Hydatedform mole

1. Hydatidiform Mole

2. Hassan Shah
Roll No: 57

3. OBJECTIVE
• At the end of this presentation the learners will be
able to
• Case Scenario of a disease
• Define hydatidiform mole
• Enlist Types of hydatidiform mole
• Explain the Pathophysiology
• Enlist sign,symptoms and complications of
hydatidiform mole
• Surgical and medical management
• Make nursing diagnosis and intervention for
hydatidiform mole

4. Case scenario
A 26-year-old woman, who is 13 weeks pregnant,
comes to the emergency department complaining of
vaginal bleeding and abdominal pain. She has a
history of one previous pregnancy which ended in a
spontaneous abortion. On examination, the
obstetrician finds that the patient's blood pressure is
elevated, and there is a significant amount of vaginal
bleeding. An ultrasound is performed, which shows
an abnormal placenta with cystic spaces, consistent
with a hydatidiform mole.

5. Hydatidiform mole

6. Hydatidiform mole
• Hydatidiform mole is a rare mass or growth that forms
inside the womb (uterus) at the beginning of a pregnancy.
• It is a type of gestational trophoblastic disease (GTD).
• Gestational trophoblastic disease (GTD) is a group of
conditions in which tumors grow inside a woman's uterus
(womb).
• The abnormal cells start in the tissue that would normally
become the placenta, the organ that develops during
pregnancy to feed the fetus.
• A cancerous form of GTD is called choriocarcinoma.

7. Classification
It is divided into two classification
• complete hydatidiform mole
• partial hydatidiform mole

8. complete hydatidiform mole(CHM):
• the entire
uterus filled
with
abnormal
vesicles, no
signs of
fetus.

9. partial hydatidiform mole
• partial
hydatidiform
mole with
evidence of a
conceptus.

10. Molar Pregnancy
Complete mole
• Fertilization an
empty egg by one
sperm.
• All placental villa
swollen.
• Fetus, cord,
amniotic membrane
are absent.
Incomplete mole
• fertilization of an
egg by two sperms
• some placental villa
swollen
• Fetus, cord, amniotic
membrane are
present

11. Pathophysiology
• Hydatiform mole is characterized by an
overgrown villous trophoblast with cystic
"swollen" villi. Macroscopically can be visible, the
second trimester, as clusters of vesicles (similar
to small grapes) developed from the
transformation of chorionic villi.
• Complete mole differs from partial mole, in
cytogenetic and microscopical appearance.

12. Mehak Munawer
Roll No:58

13. Symptoms
• Vaginal bleeding
• Lower abdominal pain due to austreching of
uterus, concealed hemorrhage, infection
• Excessive vomiting
• Breathlessness
• Trachycardia
• Expulsion of grape like vesicle per vaginal
• History of quickening absent

14. SIGN
• Patient look more ill
• Pallor
• Features of pre-eclampsia
• Absent FHS or fetal part
• Increase HCG level
• More size of uterus

15. Complication
• Molar pregnancy that continues or comes back.
• Perforation of uterus
• Pelvic sepsis
• haemorrhage
• Pre-eclampsia

16. Abid Ayaz
Roll No: 59

17. Medical management
• Methotrexate is a medicine which stops the rapid
growth of the hydatidiform mole.
• Methotrexate is given as an injection into a
muscle on every second day for one week. You
will also be given folinic acid tablets to be taken
30 hours after each methotrexate injection.

18. Surgical management
• Surgery for Hydated form mole
• The surgeon uses a thin tube to gently suck out
the molar tissue. Sometimes they might also use
a sharp instrument to cut the tissue away from the
womb lining. This is called dilation and curettage
(D & C). This treatment gets rid of all of the molar
tissue .

19. Health assessment
• pelvic examination :
• A pelvic examination may show signs similar to a
normal pregnancy, but the size of the womb may
be abnormal and the baby's heart sounds are
absent. There may be some vaginal bleeding.
• ultrasound :
• A pregnancy ultrasound will show an abnormal
placenta with or without some development of a
baby

20. Wajid Ullah
Roll No:55

21. Lab investigation
• Complete blood cell count with platelets and
blood type
• Ultrasonography: charateristic feature of
hydatidiform mole is snow storm appearence
• X-ray
• Ct scan
• MRI of the obdamen

22. Nursing diagnosis
• Weakness related to excessive bleeding and
vomiting
• Deficient Fluid Volume r/t active fluid loss due to
bleeding and vomiting
• Abdominal pain related to abnormal pregnency
and infection
• shortness of breath related to anemia

23. Conti....
• Disturbed sleep pattern related to pain
• Hyperthermia related to infection process.
• Anemia related to severe bleeding
• Anxaity related to change in health status.

24. Nursing intervention
• Administer antiemetic as ordered by the physician
• Monitor vital signs
• Elevate the head of the bed and position the
patient in semi Fowler's position
• Administer analgesic to relieve pain
• Assess nutritional status. Adequate energy reserves
are required for activity

25. Conti.....
• Assess the patient mental status.
• Prepare the patient for the surgery of removel of
hydatidiform mole.
• Prepare the patient for blood transfusion as
reqiured.

26. References
• Abeloff MD, Wolff AC, Weber BL, et al. In: Abeloff MD,
Armitage JO, Lichter AS, et al, eds. Clinical Oncology.
4th ed. Phila delphia, Pa: Elsevier; 2008: 1875–1943.
•
www.org/acs/groups/cid/documents/webcontent/003090-
pdf.pdf
• http://nci.cu.edu.eg/lectures/20PDF/Ch_6.pdfFundament
al of Gynaecology book by Arshad chohan