INTRODUCTION

Hydatiform mole , also known as molar pregnancy, is a subcategory of diseases under

gestational trophoblastic disease (GTD), which originates from the placenta and can metastasize. It is
unique because the tumor originates from gestational tissue rather than from maternal tissue. Other
forms of gestational trophoblastic disease include gestational choriocarcinoma which can be extremely
malignant and invasive and placental site trophoblastic tumors. Hydatiform mole (HM) is categorized as
a complete and partial mole and is usually considered the non-invasive form of gestational trophoblastic
disease. Complete mole is the more common type and does not contain a fetus, whereas in a partial
mole there is a deformed, nonviable fetus present. Complete moles are typically diploid, whereas partial
moles are triploid. Complete moles tend to cause higher levels of the human chorionic gonadotropin
(hCG), which is one of the main clinical features of this process. Although hydatiform moles are usually
considered benign, they are premalignant and do have the potential to become malignant and invasive.

The most common symptom of a complete mole is vaginal bleeding in the first trimester which
is normally due to the molar tissue separating from the decidua, resulting in bleeding. The typical buzz
word appearance of the vaginal bleeding is described as a "prune juice" appearance. This is due to the
accumulated blood products in the uterine cavity and resultant oxidation and liquefaction of that blood.
Another symptom of a complete molar pregnancy is hyperemesis which is due to the high level of the
hCG hormone circulating in the bloodstream. Some patients also endorse passage of vaginal tissue
described as grape-like clusters or vesicles. Late findings of the disease (after the first trimester around
14 to 16 weeks of pregnancy) including signs and symptoms of hyperthyroidism, including tachycardia
and tremors, again caused by the high levels of circulating hCG. Other late sequels are pre-eclampsia
which is pregnancy-induced hypertension and proteinuria and/or end-organ dysfunction occurring
typically after 34 weeks of pregnancy. When a patient less than 20 weeks pregnant presents with signs
and symptoms of pre-eclampsia, a complete molar pregnancy should highly be suspected. In very
advanced cases, patients present with severe respiratory distress possible from embolism of the
trophoblastic tissue into the lungs.

In a pregnant patient with vaginal bleeding, one should always obtain a serum quantitative hCG
level and patient's blood type. In hydatiform moles, the serum hCG levels are typically much higher than
patients of the same gestational date in a normal pregnancy or ectopic pregnancy. Complete moles tend
to have very high levels of serum hCG, typically greater than 100,000, whereas partial moles may be
within normal range for gestational age or even lower than expected. Blood type is important because
most patients with complete or partial hydatiform moles present with vaginal bleeding, and therefore
Rh antibody screening needs to be performed to determine whether anti-D immunoglobulin needs to be
administered if the patient is Rh(D) negative. The imaging of choice in a suspected hydatiform mole is a
pelvic ultrasound. In a complete mole, the ultrasound findings include a heterogeneous mass in the
uterine cavity with multiple anechoic spaces, most commonly referred to as a "snowstorm"
appearance. Furthermore, there is the absence of an embryo or fetus, and no amniotic fluid is present.
In a partial mole, there typically is the finding of a fetus which may be viable, the presence of  amniotic
fluid, and the placenta appears to have enlarged, cystic spaces, often described as "Swiss cheese"
appearance.

A woman suffering from a molar pregnancy may need a dilatation and curettage (D&C) or a
minor operation commonly known as “raspa.” A surgeon will carry out the D&C while asleep under
general anesthesia. Most molar pregnancies naturally end and the grape-like tissues will eventually be
expelled by the body. In some cases, it is removed by suction curettage (D&C) or sometimes through
medication. It is important that all the molar cells be removed from the uterus wall because the cells can
spread through the blood and may affect other organs, including the lungs, liver and brain. Further
testing may be done to ensure that it hasn't spread beyond your uterus. Even though molar cells can
spread, they are not cancerous and this condition has a cure rate of nearly 100 per cent.

Acoording to World Health Organization, There is a very low frequency of hydatiform moles. In
United States, the frequency has been described as 60 to 120/100,000 pregnancies for hydatiform
moles. The frequency has been shown to be higher in other countries of the world. Certain risk factors
increase the prevalence of molar pregnancies such as: Extremes of maternal age, 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 (vitamin
A precursor) and animal fats, and smoking.
 OBJECTIVES
1. To understand the main difference between complete and partial Hydatidiform mole.

