GESTATIONAL

THROPOBLASTIC
DISEASE: H-MOLE,
COMPLETE

A CASE STUDY

GROUP III
INTRODUCTION:
GTD: H-MOLE, COMPLETE
Molar pregnancy is an abnormal form of pregnancy in which a non-
viable fertilized egg implants in the uterus and will fail to come to
term. A molar pregnancy is a gestational trophoblastic disease which
grows into a mass in the uterus that has swollen chorionic villi. These
villi grow in clusters that resemble grapes. A molar pregnancy can
develop when a fertilized egg does not contain an original maternal
nucleus. The products of conception may or may not contain fetal
tissue. It is characterized by the presence of a hydatidiform mole (or
hydatid mole, mola hydatidosa). Molar pregnancies are categorized
as partial moles or complete moles, with the word mole being used
to denote simply a clump of growing tissue, or a growth.
TWO TYPES OF H-MOLE:

1. Complete molar pregnancy: Most commonly arise from

fertilization of an empty ovum by a single sperm that undergoes
duplicaton of its chromosomes. The placental tissue is abnormal and
swollen and appears to form fluid-filled cysts. There's also no
formation of fetal tissue.
2. Partial molar pregnancy: arise from two sperm fertilizing a single
ovum. There may be normal placental tissue along with abnormally
forming placental tissue. There may also be formation of a fetus, but
the fetus is not able to survive, and is usually miscarried early in the
pregnancy.
SYMPTOMS
A molar pregnancy may seem like a normal pregnancy at
first, but most molar pregnancies cause specific signs and
symptoms, including:

– Dark brown to bright red vaginal bleeding during the first trimester
– Severe nausea and vomiting
– Sometimes vaginal passage of grapelike cysts
– Pelvic pressure or pain
– Rapid uterine growth — the uterus is too large for the stage of pregnancy
– High blood pressure
– Preeclampsia
– Anemia
– Overactive thyroid (hyperthyroidism)
Risk Factors

– Low protein intake. Women with low protein intake have a possibility of developing a
hydatidiform mole because protein is needed for the development of the trophoblastic villi.
– Asian women. Asians have a higher chance of acquiring this disease because of their genetic
formation.
– Women with a blood group of A who marry men with blood group O. these blood groups,
when combined together, results in unfavorable conditions like H-mole.
– Maternal age. A molar pregnancy is more likely in women older than age 35 or younger than
age 20.
– Previous molar pregnancy. If you've had one molar pregnancy, you're more likely to have
another. A repeat molar pregnancy happens, on average, in 1 out of every 100 women.
Complications

Gestational trophoblastic neoplasia (GTN)- After a molar pregnancy has been

removed, molar tissue may remain and continue to grow.
Choriocarcinoma -a cancerous form of GTN that may spreads to other organs
Prevention

It is recommended to wait for six months to one year before trying to become
pregnant. The risk of recurrence is low, but higher than the risk for women with no
previous history of molar pregnancy. During any subsequent pregnancies, your care
provider may do early ultrasounds to monitor your condition and offer reassurance
of normal development. Your provider may also discuss prenatal genetic testing,
which can be used to diagnose a molar pregnancy.
Diagnosis

- Pregnancy test
- BLOOD TEST (HCG MONITORING)
- ULTRASOUND
- BIOPSY
- OTHER TEST: X-RAYS, BLOOD CHEM
Treatment

– Dilation and curettage (D&C): SUCTION CURETTAGE

– Hysterectomy
– CHEMOTHERAPY ). Chemo will also be needed if the pathologist finds
choriocarcinoma in the tissue sample. Chemotherapy may consist of only one
drug (methotrexate or dactinomycin). If this treatment is ineffective, a
combination of chemotherapy drugs (such as etoposide, methotrexate,
actinomycin-D, cyclophosphamide, and vincristine) may be used, or
hysterectomy may be done.
 Patient’s Profile:

Mrs. Eve is a 36 year old married woman, a plain

housewife and a devoted catholic. She was admitted at the
hospital last January 4, 2019, with chief complain of vaginal
bleeding soaking 3-4 pads per day with a presence of blood clots
for 4 days. Her physician Dr. Met diagnosed her with g2p1 (1001)
13 weeks age of gestation, h-mole, anemia severe.
 OBSTETRIC HISTORY:
G2P1 (1001)
LMP= OCTOBER 03, 2018
AOG= 13 WEEKS 2 DAYS
PNCU= RHU
PREGNANCY TEST DONE AT HOME
HISTORY OF PRESENT ILLNESS:

3 weeks prior to admission, Mrs. Eve experienced vaginal spotting and

severe nausea and vomiting while at home, she also noticed enlargement of his
abdomen differently from her previous pregnancy. This prompted her to sought
consultation at the hospital, she was then seen and examined by obstetrician on
duty and was advised to undergo pelvic ultrasound. The ultrasound was done and
it revealed h-mole. She was then advised to have her examined for beta human
chorionic gonadotropin before scheduling her for operative management. Due to
financial problem the examination was not done then she wasn’t able to come
back at the hospital.
4 days prior to admission, she experienced vaginal bleeding soaking 3-4 pads a day
with the presence of blood clots, despite of it, she never consulted a physician. The
bleeding continued for the succeeding days causing her to become weak and pale.
Thus, her nephew took her at the hospital and let her admitted. Intravenous fluid
were started, laboratories stat were done, and was advised to secure 2 units of
blood prior to surgical management (suction curettage).
PAST MEDICAL HISTORY:
Mrs. Eve denied having a family history of hypertension, diabetes mellitus, cancer
and heart disease. She claimed having colds and flu in the past and took over the
counter drugs for treatment, such as biogesic and symdex. She denied having
medical and surgical problems in the past as well. She said she never had an
abortion in the past nor having h-mole.
ANATOMY AND
PHYSIOOGY

REPRODUCTIVE SYSTEM
The reproductive system of a female produces gametes and allows her
body to support a developing fetus. The ovaries are the
primary reproductive organs of a female; they produce the female
gametes and the sex hormones estrogen and progesterone.

