Hydatidiform Mole - Nursing Case Study

by - June 15, 2020

DESCRIPTION:
Gestational Trophoblast Disease also known as Hydatidiform Mole is an abnormal proliferation and then degeneration of the trophoblastic villi. When the cells degenerate, it is being filled with fluid and appear as clear fluid – filled, grape sized vesicles. The embryo fails to develop beyond a primitive start. There are two of molar growth and these are the complete mole and partial mole. Complete mole’s trophoblastic villi is swelling and becoming cystic. When an embryo forms, it will die early with no fetal blood present. While in partial mole, there is only some trophoblastic villi that is swollen and misshapen. The embryo may grow but then macerates with some fetal blood present.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):  
A woman who have this kind of condition may seem like a normal pregnancy at first because they might experience dark brown to bright red bleeding from vagina during the first trimester and nausea and vomiting too. However, upon the consultation, the physician will find that the fundal height is much greater than the standard measurement, the uterus is overgrowth, there is an increased in blood pressure, edema, proteinuria, a highly positive hCG test, no fetus found on ultrasound, and a cyst formation which is very opposite to normal pregnancy.

DIAGNOSTIC AND LABORATORY TEST:
There are tests that a women will do in order to find the real deal of this situation. A pregnancy test may be done, although it cannot detect hydatidiform mole, but it can tell if a women is really pregnant or not. Serum or urine test for hCG is needed because if the result shows that there is a high hCG then it confirms that there is H – mole. Ultrasound is also needed because it will determine if an embryo is forming or it is just a dense growth of grape – like vesicles with a snowflake pattern filled with clear fluid.

RISK FACTORS:
One of the risk factors that is associated with this condition is when a women has a low protein intake because protein is needed for the development of trophoblastic villi. When a women who is older than 35 years of age become pregnant she might experience hydatidiform mole because pregnancy beyond 35 is considered as high risk pregnancy. A women who is in Asian heritage have a higher chance of getting this disease because of their genetic formation. And also if a women with a blood group A marry a men with blood group O, and their blood groups combined, it will give an unfavorable condition just like gestational trophoblastic disease.

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Acute Pain related to physical injury secondary to suction curettage
Grieving related to loss of pregnancy
Anxiety related to threat in current health status
Social Isolation related to loss of pregnancy
Spiritual Distress related to loss of pregnancy

NURSING CARE PLAN:
Acute Pain related to physical injury secondary to suction curettage
Grieving related to loss of pregnancy
Anxiety related to threat in current health status
NURSING MANAGEMENT / INTERVENTION:
When a women went to suction curettage, she needs to have a pelvic examination and serum test for beta subunit of hCG. The hCG needs to be analyzed for every 2 weeks until it become normal while the serum hCG is assessed for every 4 weeks for the next 6 to 12 months to check if it’s declining or not. If it’s increasing it only means that there is a malignant transformation called choriocarcinoma. The nurse will then administer a reliable contraceptive like oral estrogen or progesterone, as ordered by the physician, so that the positive pregnancy test resulting from a new pregnancy will not be confused with the increasing level that occurs with a developing malignancy. After 6 months, if hCG is still negative therefore the women is free from the risk of malignancy. But the nurse should tell the women to begin in planning for next pregnancy only after 12 months.

MEDICAL / SURGICAL MANAGEMENT:
A surgical management that will be done for hydatidiform mole is suction curettage in order to evacuate the abnormal trophoblast cells inside the uterus of the women and also to avoid any problems that might arise if it stayed longer inside the reproductive system. 

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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