MODULE 3 cells; the only divided was the sperm;

the sperm met an empty ovum = no

HYDATIDIFROM MOLE (H-MOLE)
 Abnormal proliferation of cells 
Abnormal degeneration of cells 
trophoblastic villi (associated with
choriocarcinoma; rapidly progresses
to a metastasizing malignancy *leads
to development of cancer)  embryo
do not develop *depends on the type
of H-mole of the patient  as cells
degenerate it becomes filled with fluid
(hydropic)  clear fluid-filled, grape-
sized vesicles *happens on 1/1500
pregnancies; very rare but effect is
quite tremendous
 Risk Factors:
 Women with low protein intake
 Women who got pregnant older than
35 years old
 Women of Asian heritage
 Blood group A women who marry
blood group O men (no studies are
established; based on profiling)
 Previous molar pregnancy (can be
tagged as habitual aborters unless full
diagnosed = because it will repeat)
*for women who have bleeding with
fragments = must be sent to health
facility for further analysis
fertilization
 No fetal blood present on villi (no
baby)
 (+) choriocarcinoma
 There is an increased HCG levels
2. PARTIAL MOLE
 Some of the villi form normally *there
is a union of a viable ovum and sperm
however it forms 69 chromosomes
(triploid formation) (one egg is
fertilized by one sperm but defective
or two effective sperm fertilized the
egg however there is a problem in the
division process)
 (+) macerated embryo (9 weeks
AOG) *there is a fetus formed
 Fetal blood in villi
 (-) choriocarcinoma *not too
dangerous
 Decreased HCG

 2 Types of Molar Growth:

1. COMPLETE MOLE
 ALL trophoblastic villi swell and
become cystic
 If (+) embryo, it dies early at 1-2 mm
in size *will not progress to pregnancy
 On chromosomal analysis, although
the karyotype is normal 46XX or
46XY, this chromosome component
was contributed only by the father or
an “empty ovum” *there is division of

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G.E.V.-SINLAG
 Signs and Symptoms:
 Early symptoms would show normal
signs of pregnancy but upon further
assessment:
 Uterus tends to expand faster than
normally
 Multiple pregnancy (*ovum was
fertilized by two sperm)
 Miscalculated due date
Normal Pregnancy:
 No fetal heart sounds
 No viable fetus
 Increased HCG levels
 1 to 2 million IU
 (+) after 100 days (*will decline
after) *one of the nursing
responsibilities is to monitor the
HCG levels
 Marked nausea and vomiting
 Symptoms of PIH (before the 20th
week)
 HPN; Edema
 Proteinuria (appear before 20
weeks)
 UTZ shows dense growth (no fetal
growth in uterus; no FHT); Snow flake
pattern or empty
G.E.V.-SINLAG
 Vaginal spotting with dark brown
blood
 Profuse fresh flow at week 16 (if not
detected by sonogram)
 Vaginal bleeding accompanied by
discharge of fluid-filled vesicles
 Differentiates diagnosis from
miscarriage
 Nursing responsibility: bring any
clots or tissue passed with her
 Medical Management:
 Suction and curettage
 To evacuate the mole; HCG titers
return to normal faster *if not
evacuated at early time = can lead
to choriocarcinoma
 No involved cervical dilatation
 HCG monitoring after surgery
 Increased HCG
 ½ women (+) 3 weeks
 ¼ women (+) 40 days
 Assessment of serum HCG levels
every 2 weeks – normal
 Assessment of serum HCG levels
every 4-6 weeks for the next 6-12
months – gradually decreasing HCG
*expected to be eradicated at 12
months *at 6 months expect that there
is low HCG level but wait for 12
months to be sure = after 12 months,
pregnancy is allowed
 *sexual intercourse is not prohibited
but may be difficult to diagnose if
rising HCG level is due to pregnancy
or choriocarcinoma = take a reliable
contraceptive for 12 months
 Levels that plateau for 3x or more
 Malignant transformation
 Methotrexate (it destroys fast
growing cells including h mole)
*expect they would lose hair *cells of
GI tract = N&V
2|N C M 0 1 0 9
  Prophylactic course *because of the  Laboratory values (Hg and Hct) to
possible complications of report HCP
choriocarcinoma  Coagulation factors (added risks for
 Drug of choice for choriocarcinoma hemorrhage)
 20% of women  Rh-women (to receive Rhogam)
 PE + Chest X-ray/CT scan of brain,  Fever, elevated PR, malaise,
chest, abdomen, and pelvis (check prolonged, malodorous vaginal
for metastasis) discharge (bleeding associated with
 Interferes with WBC formation infection)
(leukopenia) *makes the patient
somehow immuno compromised  Nursing Diagnoses:
 Dactinomycin  Bleeding
 Added to treatment regimen if  Potential for infection
metastasis occurs  Deficient knowledge about diagnostic
and therapeutic procedures, signs
 Nursing Responsibilities: and symptoms of additional
 Assessment: complications, dietary measures to
 Confirmation of pregnancy prevent infection
 Length of gestation as initial data  Provide information about tests and
 PA findings: procedures
 Amount of bleeding  Explain diagnostic procedures such
 Description, location, severity of as transvaginal/ transabdominal
pain UTZ (decrease anxiety)
 Estimate amount of vaginal  Purpose, how long, cause
bleeding by examining linens and discomfort
pads *QBL – 1 gram = 1 ml  Consent before procedures
 Weighing linen and pads and
estimate through cups and  Teach about infections:
tablespoon - Prevention
 How long bleeding episode  Personal hygiene
 What was done to control bleeding  Daily showers
 Bleeding + pain:  Careful handwashing before and
 Uterine cramping (spontaneous after changing pads
abortion)  Perineal pads and not tampons
 Deep, severe pelvic pain (ruptured  Safe timing of resuming intercourse
ectopic pregnancy) *if bleeding stopped; 2-4 weeks
 Unruptured ectopic (concealed after surgical procedure
bleeding) and pain only symptom - Report immediately if these
 Vital signs and urine output (CV symptoms appear:
Status)  Thermometer at home
 Rising PR and RR, falling UO  Take temperature every 8 hours for
(hypovolemia) the first 3 days at home
 Report if 38 C