2. To determine the common causes of Hydatidiform mole and its effect to individual’s health.

3. To enhance the understanding of the individuals about Hydatidiform mole.

4. To describe the signs and symptoms and provide advice and interventions about Hydatidiform mole.

5. To determine the epidemiology and complications of Hydatidiform mole.

SIGNIFICANCE OF THE STUDY

NURSING EDUCATION

The importance of this research when it comes to nursing education is that we will be able to
understand as future nurses the in-depth data on Hydatidiform mole that we can use in the future. It
will enable us to enhance our understanding and awareness of the variables and possible causes
involved and how it will impact life. In order to be more conscious of the causes and therapy for this
disease, it is essential for us to be knowledgeable about Hydatidiform mole.

NURSING PRACTICE

We, student nurses would benefit a lot from this kind of work in a way so that if they ever
encounter such a disease in the future, we could provide our patients with the right health teachings. It
will also provide us with understanding of the suitable measures that might avoid complication and
assist in prolonging the patient's life. We would also learn the distinct diagnostic tests to be carried out
in the detection of this disease so that nurses can provide the correct therapy for those in need together
with other health practitioners at an early point.

NURSING RESEARCH

In the field of nursing, nursing research is one of the significant elements. It can assist in the
change of people's life and can be used to perform experiments and create procedures, drugs and
treatments for certain illnesses. Technology is changing, especially in this present generation, and so is
people's lifestyle. More and more individuals have a sedentary lifestyle. Nursing research's function in
this is to concentrate on the people's holistic care to guarantee they get the greatest care.
 PATIENT’S PROFILE

NAME: Ms. X

AGE: 17 YEARS OLD

GENDER: FEMALE

BIRTHDAY: SEPTEMBER 19, 2002

ADDRESS: DAGUPAN CITY, PANGASINAN

NATIONALITY: FILIPINO

CIVIL STATUS: SINGLE

RELIGION: ROMAN CATHOLIC

EDUCATIONAL ATTAINMENT: JUNIOR HIGH SCHOOL (GRADE 7)

ADMITTING DATE: JANUARY 7, 2020

ADMITTING TIME: 3:40 PM

ADMITTING DIAGNOSIS: G1P0 MOLAR PREGNANCY 5 WEEKS

AOG, TEENAGE PREGNANCY
 FINAL DIAGNOSIS: G1P0 GESTATIONAL TROPHOBLASTIC
DISEASE

ADMITTING VITAL SIGNS: T:36

P:92

R:20

BP:90/60

ADMITTING PHYSICIAN: DR. GMELENIA BALANON

CHIEF COMPLAINT

Vaginal bleeding

HISTORY OF PRESENT ILLNESS

Few hours prior to admission, patient had vaginal discharge that was blood with
hypogastric pain. Hence, sought consult and was admitted.

PAST HISTORY

No previous illness

FAMILY HISTORY ILLNESS

PATERNAL

None
MATERNAL

None
 PHYSICAL ASSESSMENT

AREA OF ASSESSMENT I P P A RESULTS INTERPRETATION SIGNIFICANCE

Due to medical
GENERAL APPEARANCE * Patient looks pale Abnormal
condition

ASSESS BEHAVIOR * Coherent Normal

VITAL SIGNS

Due to medical
BLOOD PRESSURE * * 90/60 mmHg Low
condition

PULSE RATE * 92 Normal

RESPIRATORY RATE * 20 Normal

TEMPERATURE 36 Normal

CHEST * Symmetrical

No abnormal
LUNGS * Normal
sounds noted

RESPIRATORY

No abnormal in
BREATHING PATTERN * breathing patterns Normal
noted

CARDIOVASCULAR
 No abnormal
HEART SOUND * Normal
sounds noted

CARDIAC RATE * 100 Normal

MUSCULOSKELETAL

MUSCLE TONE * Strong Normal

JOINTS * Normal Normal

ABDOMEN

CONTOUR * Globular Normal

(+) Borbrygmi upon

BOWEL SOUNDS * Normal
auscultation

Urine output
amount/cc
GASTROURINARY TRACT * Normal
(negative blood in
stool)