FEMALE’S REPRODUCTIVE:EXTERNAL GENITALIA

Vulva
– The external female genitalia is referred to as vulva. It consists of the labia majora
and labia minora (while these names translate as "large" and "small" lips, often the
"minora" can protrude outside the "majora"), mons pubis, clitoris, opening of the
urethra (meatus), vaginal vestibule, vestibular bulbs, vestibular glands.
– The term "vagina" is often improperly used as a generic term to refer to the vulva or
female genitals, even though - strictly speaking - the vagina is a specific internal
structure and the vulva is the exterior genitalia only. Calling the vulva the vagina is
akin to calling the mouth the throat.
Mons Veneris
– The mons veneris, Latin for "mound of Venus" (Roman Goddess of love) is the soft mound at the front
of the vulva (fatty tissue covering the pubic bone). It is also referred to as the mons pubis. The mons
veneris protects the pubic bone and vulva from the impact of sexual intercourse. After puberty, it is
covered with pubic hair, usually in a triangular shape. Heredity can play a role in the amount of pubic
hair an individual grows.
Labia Majora
– The labia majora are the outer "lips" of the vulva. They are pads of loose connective and adipose tissue,
as well as some smooth muscle. The labia majora wrap around the vulva from the mons pubis to the
perineum. The labia majora generally hides, partially or entirely, the other parts of the vulva. There is
also a longitudinal separation called the pudendal cleft. These labia are usually covered with pubic hair.
The color of the outside skin of the labia majora is usually close to the overall color of the individual,
although there may be some variation. The inside skin is usually pink to light brown. They contain
numerous sweat and oil glands. It has been suggested that the scent from these oils are sexually
arousing.
Labia Minora
– Medial to the labia majora are the labia minora. The labia minora are the inner lips of the vulva. They are thin
stretches of tissue within the labia majora that fold and protect the vagina, urethra, and clitoris. The
appearance of labia minora can vary widely, from tiny lips that hide between the labia majora to large lips that
protrude. There is no pubic hair on the labia minora, but there are sebaceous glands. The two smaller lips of
the labia minora come together longitudinally to form the prepuce, a fold that covers part of the clitoris. The
labia minora protect the vaginal and urethral openings. Both the inner and outer labia are quite sensitive to
touch and pressure.
Clitoris
– The clitoris, visible as the small white oval between the top of the labia minora and the clitoral hood, is a small
body of spongy tissue that functions solely for sexual pleasure. Only the tip or glans of the clitoris shows
externally, but the organ itself is elongated and branched into two forks, the crura, which extend downward
along the rim of the vaginal opening toward the perineum. Thus the clitoris is much larger than most people
think it is, about 4" long on average.
– The clitoral glans or external tip of the clitoris is protected by the prepuce, or clitoral hood, a covering of tissue
similar to the foreskin of the male penis. However, unlike the penis, the clitoris does not contain any part of
the urethra.
– During sexual excitement, the clitoris erects and extends, the hood retracts, making the clitoral glans more
accessible. The size of the clitoris is variable between women. On some, the clitoral glans is very small; on
others, it is large and the hood does not completely cover it.
Urethra
– The opening to the urethra is just below the clitoris. Although it is not related to sex or reproduction, it is
included in the vulva. The urethra is actually used for the passage of urine. The urethra is connected to
the bladder. In females the urethra is 1.5 inches long, compared to males whose urethra is 8 inches long.
Because the urethra is so close to the anus, women should always wipe themselves from front to back to
avoid infecting the vagina and urethra with bacteria. This location issue is the reason for bladder
infections being more common among females.
Hymen
– The hymen is a thin fold of mucous membrane that separates the lumen of the vagina from the urethral
sinus. Sometimes it may partially cover the vaginal orifice. The hymen is usually perforated during later
fetal development.
– A tear to the hymen, medically referred to as a "transection," can be seen in a small percentage of
women or girls after first penetration. A transection is caused by penetrating trauma. Masturbation and
tampon insertion can, but generally are not forceful enough to cause penetrating trauma to the hymen.
Therefore, the appearance of the hymen is not a reliable indicator of virginity or chastity.
–
– Perineum
– The perineum is the short stretch of skin starting at the bottom of the vulva and extending to the anus.
It is a diamond shaped area between the symphysis pubis and the coccyx. This area forms the floor of
the pelvis and contains the external sex organs and the anal opening. It can be further divided into the
urogenital triangle in front and the anal triangle in back.
– The perineum in some women may tear during the birth of an infant and this is apparently natural.
Some physicians however, may cut the perineum preemptively on the grounds that the "tearing" may
be more harmful than a precise cut by a scalpel. If a physician decides the cut is necessary, they will
perform it. The cut is called an episiotomy.
 INTERNAL GENITALIA
Vagina
– The vagina is a muscular, hollow tube that extends from the vaginal opening to the cervix of the
uterus. It is situated between the urinary bladder and the rectum. It is about three to five inches long
in a grown woman. The muscular wall allows the vagina to expand and contract. The muscular walls
are lined with mucous membranes, which keep it protected and moist. A thin sheet of tissue with one
or more holes in it, called the hymen, partially covers the opening of the vagina. The vagina receives
sperm during sexual intercourse from the penis. The sperm that survive the acidic condition of the
vagina continue on through to the fallopian tubes where fertilization may occur.
– The vagina is made up of three layers, an inner mucosal layer, a middle muscularis layer, and an outer
fibrous layer. The inner layer is made of vaginal rugae that stretch and allow penetration to occur.
These also help with stimulation of the penis. microscopically the vaginal rugae has glands that
secrete an acidic mucus (pH of around 4.0.) that keeps bacterial growth down. The outer muscular
layer is especially important with delivery of a fetus and placenta.
Cervix
– The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the top end of the vagina.
