Hydatidiform Mole

Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.

1. HYDATIDIFORM MOLE By- Sandhya Kumari Nursing Tutor (OBG) Metro College of Nursing, Greater Noida

2. Hydatidiform mole is a rare mass or growth that forms inside the uterus at the beginning of pregnancy. It is a type of gestational trophoblastic disease (GTD). A cancerous form of GTD is called as choriocarcinoma . The placenta feeds the fetus during pregnancy. With a molar pregnancy, the tissues develop into an abnormal growth called a mass. DEFINITION

3. The estimated number is 1 of every 1,000 to 2,000 pregnancies. INCIDENCE and PREVALENCE

4. There are two types: Partial (incomplete) molar pregnancy: There is an abnormal growth of placenta and some fetal development. Complete molar pregnancy: There is an abnormal placenta but no fetus. TYPES

5. Hydatidiform mole results from overproduction of the tissue in that is supposed to develop into the placenta. Women older than 35 are at twice the risk and those over age of 40 are 5-10 times more likely to develop H. mole. Maternal age under 16 years are also at the risk. Problems during fertilisation Diet low in protein, vitamin A and animal fat CAUSES

6. Abnormal growth of uterus i.e. excessive growth in >50% of cases and smaller than expected growth in 1/3 rd of the cases. Nausea and vomiting severe enough to require a hospital stay Vaginal bleeding during the first 3 months of pregnancy Passing of grape like vesicles through the vagina (first 3 months of pregnancy). SYMPTOMS

7. Symptoms of hyperthyroidism i.e. heat intolerance, loose stools, rapid heart rate, restlessness, nervousness, skin warmer and more moist than usual, trembling hands, unexplained weight loss Symptoms similar to pre- eclampsia i.e. elevated blood pressure Fatigue Shortness of breath Coughing Abdominal swelling CONTD

8. Unusally large uterus (50% cases) or too small (33%) for gestation dates No fetal heart sound No quickening (fetal movement) PHYSICAL EXAMINATION

9. Complete blood count Thyroid function Liver and kidney function test Level of human chorionic gonadotropin ( hCG ) Ultrasound of pelvis X-rays MRI or CT of chest, pelvis and brain to rule out if the mole has metastasized outside the uterus INVESTIGATIONS

10. Anaemia from chronic blood loss Toxemia of pregnancy Hyperthyroidism Heart failure Trophoblastic embolization leading to severe acute respiratory problems (breathlessness). COMPLICATIONS

11. Rupture of the wall of uterus resulting in haemorrhage Development of choiocarcinoma Metastasis of cancer to lungs, lower genital tract, brain, liver, kidney and gastro intestinal tract via blood stream or lymphatic vessels. CONTD

12. Some hydatidiform mole disappears spontaneously Dilatation and curettage Hysterectomy Abdominal hysterectomy (evacuation of mole through incision made through abdomen into the uterus) TREATMENT

13. Blood transfusion in cases with severe anaemia Chemotherapy and radiation for more aggressive moles that have become malignant and for those women whose hCG level does not return to normal levels after evacuation. CONTD

14. The nurse should: Reassure the patient and give psychological support to the patient. Provide good environment free from external stimuli to ensure proper rest and sleep. Encourage to take the nutritious diet rich in protein, vitamin A and animal fat. Administer the oxygen therapy to relieve breathlessness. Provide sterile vaginal pads to prevent urinary tract infection. NURSING MANAGEMNT

15. Encourage to maintain personal hygiene and change the clothes daily. Administer some analgesics as prescribed by the doctor to relieve pain. Monitor the hCG level after molar pregnancy every week initially. The hCG level generally drops to normal within 8-12 weeks after evacuation of the mole. Once the levels are consistently normal for 3-4 weeks, monitoring is conducted monthly for 6 months. CONTD

16. Advice the patient for effective contraception and not to conceive during the period of follow up as the mole can recur. Educate the mother for ultrasonography for future pregnancies after getting treatment of the disease as after 1 st hydatidiform mole the risk for recurrence is 1.2 – 1.4% and after 2 nd mole the risk increases to 20%. CONTD

17. Prognosis for treated individual is excellent. Mortality is almost zero with early diagnosis and treatment. After D & C 84% of complete and 99.5% of partial hydatidiform moles get cured. After hysterectomy 3-5% become malignant and after evacuation 15-20% of complete moles and 2-3% of partial mole get malignant. PROGNOSIS

18. D.C. Dutta . Textbook of Obstetrics.6 th edition. New Central Book Agency (P)LTD. 2004. 193-197. BIBLIOGRAPHY