COLOR * Yellow Normal

AREA OF ASSESSMENT I P P A RESULTS INTERPRETATION SIGNIFICANCE

NEUROLOGICAL * Conscious and Alert Normal

* Oriented Normal
 * Responds to stimuli Normal

* Cooperative Normal

SKIN

SKIN COLOR * Pallor Abnormal Due to medical condition

SKIN TEXTURE * Soft Normal

SKIN TEMPERATURE * Normal Normal

SKIN TURGOR * Strong Normal

HEAD

Evenly distributed;
HAIR DISTRIBUTION * Normal
thick

HAIR COLOR * Black Normal

PRESENCE OF LESIONS * None Normal

EYE COLOR * Dark brown pupil Normal

CONJUNCTIVA * Pale Abnormal Due to medical condition

 EARS * In line with canthus Normal

* No discharges Normal

NOSE * Within the midline Normal

* No discharges Normal

MOUTH No lesions Normal

TONGUE * Pink; moist Normal

TEXTURE * Moist Normal

CONTOUR * Symmetrical Normal

GUMS * Pinkish Normal

BUCCAL SORES * None Normal

AREA OF ASSESSMENT I P P A RESULTS INTERPRETATION SIGNIFICANCE

 Symmetrical and
NECK * * straight; no presence Normal
of lesions
Symmetrical; no
dimpling; color of the
BREAST * * Normal
same; no mass or
lumps; no tenderness
 LABORATORY RESULTS

IMMUNO-HEMATOLOGY January 14, 2020 6:45PM

Blood Type: “B” positive Rh POSITIVE

Reagent: ERYCARD 2.0

IMMUNO-HEMATOLOGY January 14, 2020

Blood Type: “B” positive Rh POSITIVE

HbsAg: NONREACTIVE

Reagent: ONE STEP HbsAg Test CArd

SYPHILIS: NONREACTIVE

Reagent: INTEC ONE STEP ANT-TP TEST CARD

TYPE OF EXAMINATION: TRANSVAGINAL ULTRASOUND JANUARY 17, 2020

Findings:

Withim the gravid uterus is a single gestational sac of 12.04 cm measuring equivalent to 5 weeks
AOG WITH MULTIPLE VESICULAR STRUCTURE GRAPELIKE CLUSTER.

Other findings:

Right Ovary: 24.20 mm x 25.00 mm

Left Ovary: 25.00 mm x 26.00 mm

IMPRESSION: PREGNANCY UTERINE OF ABOUT 5 WEEKS AOG BY MEAN SAC DIAMETER

CONSIDER: PARTIAL H-MOLE ( MOLAR PREGNANCY 5 WEEKS BY MSD)

 IMMUNO-HEMATOLOGY JANUARY 17, 2020

DIAGNOSTIC/LABORATORY RESULT NORMAL ANALYSIS AND SIGNFICANCE

PROCEDURE VALUES INTERPRETATION

PARAMETER

WBC 28.98 4.0-10.0/L HIGH, may indicate that To determine if there

the immune system is is infection
working to destroy an
infection

NEUTROPHIL 97.2 55.0- 65.0 Having a high percentage To determine if there

of neutrophils in your are enough
blood is a sign that your white blood cell that
body has an infection. helps heal damaged
tissues and resolve
infections.

LYMPHOCYTES 1.4 25.0-35.0 LOW, may indicate To determine if there

presence of infection are enough
lymphocytes that
helps your immune
system, helping your
body fight off
infection.

MONOCYTES 1.3 3.0 - 6.0 A low number To determine if there

of monocytes in the are enough

blood (monocytopenia) monocytes that fights

certain infections and
can be caused by
 anything help other white

that decreases the blood cells remove

overall white blood cell dead or damaged

tissues, destroy
count.
cancer cells, and
regulate immunity
against foreign
substances.

BASOPHIL 0.0 0.0 - 1.0 Normal To determine if there

are enough Basophils
keeping the immune
system functioning
correctly.

EOSINOPHIL 0.1 2.0 - 4.0 An abnormally low To determine if your

eosinophil count can be body is sending more
the result of intoxication and more white blood
from alcohol or excessive cells to fight off
production of cortisol infections.

