Gestational Trophoblastic Disease
- Developmental anomaly of the placenta that converts the chorionic villi into a mass of clear fluid-filled vesicles.
- 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.
- Major cause of second trimester bleeding.
- Also called molar pregnancy or hydatidiform mole.
- 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.
- 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.
- 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.
- Radioimmunoassay of human chorionic gonadotropin (hCG) levels reveals extremely elevated levels of early pregnancy.
- Histologic examination may reveal the presence of vesicles.
- 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.
- Suction and curettage; if indicated.
- Weekly monitoring of beta-hCG levels until normal 3 consecutive weeks.
- Periodic follow-up for 1 to 2 years.
- Pelvic examinations and chest X-rays at regular intervals.
- Emotional support.
- Avoidance of pregnancy until hCG levels are normal (may take up to 1 year).
- 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.