Where they join together forms an almost 90 degree curve. It is cylindrical or conical in shape and protrudes through the
upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies
above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the uterus".
Uterus
– The uterus is shaped like an upside-down pear, with a thick lining and muscular walls. Located near the floor of the pelvic
cavity, it is hollow to allow a blastocyte, or fertilized egg, to implant and grow. It also allows for the inner lining of the uterus
to build up until a fertilized egg is implanted, or it is sloughed off during menses.Fallopian Tubes
– At the upper corners of the uterus are the fallopian tubes. There are two fallopian tubes, also called the uterine tubes or the
oviducts. Each fallopian tube attaches to a side of the uterus and connects to an ovary. They are positioned between the
ligaments that support the uterus. The fallopian tubes are about four inches long and about as wide as a piece of spaghetti.
Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed
area that looks like a funnel. This fringed area, called the infundibulum, lies close to the ovary, but is not attached. The
ovaries alternately release an egg. When an ovary does ovulate, or release an egg, it is swept into the lumen of the fallopian
tube by the fimbriae.
– Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the narrow passageway toward the
uterus. The oocyte, or developing egg cell, takes four to five days to travel down the length of the fallopian tube. If enough
sperm are ejaculated during sexual intercourse and there is an oocyte in the fallopian tube, fertilization will occur. After
fertilization occurs, the zygote, or fertilized egg, will continue down to the uterus and implant itself in the uterine wall where
it will grow and develop.
Ovum
Ovum, plural ova, in human physiology, single cell released from either of the female reproductive
organs, the ovaries, which is capable of developing into a new organism when fertilized (united) with
a sperm cell.
the outer surface of each ovary is covered by a layer of cells (germinal epithelium); these surround the
immature egg cells, which are present in the ovaries from the time of birth. A hollow ball of cells,
the follicle, encompasses each ovum. Within the follicle the ovum gradually matures. It takes about four
months for a follicle to develop once it is activated. Some follicles lie dormant for 40 years before they
mature; others degenerate and never develop. During child-bearing years, 300 to 400 follicles mature
and emit eggs capable of being fertilized. By the time a woman reaches menopause, most remaining
follicles have degenerated.
Structure of Formed Sperm
– Sperm are smaller than most cells in the body; in fact, the volume of a sperm cell is 85,000 times less
than that of the female gamete. Approximately 100 to 300 million sperm are produced each day,
whereas women typically ovulate only one oocyte per month as is true for most cells in the body, the
structure of sperm cells speaks to their function. Sperm have a distinctive head, mid-piece, and tail
region. The head of the sperm contains the extremely compact haploid nucleus with very little
cytoplasm. These qualities contribute to the overall small size of the sperm (the head is only 5 μm
long). A structure called the acrosome covers most of the head of the sperm cell as a “cap” that is filled
with lysosomal enzymes important for preparing sperm to participate in fertilization. Tightly packed
mitochondria fill the mid-piece of the sperm. ATP produced by these mitochondria will power the
flagellum, which extends from the neck and the mid-piece through the tail of the sperm, enabling it to
move the entire sperm cell. The central strand of the flagellum, the axial filament, is formed from one
centriole inside the maturing sperm cell during the final stages of spermatogenesis.
Fertilization
– During coitus (sexual intercourse) between a male and a female, semen is released into the vagina and transported through
the uterus into the fallopian tube. Although many factors contribute to whether or not a single act of intercourse will result
in pregnancy, most important is whether or not a sperm cell will “meet” an ovum in the fallopian tube (fertilization).
Fertilization can only occur if intercourse takes place before the time of ovulation that usually occurs “mid-cycle”, or about
14 days before the woman's next menstrual period. At the time of ovulation, the ovum is released from the ovary and
transported in the fallopian tube where it remains for about 24-48 hours. Pregnancy is most likely to occur if fresh semen is
present when ovulation occurs.
Chorionic Villi and Placental Development
In the placenta, chorionic villi develop to maximize surface-area contact with the maternal blood for nutrient and gas exchange.
Chorionic Villi
– Chorionic villi sprout from the chorion after their rapid proliferation in order to give a maximum area of contact with the
maternal blood. These villi invade and destroy the uterine decidua while at the same time they absorb nutritive materials
from it to support the growth of the embryo .
– During the primary stage (the end of fourth week), the chorionic villi are small, nonvascular, and contain only
the trophoblast. During the secondary stage (the fifth week), the villi increase in size and ramify, while the mesoderm grows
into them; at this point the villi contain trophoblast and mesoderm.
Placenta
– The placenta is a fetally derived organ that connects the developing fetus to the uterine wall to allow
nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The placenta begins
to develop upon implantation of the blastocyst into the maternal endometrium.
– The placenta functions as a feto-maternal organ with two components: the fetal placenta (chorion
frondosum), which develops from the same blastocyst that forms the fetus; and the maternal placenta
(decidua basalis), which develops from the maternal uterine tissue.
Cytotrophoblast
– The cytotrophoblast (or layer of Langhans) is the inner layer of the trophoblast. It is interior to
the syncytiotrophoblast and external to the wall of the blastocyst in a developing embryo.
– The cytotrophoblast is considered to be the trophoblastic stem cell because the layer surrounding the
blastocyst remains while daughter cells differentiate and proliferate to function in multiple roles. There
are two lineages that cytotrophoblastic cells may differentiate through: fusion and invasive. The fusion
lineage yields syncytiotrophoblast and the invasive lineage yields interstitial cytotrophoblast cells.
– Cytotrophoblastic cells play an important role in the implantation of a newly fertilized egg in the uterus.
DIAGNOSTIC
RESULTS
 REFERRENCE JAN 4, JAN 6, 2019 JAN 7, 2019
RANGE 2019 Post bt: 2 ‘u’ Post bt 1 ‘u’
s/p suction
curettage

