Maternal Hemorrhagic Causes & Disorders/2nd Trimester: Gestational Trophoblastic Disease (Hydatidiform Mole, Choriocarcinoma and Molar Pregnancy)

Question 1

GTD: What is it? Complete Mole derived from?

Answer 1

The complete mole’s genetic material it paternally derived, there is no fetus, placenta, amniotic membranes or fluid.

Question 2

GTD: Bleeding? Why?

Answer 2

There is no placenta to receive maternal blood; therefore, hemorrhage into the uterine cavity leads to vaginal bleeding

Question 3

T or F Appx 20% of GTD Complete moles progress toward a choriocarcinoma

Answer 3

True

Question 4

GTD: Partial Mole derived from?

Answer 4

Partial mole derived from both maternally and paternally

often contains abnormal embryonic or fetal parts, sac, fetal blood, but congenital anomalies are present

Question 5

T or F More Complete moles progress toward a choriocarcinoma than Partial moles

Answer 5

True

Question 6

GTD: Risk Factors

Answer 6

1) low carotene (red/yellow pigment in vegs) or animal fat intake
2) Age- early teens or over 40
3) Ovulation stimulated with clomiphene (Clomid)

Question 7

GTD: Assessment

1) Hyperemesis gravidarum due to
2) Uterine growth
3) Bleeding characteristics
4) s/s of …?
5) s/s of progessive HTN involving what systems?

Answer 7

1) Hyperemesis gravidarum due to elevated hCG levels
2) Rapid uterine growth
3) Bleeding often dark brown eg prune juice or bright red, scant or profuse
4) s/s of preeclampsia
5) Liver, Renal, cerebral, seizures, issues with coagulation

Question 8

s/s of preeclampsia r/t GTD (4)

Answer 8

1) H/A
2) Visual disturbances
3) Protein in urine
4) Epigastric pain

Question 9

Hyperemesis gravidarum must monitor for ketones, acid/base balance…why?

Answer 9

Intake is drastically reduced, fat break down will occur resulting in ketones

Question 10

GTD: Labs (1)

Answer 10

1) hCG peristently high no expected decline after weeks 10-12 of pregnancy

Question 11

GTD: Diagnostic and Therapeutic Procedures (5)

Answer 11

1) Ultrasound
2) D & C to evacuate the mole
3) baseline pelvic should be done
4) Ultrasound to confirm removal
5) hCG analysis following molar pregnancy to be done weekly for 3 weeks then monthly for 6 months up to a year to detect GTD.

Question 12

GTD: Nursing Actions (5)

Answer 12

1) Measure fundal height
2) Assess for vaginal discharge or bleeding
3) RhoGAM if Rh- mother
4) Meds and chemo meds possiblity
5) Save any clots for evaluation

Question 13

GTD: Client Education

Answer 13

1) Emotional support and support group
2) Use contraception as part of follow up care
3) Follow up care a must b/c risk of choriocarinoma