Gestational Trophoblastic Disease

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Pregnancy is the climax of a woman’s life. This is the time that she would be able to see her essence, and upgrade her role from being just a woman to becoming a life giver. Pregnancies are meant to be handled with care, but adversities could always come without knocking on your door. As nurses, we are here to educate women on their maternal health to ensure a safe, meaningful road of pregnancy.

Definition

  • Gestational trophoblastic disease is the degeneration and abnormal proliferation of the trophoblastic villi. The cells become filled with clear fluid, giving them the appearance of grape-like vesicles.

Pathophysiology

  • Fertilization occurs as the sperm enters the ovum. In instances of a partial mole, two sperms might fertilize a single ovum.
  • Reduction division or meiosis was not able to occur in a partial mole. In a complete mole, the chromosome undergoes duplication.
  • The embryo fails to develop completely. There are 69 chromosomes that develop for the partial mole, and 46 chromosomes for the complete mole.
  • The trophoblastic villi start to proliferate rapidly and become fluid-filled grape-like vesicles.

Risk Factors

This incidence happens in 1 of every 1, 500 pregnancies. There are risk factors that could precipitate the formation of hydatidiform mole, and they are as follows:

  • Low protein intake. Women with low protein intake have a possibility of developing a hydatidiform mole because protein is needed for the development of the trophoblastic villi.
  • Women older than 35 years old. Being pregnant beyond 35 years old presents a lot of risky conditions like H-mole.
  • Asian women. Asians have a higher chance of acquiring this disease because of their genetic formation.
  • Women with a blood group of A who marry men with blood group O. these blood groups, when combined together, results in unfavorable conditions like H-mole.

Signs and Symptoms

These signs and symptoms, if noticed in a pregnant woman, might indicate a possibility of gestational trophoblastic disease.

  • Uterus expands faster than normal. Because the trophoblast cells proliferate abnormally, it does so in such a rapid pace that the uterus reaches its growth landmarks before the usual time.
  • A very high serum or urine test for hCg. Trophoblast cells produce hCg, and they are produced in large amounts because the trophoblast cells are growing rapidly.
  • Vaginal bleeding. When the H-mole is still not identified at the 16th week of pregnancy, it will identify itself through vaginal bleeding accompanied by clear fluid filled vesicles.

Diagnostic Tests

Diagnostic tests are ordered to check for a presence that might indicate a positive gestational trophoblastic disease.

  • Pregnancy test. This may not be able to detect specifically the H-mole, but this will confirm if the woman is pregnant or not.
  • Urine test or serum for hCg. A very high result for hCg might indicate the presence of an H-mole.
  • Ultrasound. An ultrasound will show a dense growth of grape-like vesicles with a snowflake pattern, filled with clear fluid instead of an embryo.

Medical Management

The physician would order medications and other interventions that would ensure the safety of the woman during this complicated period.

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  • Methotrexate. Physicians may order a prophylactic course of methotrexate, which attacks rapidly growing cells like the abnormally growing trophoblastic cells.
  • Dactinomycin. This is ordered by the physician once metastasis occurs.

Surgical Management

Upon identification of the trophoblastic disease, the physician would schedule a surgical intervention to remove it from the uterus of the woman.

  • Suction curettage. This is the ideal management of gestational trophoblastic disease, to evacuate the mole inside the woman’s uterus and avoid any further complications if it stays longer inside the reproductive system.

Nursing Management

Nurses must also take action during the critical stages of the pregnancy. We must be able to function on our own while waiting for any orders from the physician.

Nursing Assessment

  • Assess the abdominal girth of the pregnant woman to check if it is within the usual landmark of pregnancy.
  • Assess for signs and symptoms of pregnancy induced hypertension, because for a woman with H-mole, they occur earlier than the 20th week of pregnancy.
  • Instruct the woman to save all perineal pads containing any clots or tissue that has passed out of her during bleeding.

Nursing Diagnosis

  • Grieving related to loss of pregnancy as evidenced by anger and social detachment.

Nursing Interventions

  • Measure abdominal girth and fundal height to establish baseline data regarding the growth of the uterus.
  • Assist patient in obtaining a urine specimen for urine test of hCg.
  • Save all pads used by the woman during bleeding to check for clots and tissues she may have discharged.
  • Provide your patient with an open environment and a trusting relationship so she would be encouraged to express her feelings.
  • Honestly answer the patient’s questions to foster a trusting relationship between nurse and client.
  • Provide an assurance that it is not her own fault that this happened to her to lessen her sense of guilt and self-blame.

Evaluation

  • Patient must be able to express her feelings effectively.
  • Patient must acknowledge the situation and seek for appropriate help.
  • Patient must learn to look forward for the future step by step.

The pain a mother experiences at the loss of a pregnancy is never comparable to any pain in the world. Expecting for an addition in the family and losing it before it is even born is a difficult situation, but somehow we, as nurses, have the ability to give them comfort and reduce the pain they are feeling through the knowledge that we have.

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Marianne is a staff nurse during the day and a Nurseslabs writer at night. She is a registered nurse since 2015 and is currently working in a regional tertiary hospital and is finishing her Master's in Nursing this June. As an outpatient department nurse, she is a seasoned nurse in providing health teachings to her patients making her also an excellent study guide writer for student nurses. Marianne is also a mom of a toddler going through the terrible twos and her free time is spent on reading books!

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