H-MOLE/GESTATIONAL TROPHOBLASTIC DISEASE  No FHR or palpation of fetal parts

 S/Sx of preeclampsia before usual time of onset such as

(HYDATIDIFORM OR H-MOLE)/MOLAR PREGNANCY
elevated BP edema and proteinuria
 Abnormal proliferation and degeneration of the
 High level of HCG with excessive N/V before 20th week of
trophoblastic villi.
gestation
 As the cell degenerate, they become filled with fluid and
 Anemia often accompanies bleeding
appears grapelike vesicles per vagina with soft abdomen
 Maybe bright red and Dark red to brownish vaginal
and absent fetal parts on palpation
bleeding with 12 weeks
 Ultrasound showing a characteristic snowstorm pattern.
Two Distinct types:
1. Complete molar pregnancy
THERAPEUTIC MANAGEMENT:
• Have only placental parts, forms when a sperm fertilizes an
1. Suction Curettage or dilatation and curettage to remove
empty egg
mole
• The chromosome are either 46XX or 46XY but are
2. Serum hCG monitoring − HCG should be monitored for
contributed by only one parent and the chromosome material
1 year and should be negative 2−8 weeks after removal of
is duplicated.
mole. It is monitored every 2 weeks until normal then
• It usually leads to carcinoma
monthly for 6 months then every 2 months for the next 6
2. Partial Mole
months.
• It has 69 chromosome in which there are three
3. Chest x ray may also be done every 3 months for 6
chromosomes for every pair instead of two. 23 from the
months because H− mole cancer cells can metastasize to
mother and 2 sets from the father. This could occur when two
lungs.
cells fertilize one egg.
4. Oral Contraceptive use for 1 year− the woman is
• It rarely leads to carcinoma
advised not to get pregnant yet and pills should not
contain estrogen
Risk factors:
5. Methotrexate − anti cancer drug for one year to prevent
1. Higher occurrence in asian
development of malignancy
2. Women below 18 and above 40 years old
6. Hysterectomy
3. Women with low socioeconomic status who have low protein
intake
NURSING CARE:
4. History of molar pregnancy
 Health education about contraceptives and rusks of future
pregnancies; pregnancy is delayed for at least 1 year.
ASSESSMENT:
 Updated laboratory examinations to detect rising of HCG
 Size of uterus is disproportionate to length of pregnancy
levels
 UTZ shows no fetal skeleton /parts
 Assess V/S, I/O
 Provide emotional support