RBC 4.25 4 - 5.40 Normal To check the RBC’s

contain hemoglobin
which carries oxygen
in body tissues

HEMOGLOBIN 128 120-160 Normal To check oxygen

transportation,
anemia and
hemodilution

HEMATOCRIT 0.35 0.370- Slightly Low. Used to measure RBC

 0.470 An insufficient supply of number and volume.
healthy red blood cells It is an integral part of
(anemia) A large number evaluation of anemia
of white blood cells due
to long-term illness,
infection or a white blood
cell disorder such as
leukemia or lymphoma

PLATELET 301 150-450/L Normal Help blood to stop

flowing from a cut by
becoming thick and
sticky

MCV 83.2 80.0-100.0 Normal Measures the average

size of your
red blood cells, also
known as
erythrocytes

MCH 30.1 27.0-34.0 Normal Refer to the average

amount of
hemoglobin found in
the red blood cells in
the body.

MCHC 362 320-360 Slightly High MCHC value is used to

evaluate the severity
a high MCHC value is
and cause of anemia.
present if there's an
increased concentration
of hemoglobin inside of
 your red blood cells.

RDW-CV 13.8 11.0-16.0 Normal To screen patient’s

urine for diabetes
mellitus and other
endocrine disorders.

RDW-SD 47.6 35.0-56.0 Normal Measures the amount

of red blood cell
variation in volume
and size

MPV 7.5 6.5-12.0 Normal Can help diagnose

bleeding disorders and
diseases of the bone
marrow.

PDW 15.4 9.0-17.0 Normal Reflects how uniform

the platelets are in
size.

PCT 0.22 0.108- Normal frequently performed

0.282 if there is a suspicion
of bacterial sepsis, a
severe systemic
infection that can
become life-
threatening.
 LABORATORY RESULTS

IMMUNO-HEMATOLOGY JANUARY 18, 2020

DIAGNOSTIC/LABORATORY RESULT NORMAL ANALYSIS AND SIGNFICANCE

PROCEDURE VALUES INTERPRETATION

PARAMETER

WBC 21.99 4.0-10.0/L HIGH, may indicate that To determine if there

the immune system is is infection
working to destroy an
infection

NEUTROPHIL 85.2 55.0- 65.0 Having a high percentage To determine if there

of neutrophils in your are enough
blood is a sign that your white blood cell that
body has an infection. helps heal damaged
tissues and resolve
infections.

LYMPHOCYTES 9.7 25.0-35.0 LOW, may indicate To determine if there

presence of infection are enough
lymphocytes that
helps your immune
system, helping your
body fight off
infection.

MONOCYTES 4.2 3.0 - 6.0 Normal To determine if there

are enough
monocytes that fights
certain infections and
 help other white
blood cells remove
dead or damaged
tissues, destroy
cancer cells, and
regulate immunity
against foreign
substances.

BASOPHIL 0.1 0.0 - 1.0 Normal To determine if there

are enough Basophils
keeping the immune
system functioning
correctly.

EOSINOPHIL 0.8 2.0 - 4.0 An abnormally low To determine if your

eosinophil count can be body is sending more
the result of intoxication and more white blood
from alcohol or excessive cells to fight off
production of cortisol infections.

RBC 4.23 4 - 5.40 Normal To check the RBC’s

contain hemoglobin
which carries oxygen
in body tissues

HEMOGLOBIN 129 120-160 Normal To check oxygen

transportation,
anemia and
hemodilution

HEMATOCRIT 0.35 0.370- Slightly Low. Used to measure RBC

 0.470 An insufficient supply of number and volume.
healthy red blood cells It is an integral part of
(anemia) A large number evaluation of anemia
of white blood cells due
to long-term illness,
infection or a white blood
cell disorder such as
leukemia or lymphoma

PLATELET 244 150-450/L Normal Help blood to stop

flowing from a cut by
becoming thick and
sticky

MCV 83.8 80.0-100.0 Normal Measures the average

size of your
red blood cells, also
known as
erythrocytes

MCH 30.5 27.0-34.0 Normal Refer to the average

amount of
hemoglobin found in
the red blood cells in
the body.

MCHC 364 320-360 Slightly High MCHC value is used to

evaluate the severity
a high MCHC value is
and cause of anemia.
present if there's an
increased concentration
of hemoglobin inside of
 your red blood cells.

RDW-CV 13.6 11.0-16.0 Normal To screen patient’s

urine for diabetes
mellitus and other
endocrine disorders.

