GESTATIONAL TROPHOBLASTIC DISEASE

HYATIDIFORM MOLE H-MOLE

I.Introduction
The purpose of this case study is to be familiar with Molar Pregnancy. How it is starts, what causes it and what are the signs and symptoms.
A.Definition is a mass of abnormal rapidly growing trophoblastic tissue in which avascular vesicles hang in grapelike clusters THAT PRODUCE LARGE AMOUNTS OF HCG.

B. Predisposing factors: 17 years old below and 35 yrs. Above Low socio-economic status Low protein intake Previous mole Higher incidence in Asian women C. Types: 1. COMPLETE MOLE LACKS AN EMBRYO OR FETUS 2. PARTIAL MOLE INVOLVES A CHROMOSOMALLY ABNORMAL EMBRYO OR FETUS. - 69 XXX or 69 XXY

D. Causes:
1. SPERM + OVUM (23) (0) 2. SPERM + OVUM (46) (23) 3. SPERM + SPERM + OVUM (23) (23) (23) = 46 (COMPLETE MOLE) = 69 (PARTIAL MOLE) = 69 (PARTIAL MOLE)

The cause is not completely understood although potential causes, e.g., defects of the ovum (egg), abnormalities within the uterus, and/or nutritional deficiencies, have been suggested. The incidence is increased in women under 20 or over 40 years old. Risk factors implicated include low socioeconomic status and diets low in protein, folic acid, and carotene

E. Signs & Symptoms Rapid increase in uterine size greater than gestational age of the fetus Marked increase HCG titer Excessive nausea and vomiting due to elevated HCG Brownish vaginal discharge around 4th month containing grapelike vesicles No FHT is detected after 10 to 12 weeks, no fetal movement after 18-20 weeks No fetal parts Painless bleeding on the 4th to 5th month of pregnancy

II. BIOPHYSICAL DATA A.) Patients Personal Data

Patients Name: Age: Gender: Civil Status City Address: Patient MJ 29 years old Female Married 7947 N.T. Garcia St., Sta Rosa, Laguna

Nationality: Educational Attainment: LMP AOG

Filipino High School Graduate October 18, 2011 16-17 weeks (G1P0)

Vital Signs
ACTUAL VITAL SIGNS VALUE NORMAL VALUE Blood Pressure Respiratory Rate 110/70 mm/Hg 120/80 mmHg 24 cycles/ minute INTERPRETATION

+ Hypotension

12-20 breaths/minute + Tachycardia 60-100 beats/minute (-) Tachycardia, within normal limits Afebrile, Within Normal Limits

Pulse Rate

98 beats/ minute

Temperature

36.4 degrees 36.5-37.5 celsius degrees celsius

Chief Complaints
Client complains of dinudugo po ako As verbalized by the subject.

B.) History of Present Illness

Around the 1st week of February, the patient experienced brownish vaginal discharge with grapelike vesicles. She was alarmed and went to a clinic for a check up. She was then referred to East Avenue Medical Center then she was told to complete a set of laboratory tests the resident doctor requested. It was only then when she found out that she had Gestational Trophoblastic Hyatidiform Mole. Methotrexate was ordered for 5 days and then D & C.

C.) Past Health History The patient has no allergy to any drug or any type of food. According to her, she completed her immunization. She does not usually get coughs or colds but experiences fever at times due to weather conditions. D.) Family Health History Father Side
Hypertension Diabetes Cancer (-) (+) (-)

Mother Side
(+) (-) (+)

Obesity Cigarettes Alcohol

(-) (-) (-)

(-)

III. Gordons Functional Health Pattern 1. Health Perception/Health Management: The patient rely more on self medicating with over the counter medicines when sick with cough or colds. She also makes use of herbal medicines that can relieve and cure her sickness. 2. Nutrition and Metabolic Pattern 3 Day Food Recall
Day 1 Breakfast: 3-4 pcs of pandesal, 10 grams of peanut butter, 1 cup of coffee & 1 glass of water Snack: none Lunch: 2 cups of rice A bowl of sinigang with 100 grams of meat and 50 grams of vegetables, 1 glass of juice & 1 glass of water Snack: none Dinner: 1 cup of rice, A bowl of sinigang with 50 grams of meat and 25 grams of vegetables, 1 glass of water Snack: none Day 2 Breakfast: A fried egg, 1 cup of fried rice, 2 pcs of dried fish (tuyo), 1 cup of coffee & 1 glass of water Snack: none Lunch: 1 cup of rice, a bowl of 100 grams braised beef, 2 glasses of water Snack: none Dinner: 1 cup of rice, a bowl of 100 grams braised beef, 1 glass of water Snack: none Day 3 Breakfast: 3-4 pcs of pandesal, 2 slice of cheese, 1 cup of coffee & 1 glass of water Snack: none Lunch: 2 cups of rice,1 piece of 150 grams fried fish, 1 piece of banana & 1 glass of water Snack: none Dinner:1 cup of rice, 1 piece of 150 grams fried fish, 1 piece of banana & 1 glass of water Snack: none

