GESTATIONAL TROPHOBLASTIC

DISEASE HYDATIDIFORM MOLE

(MOLAR PREGNANCY)
 GESTATIONAL TROPHOBLASTIC DISEASE
HYDATIDIFORM MOLE (MOLAR PREGNANCY)

Is the abnormal proliferation and then degeneration of the

trophoblastic villi. As the cells degenerate, they become
filled with fluid and appear as clear fluid-filled, grape-sized
vesicles.These tumors can be benign (non-cancerous) or
malignant (cancerous) and include conditions such as
hydatidiform mole (molar pregnancy).
ADVANCED MATERNAL
AGE PATHOPHYSIOLOGY

CONCEPTION DIAGNOSIS: ULTRASOUND,

ELEVATED HCG LEVELS

Enlarged Uterus
ABNORMAL
FERTILIZATION

Excessive Trophoblastic Vaginal Bleeding

Proliferation Treatment: Dilation and Curettage
(D&C)

Formation of
Grape-like Vesicles
 RISK FACTORS
1. Nutrition/diet - Some studies have linked low levels
of carotene and vitamin A in a person’s diet with a
higher risk of molar pregnancy.
2. Women Older than 35 y/o or younger than 25 years
3. Asian Heritage
4. Family history of molar pregnancy or previous molar
pregnancy
5. Blood type. Specific blood types — A and AB
TYPES OF H-MOLE
TYPES OF H-MOLE
 ASSESSMENT (SIGNS & SYMPTOMS)

• Uterus is fast growing than expected (because of the rapid proliferation/ growth of
the abnormal trophoblastic cells)
• HCG level is higher than the normal pregnancy level of 400,000 international
• units(lU)
• Morning or evening sickness (persistent nausea and vomiting early in pregnancy)
• High BP, edema and proteinuria BEFORE 20 weeks AOG
• Ultrasound shows NO fetal growth instead it reveals a dense growth in snowflake
pattern (because of cyst or grape-like structures)
• No FHT (because there is no viable fetus)
• Vaginal discharge/bleeding/spotting characterized as: dark-brown (like prune juice)
in color; accompanied with clear fluid-filled vesicles.
SURGICAL INTERVENTION: PROPHYLACTIC COURSE

Suction curettage or • Methotrexate, an antineoplastic

drug, is given as a prophylaxis
dilation and
to prevent malignancy.
curettageD&C) to • If metastasis occurs,
HCG MONITORING within 12
evacuate the abnormal months
Dactinomycin can be added to
Methotrexate.
trophoblast cells • Get a baseline level of HCG following the
surgical interventions. Analyze the HCG level
every 2 weeks until the level drops to normal
and remains normal for 3 weeks.
• Monthly measurements of HCG are taken for
6 months then every 2 months for a total of 1
year.
• If HCG is still negative after 6 months, a
woman is free of risk of malignancy.
• If HCG is still negative by 12 months, a
woman can begin to plan a second pregnancy.
RhoGAM or RhiG to women who are
Rh negative to prevent
isoimmunization

COUNSELING
• Allow clients to express emotions and any
concerns. They may feel inadequate because
something went wrong with the pregnancy. The
pregnancy never materialized and a fetus never
formed. They may wonder whether it will happen
again in the future or whether they will be able to
have children.
• Recommend Pelvic Ultrasound during a
subsequent pregnancy to be certain the abnormal
trophoblastic growth is detected.
Thank You