RDW-SD 47.2 35.0-56.0 Normal Measures the amount

of red blood cell
variation in volume
and size

MPV 7.5 6.5-12.0 Normal Can help diagnose

bleeding disorders and
diseases of the bone
marrow.

PDW 15.4 9.0-17.0 Normal Reflects how uniform

the platelets are in
size.

PCT 0.18 0.108- Normal frequently performed

0.282 if there is a suspicion
of bacterial sepsis, a
severe systemic
infection that can
become life-
threatening.
 LABORATORY RESULT FORM

JANUARY 17, 2020 7:35PM

TEST RESULT UNIT REFERENCE RANGE

FASTING BLOOD SUGAR ----- mnol/L 3.89-5.84

URIC ACID ----- umol/L 148-401
CREATININE 59.90 umol/L 53.0-106.08
AMYLASE ----- UL 25-86
UREA 3.41 umol/L 1.67-8.35
ALLKALINE PHOSPHATASE----- U/L 80-306
ALBUMIN ----- g/L 35-55
TOTAL PROTEIN ----- g/L 62-80
GLOBULIN ----- g/L 29-33
SGOT(AST) 44.60 U/L 0-46
SGPT(ALT) 25.30 U/L 0-49
LDH ----- U/L 225-450
SODIUM ----- mnol/L 135-148
POTASSIUM ----- mnol/L 3.5-5.3
CHLORIDE ----- mnol/L 98-107
IONIZED CALCIUM ----- mnol/L 1.13-1.32
CHOLESTEROL ----- mnol/L 3.88-5.69
TRIGLYCERIDES ----- mnol/L 0.46-1.60
HDL ----- mnol/L 1.09-2.28
LDL ----- mnol/L 0-3.37
HBA1C ----- % 4.0-5.7
TOTAL CALCIUM ----- mnol/L 2.10-2.55
RANDOM BLOOD SUGAR ----- mnol/L 3.89-8.00
BETA HCG JANUARY 18, 2020

BETA HCG RESULT UNIT NORMAL VALUES

BETA HCG 3537 mIU/mL 0.00-1.00

 ANATOMY AND PHYSIOLOGY

UTERUS

The uterus is a small, hollow, pear-sized organ found in women. Sitting between the bladder and
rectum, the lower end of the uterus opens into the cervix, which then opens into the vagina. The main
function of the uterus is for housing a developing fetus.

The uterus consists of a body and a cervix. The cervix protrudes into the vagina. The uterus is
held in position within the pelvis by condensations of endopelvic fascia, which are called ligaments.
These ligaments include the pubocervical, transverse, cervical, cardinal, and uterosacral ligaments. It is
covered by a sheet-like fold of peritoneum, the broad ligament.

The uterus is essential in sexual response by directing blood flow to the pelvis and to the
external genitalia, including the ovaries, vagina, labia, and clitoris. The reproductive function of the
uterus is to accept a fertilized ovum which passes through the utero-tubal junction from the fallopian
tube. It implants into the endometrium, and derives nourishment from blood vessels which develop
exclusively for this purpose.

The fertilized ovum becomes an embryo, attaches to a wall of the uterus, creates a placenta,
and develops into a fetus (gestates) until childbirth. Due to anatomical barriers such as the pelvis, the
uterus is pushed partially into the abdomen due to its expansion during pregnancy. Even during
pregnancy, the mass of a human uterus amounts to only about a kilogram (2.2 pounds).

The uterus is located inside the pelvis immediately dorsal (and usually somewhat rostral) to the
urinary bladder and ventral to the rectum. The human uterus is pear-shaped and about three inches (7.6
cm) long. The uterus can be divided anatomically into four segments: The fundus, corpus, cervix and the
internal os.

The lining of the uterine cavity is called the endometrium. It consists of the functional
endometrium and the basal endometrium from which the former arises.The endometrium builds a
lining periodically which is shed or reabsorbed if no pregnancy occurs. Shedding of the functional
endometrial lining is responsible for menstrual bleeding (known colloquially as a “period” in humans,
with a cycle of approximately 28 days, +/- 7 days of flow and +/- 21 days of progression) throughout the
fertile years of a female and for some time beyond.

The uterus mostly consists of smooth muscle, known as myometrium. The innermost layer of
myometrium is known as the junctional zone, which becomes thickened in adenomyosis. The
parametrium is the loose connective tissue around the uterus. The perimetrium is the peritoneum
covering of the fundus and ventral and dorsal aspects of the uterus.