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G.E.V.-SINLAG
  Vaginal discharge with foul odor,
pelvic tenderness, persistent
general malaise
 Nursing Interventions:
- Provide information about tests and
procedures
- Teach measures to prevent infection
- Provide dietary information
 Increase in iron to increase
hemoglobin and hematocrit values
 Liver, red meat, spinach, egg yolks,
carrots, raisins
 Vitamin C; citrus fruits, broccoli,
strawberries, cantaloupe, cabbage,
green peppers
 Adequate fluid intake 2500 ml (to
promote hydration after bleeding
episode)
- Teach signs of infection to report
- Reinforce follow-up care
 HCG levels with H-mole
 Acknowledge their grief
 Recognized guilt feelings
 Reliable contraceptives for 1 year if
with H-mole
- Instruct the woman who begin to
miscarry at home, to bring any clots
or tissue passed to the hospital with
her
- Instruct the woman to use a reliable
contraceptive method for 12 months
- Emotional support
- Instruct to have an early screening
with ultrasound during the next
pregnancy
HYPEREMESIS GRAVIDARUM
- Prolonged/ persistent/ uncontrolled
nausea and vomiting of pregnancy
- Past 16 weeks of pregnancy *after 16
weeks, mother should have steady
levels of HCG
G.E.V.-SINLAG
- If severe: dehydration, ketonuria,
significant weight loss (risk for LBW,
SGA)
- 1/200 to 300 women
 Risk Factors:
- Unknown
- Helicobacter pylori (associated with
gastric ulcers)
- Increased estrogen and HCG (due to
thyroid stimulating properties)
- G1 women
- Multiple pregnancies *high levels of
HCG
- Displacement of GI tract
- Hypofunction: APG and adrenal
cortex
- Abnormalities: Corpus luteum
- Genetics
 Signs and Symptoms:
- Severe nausea and vomiting
 Cannot maintain usual nutrition
- Weight loss
 5% less from pre-pregnancy weight;
occurs during 12 weeks AOG *NR:
monitor weight of the patient
- (+) ketones in the urine *the body will
find a source for energy  there will
be fat/ protein breakdown 
ketoacidosis  ketones in the urine
- Increased Hct and Hg concentration
*due to decreased fluid volume levels;
cells look like increased/ if there is an
increased Hct = dehydration
- Electrolyte imbalance
 From low intake and from vomiting
 Decreased Na, K, Chloride, Mg
- Alkalosis
 Due to loss of Hydrochloric acid
from the stomach due to vomiting
- Acidosis
4|N C M 0 1 0 9
  From starvation  protein and fat
breakdown
- Ataxia and confusion
 Due to decreased vitamin from
vomiting
- Polyneuritis
 Numbness, pain, tingling sensation
over nerves
 Decreased B vitamins
 *H. pylori prevents the absorption of
B vitamins
- Blood studies (increased BUN,
increased creatinine, increased liver
enzymes) *because of loosed fluids
- Hypovolemia; Hypotension;
Tachycardia *to circulate remaining
blood volume
- Decreased Urinary output
 Effects to Pregnancy:
- Dehydration  Not enough essential
nutrients for fetal growth 
intrauterine growth restriction;
preterm birth  pregnancy loss
 Medical Management:
- Hospitalized for 24 hours (*medical
emergency)
 r/o PUD and cholecystitis
 Monitor I and O (including vomitus);
blood chemistries *creatinine, BUN,
liver enzymes
 Restore dehydration
- No oral food and fluids 24-48 hours
*there is prolonged, consistent,
uncontrollable vomiting  GI tract is
already weak due to contraction
*rest the GI from vomiting
- IV fluid administration
 To increase hydration
 3000 ml Ringer’s lactate + vitamin
B1 and B6/ KCl *no D5 because it
can cause hyperglycemia
G.E.V.-SINLAG
*potassium will be side drip
because it can burn the patient’s
nerves *if potassium is not present
in the body = cardiac arrhythmia
- Metoclopromide ((Reglan),
Promethazine (Phenegram),
Ondansetron (Zofran)
 Anti-emetic
 Prochlorperazine/chlorpromazine
(anti-histamine)
 Nursing Management:
- Description of output (amount and
characteristic of emesis)
- Normal UO is 1ml/kg/hour
- Feces (decreased and hard due to
DHN)
- NPO (all oral food and fluid)
- *NPO (1st 24 hrs), if no vomiting 
small amounts of clear fluid 
discharge home  small quantities of
dry toast, crackers, cereal added
