Chapter 11: Gestational Trophoblastic Disease

Question 1

What is Gestational Trophoblastic Disease (GTD)

Answer 1

clinical diagnosis
-an abnormal placental development that results in the production of fluid-filled grapelike clusters (instead of normal placental tissue) and a vast proliferation of trophoblastic tissue

Question 2

What does GTD include?

Answer 2

histological diagnoses of hydatidiform mole (“mole pregnancy”), locally invasive mole, metastatic mole, and choriocarcinoma
>a hydatidiform mole pregnancy is one in which the chorionic villi degenerate into a mass of fluid-filled grapelike clusters

Question 3

Complete mole

Answer 3

-characterized by trophoblastic proliferation and the absence of fetal parts
-may result from the fertilization of an empty ovum (one whose nucleus is missing or non-functional) by a normal sperm
>because the ovum contains no genetic material, all chromosomes in a molar pregnancy are paternally derived

Question 4

Incomplete mole

Answer 4

appear with a coexistent fetus that has a triploid genotype (69 chromosomes) and multiple anomalies
>most fetuses only survive several weeks in utero before being spontaneously aborted
>almost always benign and have a much lower malignancy (being a tumor) potential than complete moles

Question 5

Invasive mole

Answer 5

similar to a complete mole but has invaded the myometrium layer of the uterus

• rarely metastasize
• respond well to single-agent chemotherapy

Question 6

Choriocarcinoma

Answer 6

invasive

• malignant trophoblastic disease that is usually metastatic and can be fatal
• can spread to lungs, vagina, pelvis, brain, liver, intestines, and kidneys
• this can occur weeks to years after any type of gestation; patients usually present with S/S of active metastases

Question 7

The Risk Factors for the Incidence of a Hydatidiform mole, whether complete or partial

Answer 7

• increases with maternal age ( usually 50 or older)

- those with a history of a previous molar pregnancy

Question 8

Higher Incidences have been found where?

Answer 8

geographical areas where the maternal diet is low in beta-carotene, animal fats, and folic acid

• and in woman with blood type A whose partners are of Blood type O
• have experienced prior miscarriages
• and who have undergone ovulation stimulation with clomiphene (Clomid)

Question 9

Signs and Symptoms

Answer 9

• vaginal bleeding that may be scant or profuse and ranges in color from dark brown to bright red
• early in pregnancy, often a discrepancy between uterine size and dates; uterine enlargement results from the rapidly proliferating trophoblastic tissue and the large accumulation of clotted blood
• anemia may result from blood loss
• may complain of excessive nausea and vomiting (hyperemesis gravidarum)
• may complain of abdominal pain (caused by uterine distention)
• gestational hypertension before 24 weeks can = hydatidiform mole

Question 10

Clinical and Laboratory Findings

Answer 10

• absence of fetal heart sounds
• markedly elevated quantitative serum hCG (may be greater than 100,000 mIU/mL
• very low levels of serum (alpha) a-fetoprotein (MSAFP)

Question 11

Less Common but serious complications of Hydatidiform mole

Answer 11

• hyperthyroidism

- trophoblastic pulmonary embolism

Question 12

How is molar pregnancy Diagnosed?

Answer 12

ultrasound examination

• the placental tissue appears in a “snowstorm” pattern because of the profuse swelling of the chorionic villi
• when a complete mole is present, no fetus is identified in the uterus

Question 13

Clinical Management

Answer 13

• involves removal of the uterine contents with meticulous follow-up that includes serial (beta) B-hCG levels
• effective contraception to prevent pregnancy at this time ; pregnancy can also mask a rise in hCG associated with malignant GTD

Question 14

hCG levels

Answer 14

a sensitive marker, hCG is secreted by the molar cells
-the amount of hormone measured in maternal serum is directly related to the number of viable molar cells
>hCG levels should be assessed every 1 to 2 weeks until hCG is undetectable on two consecutive determinations
>Then, hCG should be measured every 1 to 2 months for at least a year

Question 15

Wat should the perinatal nurse counsel the patient about?

Answer 15

-different methods of contraception
-avoid pregnancy for a year; parents not only must realize that there will be no baby, but attempts at becoming pregnant must be delayed for at least a year
>nurse must support the couple, educate contraception methods, encourage to voice fears and concerns, and answer any questions appropriately
-involve community resources such as social services, support groups, and spiritual advisors

Question 16

When is Chemotherapy initiated?

Answer 16

• if the hCG titer rises or plateaus during follow-up

- if metastases (movement of cancer cells from the original site to another site) are detected at any time

Question 17

When is surgery indicated?

Answer 17

if chemotherapy is not successful or for patients who have completed their childbearing