Hydatidiform mole (H-mole)also known as Gestational Trophoblastic Disease (GTD) is a rare

mass or growth which arises from fetal tissue that may form inside the uterus at the beginning of a
pregnancy. Frequently there is no fetus at all. In the complete or classic mole, there is marked edema
and enlargement of the villi with disappearance of the villous blood vessels.

There is proliferation of the trophoblastic lining of the villi. Hydatidiform mole (H-mole) also is
a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. It also does not
develop from cells of the uterus like cervical cancer or endometrial (uterine lining) cancer do. Instead,
these tumors start in the cells that would normally develop into the placenta during pregnancy.

Hydatidiform mole (H-mole) or GTD also begins in the layer of cells called the trophoblast that
normally surrounds an embryo. (Tropho- means nutrition, and -blast means bud or early developmental
cell.

Early in normal development, the cells of the trophoblast form tiny, finger-like projections
known as villi. The villi grow into the lining of the uterus.

In time, the trophoblast layer develops into the placenta, the organ that protects and nourishes
the growing fetus. Most Hydatidiform mole (H-mole) also are benign (not cancer) and they don't
invade deeply into body tissues or spread to other parts of the body. But some are malignant
(cancerous).

Because not all of these tumors are cancerous, this group of tumors may be referred to as
gestational trophoblastic disease, gestational trophoblastic tumors, or gestational trophoblastic
neoplasia. (The word neoplasia simply means new growth.) All forms of Hydatidiform mole (H-mole) also
can be treated. And in most cases the treatment produces a complete cure.
Types of Hydatidiform mole (H-mole)

1. Complete hydatidiform mole most often develops when 1 or 2 sperm cells fertilize an egg cell
that contains no nucleus or DNA (an “empty” egg cell). All the genetic material comes from the
father's sperm cell. Therefore, there is no fetal tissue.

Surgery can totally remove most complete moles, but as many as 1 in 5 women will have some
persistent molar tissue (see below). Most often this is an invasive mole, but in rare cases it is a
choriocarcinoma, a malignant (cancerous) form of GTD. In either case it will require further
treatment.

2. Partial hydatidiform mole develops when 2 sperm fertilize a normal egg. These tumors contain
some fetal tissue, but this is often mixed in with the trophoblastic tissue. It is important to know
that a viable (able to live) fetus is not being formed.

Partial moles usually  are completely removed by surgery. Only a small number of women with
partial moles need further treatment after initial surgery. Partial moles rarely develop into malignant
GTD.

Persistent gestational trophoblastic disease is GTD that is not cured by initial surgery. Persistent GTD
occurs when the hydatidiform mole has grown from the surface layer of the uterus into the muscle layer
below (the myometrium). The surgery used to treat a hydatidiform mole (called suction dilation and
curettage, or D&C) scrapes the inside of the uterus. This removes only the inner layer of the uterus (the
endometrium) and cannot remove tumor that has grown into the muscular layer.
Most cases of persistent GTD are invasive moles, but in rare cases they are choriocarcinomas or
placental site trophoblastic tumors.

Invasive mole

An invasive mole (formerly known as chorioadenoma destruens) is a hydatidiform mole that has grown
into the muscle layer of the uterus. Invasive moles can develop from either complete or partial moles,
but complete moles become invasive much more often than do partial moles. Invasive moles develop in
less than 1 out of 5 women who have had a complete mole removed. The risk of developing an invasive
mole in these women increases if:

 There is a long time (more than 4 months) between their last menstrual period and treatment.

 The uterus has become very large.

 The woman is older than 40 years.

 The woman has had gestational trophoblastic disease in the past.

Because these moles have grown into the uterine muscle layer, they aren't completely removed during
a D&C. Invasive moles can sometimes go away on their own, but most often more treatment is needed.

A tumor or mole that grows completely through the wall of the uterus might result in bleeding into the
abdominal or pelvic cavity. This bleeding can be life threatening.