every 2-3 hours (BRAT)  soft diet 
normal diet *if still vomiting or returns,
total parenteral nutrition (TPN)
- *start amounts of clear fluid – starting
diet
- Total Parenteral Nutrition
 Hypertonic solution
 *through subclavian vein
 Nutritionally adequate consisting of:
 Glucose, protein, amino acids,
salts, lipids, minerals, and vitamins
 To rest GIT
 Possible Nursing Diagnoses:
- Risk for deficient fluid volume related
to severe dehydration secondary to
hyperemesis
 Monitor signs of dehydration
 Decreased fluid intake less than
2000 ml/day
5|N C M 0 1 0 9
  Increased urine specific gravity
*1.010 to 1.030
 Poor skin turgor
 Dry skin and mucous membranes
 Urine output decreased = 30
ml/hour
 Do not talk about food while giving
care *triggers that can cause
nausea
 Emesis basin
 No sight and not on bedside table
 Not consistently reminded of
vomiting
 Promote oral hygiene
 Daily weight *to know if patient is
dehydrated *best time in the
morning with same clothing
 Give Ginger ale (can cause no
vomiting)
- Imbalanced nutrition, less than body
requirements related to persistent
vomiting secondary to hyperemesis
 TPN
 Check urine for glucose and
ketones 2x daily
 (+) glucose
 Infusion solution contains more
glucose than body’s metabolism
can use
 (+) ketones
 Breaking down of proteins
 Body not receiving enough
nutrients
 Reducing nausea and vomiting
 Small food portions
 Present foods attractively
 No foods with strong odor
 Low fat foods and easily digested
carbohydrates (prevents low blood
sugar  nausea)
G.E.V.-SINLAG
 Soup and other liquids in between
meals (to prevent abdominal
distention  vomiting)
 Sitting upright after meals (no
gastric reflux)
 Maintaining nutrition and fluid
balance
 SFF (every 2-3 hours)
 K and Mg-rich foods
 Mg deficiency can worsen nausea
- Fear related to the effects of
hyperemesis on fetal well-being
 Providing emotional support
 Opportunity to express how she
feels to be pregnant and to live with
HEG
PREMATURE CERVIAL DILATION
(INCOMPETENT CERVIX)
- Cervix dilates (painless) prematurely
and do not hold the fetus until term
*can cause habitual abortion
- Commonly occurs at approximately
20 weeks of pregnancy – a period
when a fetus is immature to survive
- 1% of women
 Risk Factors:
- Congenital factors
6|N C M 0 1 0 9
  Woman exposed to DES *contained
from contraceptives/ bicornuate
uterus
- Acquired factors
 Inflammation/ infection/ cervical
trauma (from repeated D&C or cone
biopsy)/ late 2nd T elective abortion/
multiple gestation
- Biochemical factors
 Relaxin *relaxation of pelvic
muscles
- Increased maternal age
- Previous pre-term births
- Short labors
 Signs and Symptoms:
- Show
 Pink-stained vaginal discharge
*bleeding may be painless due to
open cervix
- Increased pelvic pressure
 Rupture of membranes 
discharge of amniotic fluid 
uterine contractions  short labor
 fetus is born
 Sutures removed at weeks 37-38 =
NSD
 If done transabdominal route = CS
- Shirodkar Technique
 Less common and technically more
difficult
 Sutures pass through walls of cervix
(“purse string”)
 Permanent stitch (closed cervix)
 CS
 Decreased risk for infection?
- McDonald Procedure
 Most common (non-permanent)
 Cervix stitching at upper and lower
part of cervix *vertical and
horizontal stitching
 Placed between 12th and 14th week
 Strings removed 37th week
 NSD

 Diagnostic Procedure: Ultrasound

 Surgical Management:
- Cervical cerclage *manually close
the cervix *can be reversible if the
mother will undergo NSD
 Done at approximately 12 to 14
weeks
 Purse-string sutures are placed in
the cervix
 Strengthen the cervix
 Prevent it from dilating
 Confirm first if fetus of 2nd
pregnancy is healthy
 Success rates 80-90%
 Vaginal route under regional
anesthesia

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G.E.V.-SINLAG
 Nursing Management:
- After cerclage
 Promote bed rest
 Slight or modified trendelenburg
position (decreased pressure on
new suture)
- Sexual relation may be resumed after
rest periods

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