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UNIT 3 - HYDATIDIFORM MOLE - Coggle Diagram
UNIT 3 - HYDATIDIFORM MOLE
DEFINITION
Gestational trophoblastic disease caused by an abnormal proliferation of trophoblastic villi which leads to a grape-like mass in the uterus
Also known as vesicular mole or molar pregnancy
TYPES
COMPLETE MOLE
no fetus present
sperm that duplicates its own chromosomes while the maternal chromosomes in the ovum are inactivated
PARTIAL MOLE
may be fetal tissue or membrane present
the maternal contribution is usually present, but the paternal contribution is doubled, therefore the karyotype is triploid
RISK FACTORS
age (women older than 35 or younger than age 20)
previous molar pregnancy increases the risk 1% to 2% for future pregnancies
women with previous spontaneous abortions or infertilities
dietary factors including patients that have diets deficient in carotene and animal fats
smoking
CLINICAL FEATURES
higher levels of beta-hCG than expected for gestation
characteristic "snowstorm"ultrasound pattern that shows the vesicles and the absence of a fetal sac
a uterus that is larger than expected for gestational age
vaginal bleeding which varies from dark-brown spotting to profuse hemorrage
excessive nausea and vomiting - related to high levels of beta-hCG from the proliferating tophoblasts
early development of preeclampsia
DIAGNOSTIC EVALUATION
QUANTITATIVE BETA hCG TEST : positive pregnancy test because of the human chorionic gonadotopin (hCG) released by the trophoblast cells
ULTRASOUND : transvaginal or pelvic ultrasound results will show a grape-like vesicle or a classic snowstorm-like appearance
THERAPEUTIC MANAGEMENT
evacuation of the trophoblastic tissue of the mole
continous follow-up of the woman to detect malignant changes of any remaining trophoblastic tissue
mole is removed by vacuum aspiration followed by curettage
COMPLICATION
Perisitent gestational trophoblastic neoplasia (GTN)
after a molar pregnancy has been removed, molar tissue may remain and continue to grow. one sign of persistent GTN is a high level of hCH even after the removal of mole
NURSING CONSIDERATIONS
encourage pt and family to express their feelings about the disorder and offer emotional support
stress the need for regular monitoring to detect malignant changes
instruct the pt to report new symptoms promptly
explain to the pt to use contraceptives to prevent pregnancy for atleast 1 year after hCH levels return to normal and her body reestabilishes regular ovulation and menstrual cycles
PREVENTION
Prophylactic chemotherapy - Methotrexate or Actinomycin-D after evacuation prevent malignant gestational trophoblastic disease
chemotherapy and irradiation - used for metastic carcinoma