Hydatidiform Mole

H.
MOLE
Hydatidiform Mole
Gestational trophoblastic disease is

abnormal proliferation and degeneration of
the trophoblasitic villi. As the cells
degenerate, they become filled with fluid
and appear as clear fluid, grape-sized
vesicles.
With this condition, the embryo fails

to develop beyond a primitive start.
Pathophysiology
PATHOPHYSIOLOGY
LABORATORY TESTS:
i.Serum or urine test of hCG for pregnancy because hCG is produced by

trophoblast cells that are overgrowing (positive if 1 to 2 million IU compared
with a normal pregnancy level of 400,000 IU)
ii.Sonogram – to show defense growth (typically a snowflake pattern) but no
fetal growth in the uterus
iii.Chest x-ray – To check if lungs are affected with the metastatic/cancerous
cells from the uterus.
iv.Checking hCG levels 6 weeks after childbirth to confirm that no
trophoblastic disease has developed.
v.A pelvic exam, to evaluate the size of the uterus and check for
abnormalities.
vi.A blood test to measure the amount of a pregnancy hormone, called
human chorionic gonadotropin (hCG), to see whether the level is
abnormally high for the length of the pregnancy.
vii.A pelvic ultrasound test. If pelvic exam or hCG level suggests a molar
pregnancy, an ultrasound can be used to confirm the diagnosis. Some
molar pregnancies are first diagnosed during an ultrasound done for
another purpose.
MEDICAL ASSESSMENTS:
i. Assessment of vaginal spotting of dark- brown blood or as a profuse fresh
flow. As bleeding progresses, maybe accompanied with discharge of clear
fluid-filled vesicles.
i. Report any bleeding, excessive vomiting or abdominal pain during pregnancy

to your doctor. If you have prolonged vaginal bleeding after childbirth, an
abortion or a miscarriage, contact your doctor for an evaluation.
ii. For any pregnancy, make sure you have appropriate prenatal care beginning
in the first trimester, with regular checkups.
iii. Following mole extraction

iv. chest x-ray
v. Prophylactic cause of methatrexate – drug choice for choriocarcinoma. But
should be weighed carefully because it interfere WBC formation.
vi. If you have no future plans to become pregnant, you may consider a
hysterectomy, which reduces the chance of developing gestational
trophoblastic disease after a molar pregnancy.
MEDICAL INTERVENTIONS:
i.It is important for women with molar pregnancies to be evaluated
periodically after the problem has been treated.
i.Women are advised not to attempt pregnancy for some time in order to be
sure that levels of HCG remain at zero and that no further treatment is
needed. There is a risk that a molar pregnancy can come back after
treatment.
i.If you have Rh-negative blood, you will also have a shot of Rh immune
globulin. This prevents a problem called Rh sensitization, which can cause
serious problems in a future pregnancy.
i.Preventing pregnancy while hCG levels are being monitored, usually about
6 months. It is very important that you practice highly effective birth control
during the entire period of follow-up. For more information on contraception,
see the topic Birth Control.
i. Close medical supervision if you happen to conceive within 12 months of
molar pregnancy treatment.
ii. Routine prenatal care and a late first-trimester fetal ultrasound to confirm a
healthy pregnancy.
iii. Chemotherapy with a single drug — This treatment with medication toxic to
the molar tissue is used to treat a molar pregnancy tumor that has features
suggesting a good prognosis.
iv. Chemotherapy with multiple drugs — Treatment with several medications
toxic to the molar tissue usually is needed to treat invasive tumors with poorer
prognosis.
v. Radiation treatment — This uses high-strength X-ray beams to destroy cancer
cells in the exceedingly rare case when a tumor has spread (metastasized) to the
brain.
1. Suction dilation and curettage (D and C) — This is a
surgical procedure used to remove noncancerous
hydatidiform moles. The opening in the cervix is dilated
and the inside uterus lining is scraped (curetted) clean
using suction and another spoonlike instrument.
D & C is commonly used to obtain tissue for
microscopic evaluation to rule out cancer. D & C may
also be used to diagnose and treat heavy menstrual
bleeding, and to diagnose endometrial polyps and
uterine fibroids. D & C can also be used as an early
abortion technique up to 16 weeks.
1. Dilatation/dilation and evacuation (D&E) is a
procedure in which the cervix is dilated and tissue is
removed from the uterus. D&E is used to describe two
different procedures. D&E can also be used to
describe a surgical removal of a fetus and placenta
between 14-20 weeks of gestation, called also late
abortion or second trimester abortion.
To accomplish dilatation/dilation and evacuation, a
negative pressure/vacuum is used to aspirate
tissue from the inside of the uterus. The procedure
is thought to be less traumatic to the surface of the
uterine cavity than a sharp curettage.
1. Removal of the uterus (hysterectomy) — This is used rarely to
treat hydatidiform moles but may be chosen, particularly if the
woman does not want to become pregnant again. It may be done
through the abdomen or the vagina. Other
• Tumors in the uterus like uterine fibroids or endometrial cancer
• Cancer of the cervix or severe cervical dysplasia (a
precancerous condition of the cervix)
• Cancer of the ovary
• Endometriosis, in those cases in which the pain is severe and not
responsive to nonsurgical treatments
• Severe, long-term (chronic) vaginal bleeding that cannot be controlled
by medications
• Prolapse of the uterus
• Complications during childbirth (like uncontrollable bleeding)
Nu
Palpate and check the level of the uterus because it tends to expand faster than
normally and could reach the symphysis and umbilicus.
Could assess fetal heart sounds to verify no variable fetus.
Verify and interpret results of the serum test as compared to normal.
Note for nausea and vomiting, may be due to increase hCG levels
Assess for vaginal discharges as to bleeding, spotting and clear fluid-filled

