up surveillance of hcG for an entire
year.
4-family planning counseling should be offered.
After 1 years
5-advice the client to avoid pregnancy for at last one year, after which
time conception is permitted if HCg levels are within normal limits.
6-psychological support is essential.

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Nursing evaluation:
1-the client verbalizes the pathophysiological changes in her
reproductive system & the need for immediate treatment & follow-up
procedure.
2-the client exhibit no signs or symptoms of complication.
3-the client returns to her previous level of functioning after the operative
procedure (evacuation).
The client verbalize the need for continued follow–up for at least 1 year.