Hydatidiform Mole- is a type of gestational trophoblastic neoplasm that

occurs in 1 out of 1000 pregnancies, it is a rare mass or growth that

forms inside the uterus at the beginning of a pregnancy
It is a developmental anomaly of the placenta that converts the chorionic
villi into a
mass of clear fluid-filled vesicles. It is the major cause of second trimester bleeding and is also called
molar pregnancy.

A hydatidiform mole, or molar pregnancy, results from over-production of the tissue that is supposed to
develop into the placenta. The placenta normally feeds a fetus during pregnancy. In this condition, the
tissues develop into an abnormal growth, called a mass.

Two types of moles:

a. Complete moles – neither an embryo nor an amniotic sac. It is characterized by swelling

and cystic formation of all trophoblastic cells. No fetal blood is present. If an embryo did
develop, it was most likely only 1 to 2 mm in size and died early on. A complete mole is
highly associated with the development of choriocarcinoma.

b. Partial mole – embryo (usually with multiple anomalies) and amniotic sac. It is
characterized by edema of a layer of the trophoblastic villi with some of the villi forming
normally. Fetal blood may be present in the villi, and an embryo up to the size of 9
weeks gestation may be present. Typically, a partial mole has 69 chromosomes in which
there are three chromosomes for every one pair.

Pathophysiology

 Trophoblastic villi cells located in the outer ring of the blastocyst (the structure that develops
via cell division around 3 to 4 days after fertilization) rapidly increase in size, begin to
deteriorate, and fill with fluid.
 The cells become edematous, appearing a grapelike clusters of vesicles.
  As a result, the embryo falls to develop past the early stages.

Causes

 Exact cause is unknown

 May be associated with poor maternal nutritional (specifically, an insufficient intake of protein
and folic acid), a defective ovum, chromosomal abnormalities, or hormonal imbalances.
 Preceding molar pregnancy in about 50% of patients with choriocarcinoma.
 Preceding spontaneous or induced abortion, ectopic pregnancy, or normal pregnancy in the
remaining 50% of patients.

Assessment findings

 Disproportionate enlargement of the uterus; possible grapelike clusters noted in the vagina on
pelvic examination.
 Excessive nausea and vomiting, abdominal cramping.
 Intermittent or continuous bright red or brownish vaginal bleeding
 Passage of tissue resembling grapelike clusters.
 Symptoms of gestational hypertension before 20 weeks’ gestation.
 Absence of fetal heart tones.

 Abnormal growth of the womb (uterus)

o Excessive growth in about half of cases
o Smaller-than-expected growth in about a third of cases
o Disproportionate enlargement of the uterus; possible grapelike clusters noted in the
vagina on pelvic examination
 Nausea and vomiting that may be severe enough to require a hospital stay
 Intermittent or continuous bright red or brownish vaginal bleeding in pregnancy during the first 3
months of pregnancy
 Passage of tissues resembling grapelike clusters
 Symptoms similar to preeclampsia that occur in the 1st trimester or early 2nd trimester (High
BP, swelling of feet, hands and ankle)
 Absence of fetal heart tones

Laboratory Tests
 Serum or urine test of human chorionic gonadotropin (hCG) for pregnancy because hCG is
produced by trophoblast cells that are overgrowing (positive if 1 to 2 million IU compared with
a normal pregnancy level of 400,000 IU) - reveals extremely elevated levels of early
pregnancy
 Chest x-ray – To check if lungs are affected with the metastatic/cancerous cells from the
uterus.
 A pelvic exam, to evaluate the size of the uterus and check for abnormalities.
 A blood test to measure the amount of a pregnancy hormone, called human chorionic
gonadotropin (hCG), to see whether the level is abnormally high for the length of the
pregnancy.
 A pelvic ultrasound test. If pelvic exam or hCG level suggests a molar pregnancy, an
ultrasound can be used to confirm the diagnosis. Some molar pregnancies are first diagnosed
during an ultrasound done for another purpose.
 Ultrasonography performed after 3 months’ gestation reveals grapelike clusters rather than a
fetus, an absence of fetal skeleton, and evidence of a snowstorm-like pattern.
 Hemoglobin level, hematocrit, red blood cells (RBC) count, prothrombin time, partial
thromboplastin time, fibrinogen levels, and hepatic and renal function findings are all abnormal.
 White blood cells count and erythrocyte sedimentation rate are increased.
Treatment

Medical Intervention:

It is important for women with molar pregnancies to be evaluated periodically after the problem has
been treated.

Women are advised not to attempt pregnancy for some time in order to be sure that levels of HCG
remain at zero and that no further treatment is needed. There is a risk that a molar pregnancy can
come back after treatment.

If you have Rh-negative blood, you will also have a shot of Rh immune globulin. This prevents a
problem called Rh sensitization, which can cause serious problems in a future pregnancy.

Preventing pregnancy while hCG levels are being monitored, usually about 6 months. It is very
important that you practice highly effective birth control during the entire period of follow-up.

Close medical supervision if you happen to conceive within 12 months of molar pregnancy treatment.
Routine prenatal care and a late first-trimester fetal ultrasound to confirm a healthy pregnancy.

Chemotherapy with a single drug — This treatment with medication toxic to the molar tissue is used to
treat a molar pregnancy tumor that has features suggesting a good prognosis.
Chemotherapy with multiple drugs — Treatment with several medications toxic to the molar tissue usually
is needed to treat invasive tumors with poorer prognosis.
Radiation treatment — This uses high-strength X-ray beams to destroy cancer cells in the exceedingly
rare case when a tumor has spread (metastasized) to the brain.

Surgical Intervention:

Suction dilation and curettage (D and C) — This is a surgical procedure used to remove noncancerous
hydatidiform moles. The opening in the cervix is dilated and the inside uterus lining is scraped
(curetted) clean using suction and another spoonlike instrument.
D & C is commonly used to obtain tissue for microscopic evaluation to rule out cancer.
D & C may also be used to diagnose and treat heavy menstrual bleeding, and to
diagnose endometrial polyps and uterine fibroids. D & C can also be used as an early
abortion technique up to 16 weeks.

Dilatation/dilation and evacuation (D&E) is a procedure in which the cervix is dilated and tissue is
removed from the uterus. D&E is used to describe two different procedures. D&E can also be used to
describe a surgical removal of a fetus and placenta between 14-20 weeks of gestation, called also late
abortion or second trimester abortion.

To accomplish dilatation/dilation and evacuation, a negative pressure/vacuum is used to aspirate tissue

from the inside of the uterus. The procedure is thought to be less traumatic to the surface of the
uterine cavity than a sharp curettage.

Removal of the uterus (hysterectomy) — This is used rarely to treat hydatidiform moles but may be
chosen, particularly if the woman does not want to become pregnant again. It may be done through
the abdomen or the vagina.

Nursing Interventions:
 Obtain baseline vital signs.
 Preoperatively observe the patient for signs of complications, such as hemorrhage,
uterine infection, and vaginal passage of vesicles.
 Save any expelled tissue for laboratory analysis.
 Prepare the patient physically and emotionally for surgery, if indicated.
 Postoperatively, monitor vital signs and fluid intake and output, and assess for signs of
hemorrhage.
 Encourage the patient and her family to express their feelings.
 Offer emotional support, and help them through the grieving process.
 Help the patient and her family develops effective coping strategies, referring them to a
mental health professional, if needed.