vesicles.
Health teaching and possible complications such as malignancy of cells that

would lead to choriocarcinoma.
Complete assessment consists of patient history, physical examination, and

laboratory data. The history should include the patient's sex, age, address,
occupation, and place of work; known exposure to illness and recent medications,
including antibiotics; and date of disease onset.
Detail information about recent hospitalization; blood transfusions; blood

donation denial by the Red Cross or other agencies; recent travel or camping trips;
exposure to animals; and vaccinations.
 If applicable, ask about possible exposure to sexually transmitted diseases
or about drug abuse.
 Also, try to determine the patient's resistance to infectious disease. Ask

about usual dietary patterns, unusual fatigue, and any conditions, such as
neoplastic disease or alcoholism, that may predispose him to infection. Notice
if the patient is listless or uneasy, lacks concentration, or has any obvious
abnormality of mood or affect.
 In suspected infection, a physical examination must assess the skin,

mucous membranes, liver, spleen, and lymph nodes. Check for and make
note of the location and type of drainage from any skin lesions. Record skin
color, temperature, and turgor; ask if the patient has pruritus. Take his
temperature, using the same route consistently, and watch for a fever, which
is the best indicator of many infections.
 Note and record the pattern of temperature change and the effect of
antipyretics. Be aware that certain analgesics may contain antipyretics. With a
high fever, especially in children, watch for seizures.
Acute pain r/t disease process
Nursing Interventions:
 Assess reports of pain (PQRST). Evaluate pain and its characteristics
 Provide comfort measures and diversional activities. Provide relief of

pain.
 Encourage stress management techniques. To cope up with stress

and activities
Nursing Diagnosis: Hyperthermia r/t increased metabolic
rate secondary to illness
Apply TSB to decrease core temperature
Promote rest to relieve stress and prevent work overload
Encourage patient to increase fluid intake to ensure hydration

Nursing Diagnosis: Impaired Physical Mobility r/t muscle
weakness
 assist on performing ROM exercises passively. Improve muscle

strength and joint mobility
 reposition pt as to turning pt to sides and sitting position. To

prevent skin irritation and ulceration through turning pt to her sides
 schedule activities with adequate rest periods during the day and
encourage to do whatever possible activity according to tolerance
Nursing Diagnosis: Fatigue r/t to poor physical condition
•assist on performing ROM exercises passively. Improve muscle

strength and joint mobility
•reposition pt as to turning pt to sides and sitting position. To prevent

skin irritation and ulceration through turning pt to her sides
•schedule activities with adequate rest periods during the day and
encourage to do whatever possible activity according to tolerance
Nursing Diagnosis: Nausea r/t hormonal imbalance
•Encourage pt. to eat small, frequent meals. So stomach does not feel excessively
full.
•Provide frequent oral care. To cleanse mouth and minimize bad tastes
•Advise client to eat dry foods such as crackers and toast when nausea occurs.

Hydatidiform Mole

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H.

Gestational trophoblastic disease is

With this condition, the embryo fails

i.Serum or urine test of hCG for pregnancy because hCG is produced by

i. Report any bleeding, excessive vomiting or abdominal pain during pregnancy

iii. Following mole extraction

Could assess fetal heart sounds to verify no variable fetus.

Verify and interpret results of the serum test as compared to normal.

Assess for vaginal discharges as to bleeding, spotting and clear fluid-filled

Health teaching and possible complications such as malignancy of cells that

Complete assessment consists of patient history, physical examination, and

Detail information about recent hospitalization; blood transfusions; blood

 Also, try to determine the patient's resistance to infectious disease. Ask

 In suspected infection, a physical examination must assess the skin,

 Assess reports of pain (PQRST). Evaluate pain and its characteristics

 Provide comfort measures and diversional activities. Provide relief of

 Encourage stress management techniques. To cope up with stress

Apply TSB to decrease core temperature

Promote rest to relieve stress and prevent work overload

Encourage patient to increase fluid intake to ensure hydration

 assist on performing ROM exercises passively. Improve muscle

 reposition pt as to turning pt to sides and sitting position. To

•assist on performing ROM exercises passively. Improve muscle

•reposition pt as to turning pt to sides and sitting position. To prevent

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