WBC 5.00-10.00 10^9/L 16.27 14.18 19.19

COMPLETE
NEUTROPHILS 2.00-7.00 10^9/L 10.10 10.10 13.97
LYMPHOCYTES # 0.80-4.00 10^9/L 5.05 3.15 3.84

BLOOD
MONOCYTE # 0.12-1,20 10^9/L 0.68 0.57 0.84
EOSINOPHILS # 0.02-0.50 10^9/L 0.33 0.35 0.52
BASOPHILS#
NEUTROPHILS %
0.00-0.10 10^9/L
50.0-70.0 %
0.11
62.1
0.01
71.2
0.02
72.8
COUNT
LYMPHOCYTES % 20.0-40.0 % 31.1 22.2 20.0
– DONE TO DETERMINE abnormal
MONOCYTES % 3.0-12.0 % 4.2 4.0 4.4
deviation of results from normal
EOSINOPHILS % 0.5-5.0 % 2.0 2.5 2.7
range, basically to determine
BASOPHILS % 0.0-1.0 % 0.6 0.1 0.1
anemia.
RBC 3.50-5.50 10^9/L 2.34 Due to bleeding 2.86 3.36
HEMOGLOBIN 110-160 G/L 71 Due to bleeding 88 104
HEMATOCRIT 37.0-54.0 % 22.0 Due to bleeding 26.4 31.6
MCV 80.0-100.0 fL 94.0 92.2 94.1
MCH 27.0-34.0 pg 30.4 30.8 31.0
MCHC 320-360 g/L 323 333 329
RDW-CV 11.0-16.0 % 13.2 11.8 12.2
PLATELET 150-450 10^9/L 280 248 299
 PELVIC
PELVIC UTZ RESULT: ULTRASOUND
UTERUS IS ENLARGED SHOWING SNOW STORM PATTERN. - Ultrasonography is the criterion
standard for identifying both
complete and partial molar
IMPRESION: H-MOLE pregnancies.
RADIOLOGIC FINDINGS:
LUNG FIELDS ARE CLEAR
HEART IS NORMAL IN SZE CHEST X-RAY
AORTA IS UNREMARKABLE - baseline chest radiograph should
be taken. The lungs are a primary
BOTH HEMIDIAGPHRAGMS AND COSTOPHRENIC SUCI AND site of metastasis for malignant
VISUALIZED BONES ARE INTACT trophoblastic tumors.

IMPRESSION: ESSENTIALLY NEGATIVE

 BETA HUMAN
CHORIONIC
NORMAL RANGE RESULT INTERPRETATION
GONADOTROPIN
BETA HCG <6.15 IU/L >15,000 IU/L INCREASED:
A complete mole usually releases
COMPLETE MOLE more HCG than a normal placenta,
so finding higher than expected
HCG levels in the blood can be a sign
that a complete mole is present.
Blood typing:
essential for cross-matching prior to blood transfusion

BLOOD TYPE: O rh POSITIVE

 REFERRENCE VALUE RESULTS

COLOR AMBER/LIGHT YELLOW LIGHT YELLOW

TRANSPARECY CLEAR OR CLOUDY TURBID
PUS CELLS 0-5 HPF 2-3 /HPF
RBC 0-2 HPF NUMEROUS
EPITHELIAL CELLS 0-15 HPF FEW
BACTERIA - FEW
MUCUS THREAD
YEAST CELLS
-
-
-
-
URINALYSIS:
URATES - -
to determine presence of glucose in
PHOSPHATE - --
LEUKOCYTES - -
the urine and deviation of results
NITRITE - - from normal values. To determine
UROBILINOGEN - - the presence of glucose in the urine.
PROTEIN - -
PH 4.5-8 6.5
Blood 3+
GRAVITY 1.010-1.030 1.010
Ketone - -
BILIRUBIN - -
GLUCOSE - -
IMPRESSION: NORMAL

