H.

MOLE
GESTATIONAL TROPHOBLACTIC
DISEASE
 What is Gestational Trophoblastic disease?

▪ Existing in many terms like Hydatidiform mole, is a

condition associated with second-trimester bleeding. It is
an abnormal proliferation and degeneration of the
trophoblastic villi.
▪ As the cells degenerate, they become filled with fluid
and appear as clear fluid-filled, grape-sized vesicles.
 HYDATIDIFORM MOLE

▪ With this condition, the embryo fails to

develop beyong a primitive start.
▪ Such structures must be identified because
they are associated with Choriocarcinoma, a
rapidly metastasizing malignancy.
▪ The incidence of GTD is approximately 1 in
every 1,500 pregnancies.
 Types of Hydatidiform Mole: Complete vs. Partial

H. mole pregnancies are either classified as complete or partial moles

depending on the appearance and the chromosome analysis seen on
histology.

▪ For Complete H. mole: Just remember that if it is complete it is

an ‘EMPTY OVUM’ meaning there is an abnormal sac but no
fetus. Studies show that this type often leads
to Choriocarcinoma. The hCG levels for this type is also higher
than partial.
For Partial H. mole: If the complete is known to have an empty
ovum, partial H. Mole has partially formed normal villi with a
macerated embryo present. Partially formed because there is
a misshapen part of the trophoblast and macerated embryo
because the embryo has an abnormally high chromosome
levels.
NORMAL CHROMOSOME IS: 23 M, 23 F = 46

COMPLETE PARTIAL

46 SPERM CELL 46 SPERM CELL

0 EGG CELL 23 EGG CELL
 SIGNS AND SYMPTOMS
Amenorrhea
Size of fundus is bigger than
the gestational age.
Vaginal bleeding as a main
complaint: due to the
separation of vesicles from
the uterine wall and there
may be blood-stained, watery
discharge from the vesicles
Abdominal pain
Pallor indicating anemia may be
present
Hyperthyrodism develops in 3-
10% of cases manifested by
enlarged thyroid gland and
tachycardia ( due to chorionic
thyrotropin secreted by the
trophoblast and hCg also has a
thyroid stimulating effect)
 RISK FACTORS

Increased maternal age ( more

than 35 y.o
Low socioeconomic status; Low
protein diet
Asian heritage
 DIAGNOSIS

▪ Passage of vessicles
▪ TRIAD SIGNS : Big uterus, Vaginal bleeding
(brownish and intermittent) HCG greater than 1
million
▪ Ultrasound – no fetal sac, no fetal skeleton
 TREATMENT

▪ Hysterectomy if above 45 years old and no future

pregnancy is desired or with increased chorionic
gonadtropin levels after D&C
▪ hcg titer monitoring for one ear NO PREGNANCY ( use
contraception) because signs of pregnancy mask early
signs of choriocarcinoma
▪ Medical replacement: blood, fluid, plasma
▪ chemotherapy for malignancy: Methotrexate is the drug
of choice.
 NURSING IMPLEMENTATIONS

• Advise bedrest
• Monitor VS, blood loss, molar/tissue passage, I&O
• Maintain fluid and electrolyte balance, plasma and blood volume through
replacements as ordered.
• Prepare for D&C, Hysterectomy
• Provide psychological support
• Emphasize the need for follow up HCG titer determination for one year
• Reinforce instructions on NO PREGNANCY FOR ONE YEAR: give
intstruction related to contraceptions