Sometimes after removing a complete hydatidiform mole, the tumor spreads (metastasizes) to other
parts of the body, most often the lungs. This occurs about 4% of the time (or 1 in 25 cases).
 PATHOPHYSIOLOGY
NON MODIFIABLE RISK FACTORS MODIFIABLE RISK FACTORS

 AGE IS BELOW 20 ( CLIENT IS  SMOKING

17 YEARS OLD)

COITUS

EGG IS FERTILIZED BY ONE OR TWO

SPERM BY WHICH THEN
REDUPLICATES ITSELD YIELDING THE
GENOTYPES OF 69XXY (TRIPLOID OR
92XXXY (TETRAPLOID)

ABNORMAL FERTILIZATION

HYPERPLASIA

FOCAL SWELLING OF CHORIONIC VAGINAL BLEEDING

VILLI

THROMBOPLASTIC TISSUE
HYPOGASTRIC PAIN FORMATION

FORMATION OF MOLES

PARTIAL HYDATIDIFORM MOLE

 MEDICAL MANAGEMENT
Hydatidiform mole is an abnormal pregnancy characterized by varying degrees of trophoblastic
proliferation (both cytotrophoblast and syncytiotrophoblast) and vesicular swelling of placental villi
associated with an absent or abnormal fetus/embryo.

Once the diagnosis of molar pregnancy is suspected based on history, physical examination, hCG
level, and ultrasound findings, the patient should be evaluated for the presence of medical
complications (anemia, preeclampsia, hyperthyroidism), which may need to be corrected. Basic
laboratory tests should include complete blood count, comprehensive metabolic panel, thyroid function
test, urinalysis, and chest x-ray, as well as blood type and screen with cross match if anemic or uterus ≥
16-week gestational size. An electrocardiogram and coagulation profile may also be indicated. Once the
patient is determined to be hemodynamically stable, the most appropriate method of molar evacuation
should be decided upon.

Suction evacuation and curettage is the preferred method of evacuation of a hydatidiform mole,
independent of uterine size, for patients who wish to maintain their fertility. After anesthesia is
achieved, the cervix is dilated to allow a 12- to 14-mm suction cannula to pass into the lower uterine
segment and then rotated as the intrauterine contents are removed, preferably under ultrasound
guidance. Suction evacuation should be followed by gentle sharp curettage. Uterotonic drugs should be
started after initiation of evacuation of the uterus, although oxytocin receptors may be absent. Because
risk of excessive bleeding increases with uterine size, 2 units of blood should be immediately available
when the uterus is ≥ 16-week gestational size. Attention to blood and crystalloid replacement decreases
pulmonary complications. It is clear that with judicious use of appropriate equipment, access to blood
products, careful intraoperative monitoring, and early anticipation of complications, patient outcomes
improve. Patients who are Rh-negative should receive Rho(D) immune globulin at the time of
evacuation, as Rh D factor is expressed on trophoblastic cells.

Hysterectomy is an alternative to suction curettage in patients who do not wish to preserve

fertility or are older and at increased risk for development of postmolar gestational trophoblastic
neoplasia. The adnexa may be left intact even in the presence of theca lutein cysts. In addition to
evacuating the molar pregnancy, hysterectomy provides permanent sterilization and eliminates risk of
local myometrial invasion as a cause of persistent disease. Prophylactic chemotherapy such as
Methotrexate or Actinomycin D at the time or immediately after evacuation of a molar pregnancy is
associated with a reduction in incidence of postmolar GTN.
 DISCHARGE PLANNING
Medication •Encourage the patient for compliance of medication.

•Educate the patient and the significant others about the adverse effect of
the medication as manifested by untoward symptoms that may require
immediate notification of the physician.

Environment •Instruct the significant others to provide the client a calm and well
ventilated environment.

•Instruct the significant others to maintain environment sanitation.

Treatment •Encourage the patient to seek for follow-up check up.

Health teaching •Educate the patient on how to perform proper perineal care such as
washing the vagina from front to back.

•The patient must avoid pregnancy for 1 year to avoid any confusion about
the development of malignant disease. Effective contraception must be use.

Outpatient •Advice the client to use their Philhealth card if there is any to avail it's
benefits.

•Contraception is recommended for 6 months to a year after evacuation.

Diet •Encourage the family to prepare nutritious foods such as vegetables, fruits
and meats.

•Advice the family to give the patient's foods rich in Vitamin C such as
oranges and calamansi juice.

Social •Encourage family members to assist and support the client in meeting her
needs and allow open communication.

Spiritual •Encourage the patient to attend mass every sunday.

•Advise the patient to maintain a close ralationship to God and with her
family.