HYDATIDIFORM MOLE

Question 1

group of conditions in which tumors grow inside a woman’s uterus

pathologic proliferation of trophoblastic cells

Answer 1

Gestational Trophoblastic Disease

Question 2

Types of GTD:

Answer 2

~Hydatidiform mole
~Invasive mole (chorioadenoma destruens)
~Choriocarcinoma
~Epithelioid trophoblastic tumor
~Placental-site trophoblastic tumor

Question 3

Risk Factors

Answer 3

~Younger than 20 and older than 35 years old
~Diet low in CHON & Vit. A
~Contraceptive pills
~Hx of molar pregnancy

Question 4

Abnormal proliferation and then degeneration of trophoblastic villi

• cells degenerate, filled w/ fluid and appear as clear fluid-filled, grape-sized vesicles

Answer 4

Hydatidiform Mole

Question 5

Molar pregnancies can be…

Answer 5

Complete and Partial

Question 6

Pathophysiology of Monospermic complete Mole

Answer 6

1. The maternal chromosomes are lost

2.) The Paternal chromosomes double up

3.) Results in a conceptus with 46 chromosomes but all of them are derived from the father

Question 7

Pathophysiology Dispermic Complete Mole

Answer 7

1.) Fertilisation by 2 sperm

2.) The maternal chromosomes are lost

3.) Results in a conceptus with 46 chromosomes but all of them are derived from the father

Question 8

COMPLETE MOLE:

Normal sperm + Empty Egg = ______

Answer 8

Fertilization

Question 9

Pathophysiology of Partial Mole

Answer 9

2 sperm fertilize an egg. This results in a triploid conceptus with 69 chromosomes

Question 10

PARTIAL MOLE:

2 sperms / 1 sperm without 1st meiotic division + Normal Ovum = ______

Embryo may have fetal sac / heartbeat, Vascularized Villi and multiple anomalies =

Answer 10

1.) Fertilization

2.) Little chance of survival

Question 11

Assessment

Answer 11

~Confirmation of pregnancy and length of gestation

~Amount of bleeding and description, location and severity of pain

~Assess hCG Level

Question 12

Assessment with ultrasound Exam

Answer 12

1.) a partial mole that includes some fetal tissue and membranes

2.) complete mole that is composed only of a enlarged villi but contains no fetal tissue or membranes.

Question 13

Planning

Answer 13

1.) The woman will have an eventful recovery following successful evacuation of the mole

2.) The woman and her partner will verbalize their grief at the loss of their anticipated child.

3.) The woman will be able to explain GTD and its treatment, follow-up and long term implications for pregnancy.

Question 14

Nursing Management

Answer 14

~Assess the woman’s emotional state and coping ability

~Relieve woman’s anxiety and family’s grief about the lost of pregnancy.

~Observe bleeding and signs of infection

Question 15

Therapeutic Management: Collaborative

Answer 15

A. Evacuation of the trophoblastic tissue

B. Continuous follow-up care

Question 16

Continuous follow-up

Answer 16

~A baseline CXR & a PE including pelvic exam

~Weekly hCG levels for 3 consecutive weeks. Titers are then monitored monthly for 6 months, followed by every 2 months for 6 months more.

~Continued high or rising hcG titers - D&C is performed and the tissue examined.

~If malignant cells are found
Chemotherapy - methotrexate

Question 16

Evacuation of the trophoblastic tissue

Answer 16

1.)Before evacuation, chest radiography, CT scan, or MRI may be performed

2.)CBC, coagulation status, and blood type and screen or cross-matching procedures

3.)The mole is usually removed by Vacuum Aspiration followed by curettage.

4.)After tissue removal, IV oxytocin is given, to contract the uterus.