Gestational Trophoblastic Disease (Hydatidiform Mole)

Hydatidiform mole (gestational trophoblastic disease) is an abnormal pregnancy

resulting from a developmental anomaly of the placenta. It is characterized by the
conversion of the chorionic villi into a mass of clear vesicles. There may be no
fetus, or a degenerating fetus may be present.

Pathophysiology and Etiology

1. It is believed to be derived from genetic abnormalities as the paternal
haploid, X-carrying set of chromosomes that reaches 46 XX by its own
duplication. Not all moles have the 46 XX chromosomal makeup.
2. It arises in fetal rather than maternal tissue.
3. Large amounts of β-hCG are present secondary to the proliferation of
chorionic tissue. Assay values of β-hCG are elevated in the condition.
4. Contributing factors may include chromosomal abnormalities,
malnutrition, hormonal imbalance, age under 20 or over 40, and low
economic status.

Clinical Manifestations
1. First trimester vaginal bleeding
2. Absence of fetal heart tones and fetal structures
3. Rapid enlargement of the uterus; size greater than dates
4. β-hCG titers greater than expected for gestational age
5. Expulsion of the vesicles
6. Hyperemesis (severe nausea and vomiting)
7. Signs of preeclampsia before 24 weeks’ gestation

Diagnostic Evaluation
1. β-hCG levels – elevated
2. Ultrasound – shows a characteristic picture of the mole in most cases

Management
1. Suction curettage is the method of choice for immediate evacuation of the
mole with possibility of laparotomy.
2. Follow-up for detection of malignant changes because a complication is
the development of choriocarcinoma of the endometrium.
3. Administer RhIG (RhoGAM) according to your facility’s policy if woman is
Rh negative.

Complications
1. Significant blood loss

Nursing Assessment
1. Monitor maternal vital signs; note presence of hypertension.
2. Assess the amount and type of vaginal bleeding; note the presence of any
other vaginal discharge.
3. Assess the urine for the presence of protein.
 4. Palpate uterine height; if above the umbilicus, measure the fundal height.
5. Determine date of last menstrual period (LMP) and date of positive
pregnancy test.
6. Evaluate CBC results and Rh type.

Nursing Diagnoses
1. Risk for Deficient Fluid Volume related to maternal hemorrhage
2. Anxiety related to loss of pregnancy and medical interventions

Nursing Interventions
Maintaining Fluid Volume
1. Obtain blood samples for type and screen, and have 2 to 4 units of whole
blood available for possible replacement.
2. Establish and maintain I.V. line; start with a large needle to accommodate
possible transfusion and large quantities of fluid.
3. Assess maternal vital signs, and evaluate bleeding.
4. Monitor laboratory results to evaluate patient’s status.

Decreasing Anxiety
1. Prepare the patient for surgery. Explain preoperative and postoperative
care along with intraoperative procedures.
2. Educate patient and family on the disease process.
3. Allow the family to grieve over the loss of pregnancy.

Patient Education and Health Maintenance

1. Advise the woman on the need for continuous follow-up care.
2. Provide reinforcement of follow-up procedures:
a. Measure β-hCG levels every 1 to 2 weeks until normal – then begin
monthly testing for 6 months, then very 2 months for a total of 1 year.
b. Consider chemotherapy or hysterectomy if β-hCG levels rise or begin to
plateau or there is evidence of metastasis.
3. Encourage ongoing discussion of care with health care provider.

Evaluation: Expected Outcomes

1. Vital signs stable; laboratory work within normal limits
2. Verbalizes concerns about self and related procedures; describes follow-up
care and its importance.