BLOOD
RESULT REFERENCE RANGE
TEST
SGPT 12.58 U/L 0.00- 45.00 U/L

SGOT 23.57 U/L 0.00- 35.00 U/L

UREA 2.224mmol/L 2.8-7.2 mmol/L

CREATININE 64.5 umol/L 55.00-96.00 umol/L

 PHYSICAL
ASSESSMENT
HEIGHT: 5’1” WEIGHT: 52.9 KG January 5, 2019
GENERAL CONDITION:
Mrs. Eve was lying on her bed. She was awake and coherent, but she was weak
and pale in skin color including her conjunctiva. With vaginal bleeding soaking 3
pads a day.
General No seizure, afebrile, with mild dizziness

CVS Mild palpitation, increase cardiac rate (CR=113), No pedal edema, delayed capillary refill SYSTEMIC
Respiratory RR=20 no difficulty of breathing, + exertional discomfort(dyspnea when exerting effort)
REVIEW
Vital Signs
Urinary No painful urination, (+)frequent, scanty urination

GIT No diarrhea, (+ )nausea, mild abdominal distention a. Blood Pressure: 150/110 mmhg

b. Pulse: 115 bpm

Reproductive Vaginal bleeding (4days) soaking 3-4 pads per day.
c. Respiratory Rate: 20 breaths / min
MSK Body weakness, needs mild assistance in adl’s d. Temperature: 37.3°C

CNS No headache, no blurred vision, no seizure

Impression: hypertensive,
Endocrine No excessive sweating, no tremors tachycardia, normal body
temperature.
Head Breast
Conjuctiva: pale – Both breasts were symmetrical and
Sclera: White and no sign of jaundice nipples were normally averted. No
fungal infection beneath the
Mouth: Lips were pale breast, no masses, no retraction of
Thyroid: Not enlarged the nipples, no leakage and other
Lymph node: Not palpable abnormalities were noted.
Impression: Normal
Cardiovascular System

a. Inspection: The chest was symmetrical and normal in shape. There was no scar,
no precordial bulging, no visible apex beat and no prominent dilated veins.

b. Palpation: The apex beat was located in the 5th intercostal space, at the
midclavicular line. There was mild palpitation noted. The peripheral pulses were
present with regular rhythm but fast and bounding.
c. Auscultation: The first and second heart sounds were normal. There were no
murmurs heard. Increased heart rate was noted.
Impression: tachycardia was noted
Respiratory System

a. Inspection: The chest moved symmetrically with respiration with no deformity seen. There was
no sign respiratory distress. There were no scar, prominent dilated.

b. Palpation: The chest expansion and vocal fremitus were equal anteriorly and posteriorly at all
three zones of the lung.

c. Percussion: The lung was resonant bilaterally, anteriorly and posteriorly. There were normal
liver and cardiac dullness.

d. Auscultation: There were vesicular breath sound anteriorly and posteriorly at all three zones.
No added sounds heard
Abdominal Examination

Inspection: On examination, the abdomen was distended by graviduterus. There was stretch
marks seen. The umbilicus was centrally located and inverted. No fetal movement.
Auscultation: no fetal heart tone

Light palpation: The abdomen was soft and non-tender. There was singleton mass. Liver, spleen
and kidney were not palpable.
> Leopold Maneuver : fundal height was 22 cm.

Impression: Uterus larger than date

PATHOPHYSIOLOGY:
COMPLETE H-MOLE
ETIOLOGY:
RISK FACTORS:
UNKNOWN - DEFECTIVE OVA
- 36 Y/O
- ASIAN RACE
- NUTRITIONAL DEFICIENCY
- LOW PROTEIN,LOW FOLIC ACID
INTAKE

COITUS
 ABNORMAL
FERTILIZATION

1 SPERM CELL (23 CHROM) + 2 SPERM CELL (23 X/Y

EMPTY EGG CHROMOSOMES) + EMPTY EGG

SPERM CHROM DUPLICATION: SPERM CHOMOSOME DUPLICATION:

46 CHROMOSOMES 46 XX CHROM/46 XY CHOM
(HOMOZYGUS COMPLETE MOLE) HETEROZYGUS COMPLETE MOLE

ABNORMAL FORMATION OF CYTOTHROPOBLAST

 ABNORMAL FORMATION OF CYTOTHROPOBLAST

FLUID DISTENTION IN CHORIONIC VILLI DECREASE UTERINE PLACENTAL BLOOD FLOW

FORMATION OF GRAPE-LIKE VESICLE IMBALANCE BETWEEN VASOCONSTRICTORS AND

VASODILATORS

HYPERPLASIA OF THROPOBLASTIC TISSUES VASOSPASM

DECREASE RENAL PRESSURE NATRIURESIS

HYPERTENSION
 HYPERPLASIA OF THROPOBLASTIC TISSUES

INCREASE HCG LEVEL:

EXCESSIVE UTERINE ENLARGEMENT UTZ: H-MOLE
HYPEREMESIS (>15,000 IU/L)