3. Elimination Pattern She has no problem regarding elimination. She has her regular bowel movements every morning. 4. Activity Exercise Pattern Her day typically starts with opening the store and going to market to buy stocks and purchase the dish for the day. After that she cooks and does the house hold chores. She has no particular mention of routine exercise; she considers her daily chores and manning the store as her daily routine of activity pattern. 5. Sleep-rest Pattern She has an eight-hour sleep pattern. She hits the sack around 10 oclock in the evening and wakes up around 6 oclock in the morning. She has no trouble of initiating sleep. 6. Cognitive Perceptual Pattern She has no defects in the following: eyes, arms and legs and hearing, mental status. Self Perception/Self Concept Pattern She is so concerned with her family and aiming for a peaceful life. She exercises respect among her family members and others. She perceives herself as an ordinary member of the poor society. 8. Role relationship Pattern She is friendly, a serious person and understands very well her role to society. She is a newly wed. She is very sweet and caring to her husband.

9. Sexuality-reproductive pattern Her normal practice of sexual intercourse is 2-3 times a week. She does not feel any pain or any abnormality when having sex. 10. Coping/Stress She takes problem seriously and tries very hard to cope with it. She cant settle unless she has resolved the matter/problem. When problems arise she faces it head on with prayer and an open mind. 11. Value benefit and belief Being a Roman Catholic by faith, she regularly attends mass every Sunday with her husband. She believes in God as the Supreme Being who is in-charge of guiding us and keeping us safe.

IV. CEPHALOCAUDAL ASSESSMENT

General Survey The patient was assessed lying on bed in supine position, awake, conscious and coherent and not in respiratory distress. She was oriented to person, place and time and talks coherently. She was properly groomed. She was cooperative and responsive during the entire assessment.
Head to Toe Assessment Skin: (-) Pallor, (-) Jaundice, good skin turgor Head: Normocephalic, Symmetrical, (-) Masses Eyes: Lids Symmetrical, (-) lesions Ears: Normoset, Symmetrical Nose: Symmetrical nasolabial fold, (-) Flaring Lips: Pinkish, Symmetrical Pharynx: Pinkish mucosa, (-) lesions Chest & Lung: Symmetrical, (-) Lesions Heart: Heart tone within normal limits Breast & Axillae: Symmetrical, Smooth, (-) Lesions Abdomen: Smooth, Symmetrical, (-) Lesions, (+) distension hypogastric area, Back & Extremities: Smooth, Symmetrical, (-) Lesions, (-) Spinal deformity, Extremities w/ good flexion, Pinkish nail beds

V. DIAGNOSTIC EXAM. A. Laboratory Tests and Diagnostic Examinations Complete Blood Count The CBC is a series of different tests used to evaluate the blood and the cellular components of RBCs, WBCs and platelets. The CBC is used to assess the patient for anemia, infection, inflammation, polycythemia, hemolytic disease, and the effects of ABO incompatibility, leukemia and dehydration status. Urinalysis Urinalysis (UA) simply means analysis of urine. This is a very commonly ordered test that is performed in many clinical settings such as hospitals, clinics, emergency departments, and outpatient laboratories. Urinalysis is a simple test, which can provide important clinical information, it has a quick turn-around time, and it is also cost effective. Urinalysis is very a useful test in the diagnosis of and screening for many diseases and conditions. diagnosing urinary tract infections (UTIs), diagnosing kidney stones, screening for and evaluating many types of kidney diseases, and monitoring the progression of diseases such as diabetes mellitus and high blood pressure

Ultrasound Ultrasound (also termed sonography & ultrasonography) is a non-invasive diagnostic medical technique that uses high frequency sound waves to produce images of the internal structures of the body. Using an ultrasound, a technician or doctor moves a device called a transducer (probe) over part of your body. The transducer emits sound waves which bounce off the internal tissues, and creates images from the waves that bounce back. Different densities of tissues, fluid, and air inside the body produce different images that can be interpreted by a physician, typically a radiologist (a physician who specializes in imaging technologies).

VI. ANATOMY AND PHYSIOLOGY The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
External Female Reproductive System Internal Female Reproductive System

VIII. Treatment & Surgical Procedures D and C or D & E to remove the mole. ( If the woman is more than 40 yrs old, hysterectomy is done since she has a higher chance of developing CHORIOCARCINOMA Monitor HCG for 1 year ( HCG shld be negative 2-6 weeks after removal of H-mole.) Chest X ray every 3 mos for 6 mos. The lungs are the most common site of metastasis of choriocarcinoma Chemotherapy ( Methotrexate) if: -HCG titers are increased for 3 consecutive weeks or double at anytime -HCG titers remain elevated 3-4 mos. after delivery