SPONTANEOUS ABORTION

VAGINAL BLEEDING

ANEMIA

DECREASE BLOOD VOLUME

HGB=71G/L PALE IN APPEARANCE BODY WEAKNESS
HCT= 22.0 %
RBC= 2.34 10^9/L
DRUG STUDY
DRUG ACTION INDICATION SIDE EFFECTS NURSING CONSIDERATION
GENERIC NAME: INHIBITS INDICATED FOR  DIZZINESS  DRUGS CAN BE USE
LOSARTAN POTASSIUM VASOCONSTRIC HYPERTENSION ALONE OR WITH OTHER
TIVE AND ANTIHYPERTENSIVES
BRAND NAME: ALDOSTERONE CONTRAINDICATION ADVERSE EFFECT  MONITOR PATIENT’S
COZAAR SECRETING  CONTRAINDICATED  ANGIOEDEMA BLOOD PRESSURE
ACTION OF TO PATIENTS CLOSELY TO EVALUATE
DOCTOR’S ORDER: ANGIOTENSIN HYPERSENSITIVE YO EFFECTIVENESS OF
LOSARTAN 50 MG 1 II BY BLOCKING DRUG. BREAST THERAPY
TAB OD ANGIOTENSIN FEEDING IS NOT  MONITOR PATIENT WHO
II RECEPTOR RECOMMENDED ARE ALSO TAKING
CLASSIFICATION: ON THE DURING LOSARTAN DIURETICS FOR
ANTIHYPERTENSIVES SURFACE OF THERAPY. SYMPTOMATIC
VASCULAR  USE CAUTIOUSLY TO HYPOTENSION
SMOOTH PATIENT WITH  REGULARLY MONITOR
MUSCLE AND IMPAIRED RENAL PATIENT’S RENAL
OTHER TISSUE AND HEPATIC FUCTION
FUNCTION.  ADVISED PATIENT TO
IMMEDIATELY REPORT
SWELLING OF FACE, EYES,
LIPS, OR TONGUE OR ANY
DIFFICULTY BREATHING
DRUG ACTION INDICATION SIDE EFFECTS NURSING CONSIDERATION
GENERIC NAME: UNKNOWN. THOUGHT TO INDICATED FOR ESSENTIAL AND  DROWSINESS  DRUG MAY BE GIVEN TO LOWER BLOOD
CLONIDINE STIMULATE ALPHA2 RENAL HYPERTENSION  DIZZINESS PRESSURE IN SOME HYPERTENSIVE
HYDROCHLORIDE RECEPTORS AND INHIBIT  SEDATION EMRGENCIES\
THE CENTRAL  WEAKNESS  MONITOR BP AND PR FREQUENTLY.
BRAND NAME: VASOMOTOR CENTERS,  CONSTPATION DOSAGE USUALLY ADJUSTED TO
CATAPRES DECREASING  DRY MOUTH PATIENT’S BP AND TOLERANCE
SYMPATHETIC OUTFLOW  OBSERVE PATIENT’S TOLERANCE TO
DOCTOR’S ORDER: TO THE HEART, KIDNEYS, CONTRAINDICATION ADVERSE EFFECT DRUG’S THERAPEUTIC EFFECTS, WHICH
CLONIDINE 75mcg/tab 1 AND PERIPHERAL  CONTRAINDICATED TO PATIENTS  BRADYCARDIA MAY REQUIRE INCREASES DOSAGE
tab SL now repeat BP CASCULATURE, AND HYPERSENSITIVE YO DRUG  SEVERE  WHEN STOPPING THERAPY IN PATIENTS
after 20 mins x 3 doses if LOWERING PERIPHERAL  TRANSDERMAL FORM: REBOUND RECEIVING BOTH CLONIDINE ND MBETA
BP more than or equal to RESISTANCE, BLOOD CONTRAINDICATED IN PATIENT HYPERTENSION BLOCKER FIRST GRADUALLY
140/90 mmhg PRESSURE AND HEART HYPERSENTIVE TO ANY WITHDRAW BETA BLOCKER FIRST TO
RATE. COMPONENT OF THE MINIMIZE ADVERSE REACTIONS
CLASSIFICATION: ADHESIVE LAYER OF  ELDERLY PATIENTS MAY BE MORE
ANTIHYPERTENSIVES TRANSDERMA SYSTEM SENSITIVE THAN YOUNGER ONE’S TO
 EPIDURAL FORM: DRUG’S HYPOTENSIVE EFFECTS.
CONTRAINDICATED IN
PATIENTS RECEIVING
ANTICOAGULANT THERAPY, IN
THOSE WITH BLEEDING
DIATHESIS, IN THOSE WITH AN
INJECTION SITE INFECTION, IN
THOSE WHO ARE
HEMODYNAMICALLY UNSTABLE
OR HAVE SEVERE CV DISEASE.
DRUG ACTION INDICATION SIDE EFFECTS NURSING CONSIDERATION
GENERIC NAME: COMPETES ITH  INDICATED FOR ALLERGY  DROWSINESS  STOP DRUG 4 DAYS BEFORE DIAGNOSTIC
DIPHENHYDRAMINE HISTAMINE FOR H1 SYMPTOMS  SLEEPINESS SKIN TESTING
HYDROCHLORIDE RECEPTOR SITES,  DIZZINESS  ALTERNATE INJECTION SITES TO PREVENT
PREVENTS, BUT  NAUSEA IRRITATION. GIVE IM INJECTION DEEP
BRAND NAME: DOESN’T REVERSE,  DRY MOUTH INTO LARGE MUSCLE
DIPHENHIST HISTAMINE-MEDIATED  EPIGASTRIC  DIZZINESS, EXCESSIVE SEDATION,
RESPONSES, DISTRESS SYNCOPE, TOXICITY, PARADOXICAL
DOCTOR’S ORDER: PARTICULARLY THOSE  TICKENING OF STIMULATION, AND HYPEOTENSION ARE
DIPHENHYDRAMINE OF THE BRONCHIAL BRONCHIAL MORE LIKELY TO OCCUR IN ELDERLY.
1 AMP IM NOW TUBES, GI TRACT, SECRETIONS  WARN PATIENT TO AVOID ALCOHOL AND
UTERUS, AND BLOOD HAZARDOUS ACTIVITIES THAT REQUIRE
CLASIIFICATION: VESSELS. CONTRAINDICATION ADVERSE EFFECT ALERTNESS
ANTIHISTAMINE STRUCTURALLY  CONTRAINDICATED TO  SEIZURES
RELATED TO LOCAL PATIENTS HYPERSENSITIVE YO  THROMBOCYTOP
ANESTHETICS, DRUG DRUG, NEWBORNS, ENIA
PWOVIDES LOCAL PREMATURE NEONATES,  AGRANULOCYTO
ANESTHESIA AND BREASTFEEDING WOMEN, SIS
SUPRESSES COUGH PATIENTS WITH ANGLE-  ANAPHYLACTIC
REFLEX. CLOSURE GLAUCOMA, SHOCK
STENOSIS PEPTIC ULCER,
SYMPTOMATIC PROSTATIC
HYPERPLASIA, BLADDER NECK
OBSTRUCTION, OR
PYLORODUODENAL
OBSTRUCTION AND THOSE
HAVINF ASTHMATIC ATTACK
 AVOID USE IN PATIENT TAKING
MAOI
DRUG ACTION INDICATION SIDE EFFECTS NURSING CONSIDERATION
GENERIC NAME: INHIBITS CELL-  TO PREVENT ENDOCARDITIS  NAUSEA  BEFORE GIVING DRUG, ASK PATIENT
AMPICILLIN WALL SYNTHESIS IN PATIENTS HAVING  DIARRHEA ABOUT ALLERGIC REACTIONS TO
DURING DENTAL, GI, PENICILLIN. A NRGATIVE HISTORY
BRAND NAME: BACTERIAL GENITOURINARY OF PENICILLIN ALLERGY IS NO
AMPICIN MULTIPLICATION PROCEDURES GUARANTEE AGAINST A FUTURE
ALLERGIC REACTION.
DOCTOR’S ORDER: CONTRAINDICATION ADVERSE EFFECT  GIVE DRUG IM OR IV ONLY IF
AMPICILLIN 2g IV  CONTRAINDICATED TO  SEIZURES PRESCRIBED, AND THE INFECTION IS
ANST PRIOR TO PATIENTS HYPERSENSITIVE  PSEUDOMEMBRANEO SEVERE, OR IF PATIENT CAN’T TAKE
OR YO DRUG OR TO OTHER US COLITIS ORAL MEDS
PENICILLINS  THROMBOCYTOPENIA  IF LARGE DOSES ARE GIVEN OR IF
CLASIIFICATION:  USE CAUTIOUSLY IN  THROMBOCYTOPENIA THERAPY IS PROLONGED BACTERIAL
ANTI-INFECTIVES/ PATIENTS WITH OTHER PURPURA OR FUNGAL SUPERINFECTION MAY
ANTIBIOTICS DRUG ALLERGIES  LEUKOPENIA OCCUR, ESPECIALLY IN ELDERLY,
(ESPECIALLY TO  AGRANULOCYTOSIS DEBILITATED OR
CEPHALOPORIN) BECAUSE IMMUNOSUPPRESSED PATIENTS
OF POSSIBLE CROSS-  WATCH OUT FOR SIGNS AND
SENSITIVITY AND IN THOSE SYMPTOMS OF HYPERSENSITIVTY,
WITH MONONUCLEOSIS SUCH AS ERYTHEMATOUS
BECAUSE OF A HIGH RISK OF MACULOPAPULAR RASH,
MACULOPAPULAR RASH URTICARIA, AND ANAPYLAXIS
 IN PATIENTS WITH IMPAIRED RENAL
FUNCTION, DECREASE DOSAGE
NURSING CARE
PLAN
ASSESSMENT NURSING SCIENTIFIC PLANNING NURSING INTERVENTIONS EVALUATION
DIAGNOSIS EXPLANATION
SUBJECTIVE: FLUID HYPERPLASIA OF SHORT TERM GOAL: INDEPENDENT: SHORT TERM: GOAL MET
“NAPUPUNO KO VOLUME THROPOBLASTIC 1.ESTABLISHED RAPPORT TO
ANG TATLONG DEFICIT TISSUE Within 8 hours, the patients PATIENT AND TO SIGNIFICANT The patient understood the cause of
SANITARY NAPKIN RELATED TO will verbalize understanding OTHER blood loss and was able to cooperate in
SA MAGHAPON” ACTIVE of causative factors and medical management (consented blood
AS VERBALIZED BY BLEEDING EXCESSIVE purpose of individual 2.MONITORED VITAL SIGNS transfusion) and surgical management
THE PATIENT UTERINE therapeutic interventions (suction curettage done).
ENLARGEMENT and medications and the 3. REITERATED THE CAUSE OF
OBJECTIVE: patient will cooperate to the BLEEDING AND WEAKNESS AND THE LONG TERM: GOAL PARTIALLY MET
 PALE interventions. NEED FOR MEDICAL AND SURGICAL
CONJUNCTIVA SPONTANEOUS MANAGEMENT TO STOP AND The laboratory result were increased but
 PALE LIPS ABORTION LONG TERM GOAL: REPLACE BLOOD LOSS. still below normal level:
 PALE IN SKIN Within 48 hours, Hgb=104
COLOR The patient will maintain 4.ENCOURAGED INCREASE FLUID Rbc=3.36
 WITH BODY VAGINAL BLEEDING fluid volume level as AND IRON RICH FOOD INTAKE Hct=31.6
WEAKNESS evidenced by increase
laboratory results to normal 5. MAINTAINED IV ROUTES PATENT. There is still fluctuation of blood
>HGB=71G/L ANEMIA level, stable vital signs, pressure:
>HCT= 22.0 % pinkish conjunctiva, absence DEPENDENT: BP= ranges 140/90- 160/90
>RBC= 2.34 10^9/L >PALLOR of pallor and verbalize 1. ADMINISTERED IV FLUIDS AND T=36.6
>BODY WEAKNESS absence of weakness. BLOOD PRODUCTS AS PER Cr= 89 bpm
T= 37.3°C >DECREASE BLOOD DOCTOR’S ORDER. Rr= 19 cpm
CR=115 bpm VOLUME
RR=20 cpm HGB=71G/L 2. PREPARED PATIENT AND Absence of pallor noted.
BP=150/110mmhg HCT= 22.0 % FACILITATED SURGICAL
RBC= 2.34 10^9/L MANAGEMENT: SUCTION The patient verbalized “mas malakas na
CURETTAGE. ako ngayon kesa dati”.
ASSESSMENT NURSING SCIENTIFIC PLANNING NURSING INTERVENTIONS EVALUATION
DIAGNOSIS EXPLANATION
SUBJECTIVE: ACTIVITY HYPERPLASIA OF SHORT TERM GOAL: INDEPENDENT: SHORT TERM: GOAL MET
“MABILIS AKONG INTOLERANCE THROPOBLASTIC - ESTABLISHED RAPPORT TO
MAPAGOD AT RELATED TO TISSUE Within 8 hours, the patients PATIENT AND TO SIGNIFICANT The patient was able to use
MEDYO IMBALANCE OF will verbalize understanding OTHER techniques like taking rest
NAHIHIRAPAN OXYGEN SUPPLY of causes of symptoms and between activities.
AKONG HUMINGA AND DEMAND EXCESSIVE UTERINE purpose of individual - ASSESED VITAL SIGNS
KAPAG DUE TO BLOOD ENLARGEMENT therapeutic interventions The patient understood the
GUMAGALAW AKO” LOSS and medications. and the - REITERATED THE CAUSE OF cause of blood loss and was
CLAIMED BY PATIENT patient will cooperate to the INTOLERANCE AND WEAKNESS able to cooperate in medical
SPONTANEOUS interventions: the patient AND THE NEED FOR MEDICAL management (consented
OBJECTIVE: ABORTION will be able to use identified AND SURGICAL MANAGEMENT blood transfusion) and
> WITH BODY techniques to enhance TO STOP AND REPLACE BLOOD surgical management
WEAKNESS activity intolerance LOSS. (suction curettage done).
>NOTED VAGINAL BLEEDING - ENCOURAGED TO AVOID
PERFORMANCE OD LONG TERM GOAL: OVEREXERTION, AND TO LONG TERM: GOAL MET
ADL’S WITH Within 48 hours, PERFORM ACTIVITY WITH
ASSISTANCE ANEMIA The patient will be able to RESTING PERIOD The patient was able to
> + PALLOR perform routine activities in - INVOLVED S.O IN ASSISTING perform her routine activity
>DECREASE BLOOD maximum tolerance without PATIENT IN HER ACTIVITY without assistance.
HGB=71G/L VOLUME assistance and will verbalize - ADVISED TO GRADUALLY
>HCT= 22.0 % HGB=71G/L absence of dob/sob upon INCREASE ACTIVITY “Hindi na ako
>RBC= 2.34 10^9/L HCT= 22.0 % performing activity. nakakaramdam ng hirap sa
RBC= 2.34 10^9/L DEPENDENT: paghinga habang
T= 37.3°C - Provide supplemental oxygen gumagalaw.” Claimed by
CR=115 bpm as needed patient
RR=20 cpm DECREASE OXYGEN - Administered blood transfusion
BP=150/110mmhg CARRIER IN THE as ordered
ASSESSMENT NURSING DIAGNOSIS PLANNING NURSING INTERVENTIONS EVALUATION
SUBJECTIVE: IMPAIRED SKIN SHORT TERM GOAL: INDEPENDENT: SHORT TERM GOAL:
“Namumula po ang INTEGRITY RELATED Within 1 hour, the - Established rapport to patient and
mukha at katawan TO POST BLOOD patient will verbalize to significant other GOAL MET
ng pasyente ko” TRANSFUSION absence of pruritus
verbakized by REACTION and decrease in skin - Assesed vital signs Noted decrease rashes on
patient’s nephew redness. the face and body.
- Re-Instructed client and s.o to “Hindi na makati” reported
“Medyo makati po” LONG TERM GOAL: report delayed signs of reaction. by patient
claimed by patients Within 8 hours, the
patient will be free of - Suggested to avoid scratching the
OBJECTIVE: signs of skin Long term goal:
 + rashes all over hypersensitivity.
the body - Advised use of ice/lotion to Goal met.
 - difficulty of alleviate itching
bleeding No signs of hypersensitivity
 - swelling - Monitored for other delayed noted.
 S/P BT 2ND UNIT reactions.
OF WB
DEPENDENT: T= 36.5
T= 36.5 - Administered diphenhydramine 1 BP= 140/100 mmhg
BP= 150/110 mmhg amp IV as ordered. CR=89 bpm
CR=92 bpm RR=21 cpm
RR=20 cpm
THANK YOU!