The document presents a case study of a 35-year-old Filipino woman who experienced nausea, vomiting, and a positive pregnancy test. An ultrasound revealed a hydatidiform mole. She was referred for a dilatation and curettage procedure. The summary includes her medical history, physical assessment, admitting diagnosis of gestational trophoblastic disease/hydatidiform mole, treatment plan, nursing care plans, and education on prescribed medications including cefuroxime, mefenamic acid, and methotrexate.

1. A Case Presentation on
Gestational Trophoblastic
Disease (Hydatidiform Mole)
Group 6-B

2. I. PATIENT’SDEMOGRAPHICPROFILE
Name: O.P.
Permanent Address: La Trinidad, Benguet
Sex: Female
Civil Status: Married
Birthdate: April 29, 1987
Birthplace: Dapdapig, Gregorio Del Pilar, Ilocus Sur
Age: 35yrs. old
Citizenship: Filipino
Religion: Roman Catholic
Educational Attainment: College graduate
Occupation: Housewife

3. Patient experienced nausea and vomiting around the third
week of March. She then took a pregnancy test, and it turned
out to be positive. A day prior to consultation, the patient went
for a routine check-up with a private doctor. Ultrasound was
done, revealing a complex endometrial mass, a hydatidiform
mole, minimal synchronize hemorrhage, an intramural myoma,
and normal ovaries. Patient was advised for dilatation and
curettage in another institution. Patient was referred to the
institution of BGHMC for the procedure knowing she had
experienced vaginal bleeding twice, no hypogastric pain, no
contractions.
II. Present HealthHistory:

4. III. Past Healthand/ or Surgical History
In the year 2015, the patient had a visit to a
hospital regarding her warts on her hands; the doctor
then prescribed medication that can help relieve the
warts. That was the only instance when the patient had
a check-up; other than that, she was healthy.

5. Furthermore, according to the patient, she had
experienced common illnesses such as cough and colds, sore
throat, headache but never been positive with COVID-19
virus. She managed this illnesses with some home remedies
and with intake of over the counter drugs.

6. Family History
The patient has no family history of hydatidiform mole pregnancy. Though,
in her family, only her maternal grandmother has a history of illness, which is
leukemia; all of her other family members have no known diseases, including
her husband.
Social Economic Status
Patient was a domestic helper in the past three years in Hong Kong.
Currently, she is a housewife; she used to stay at home and do all the household
work and sometimes help her husband on the field. Meanwhile, her husband is a
farmer, which is where their main source of income comes from.

7. IV. Reviewof Systems
The vital signs of the patient on the day of admission are as follows: BP: 100/60, temp: 36.7C
SPO2: 98%, CR:76, RR:18. The patient is weighing 53kg and 5’2cm tall.
Psychosocial
With regards to her level of consciousness, she responds, understands instructions, and has
the ability to comprehend. The patient was alert and oriented to time and place. The patient
shows signs of stress and grieving.
Elimination
The patient was able to eliminate normally with a balanced fluid input and urine output. The
patient defecates once a day and urinates not more than 5 times a day.
Activity and Mobility
Upon admission patient was able to ambulate and can do activities of daily living. There’s
no damage to daily functions. However, after the (D&C) procedure she needed minimal
assistance for the first few hours as the effects of the anesthesia didn’t completely wear off.

8. Rest and Sleep Status
Patient claims that she can sleep with an intermittent sleep of 7 hours upon hospitalization,
which is not enough for her as she verbalized. No evidence of fatigue or restlessness is observed.
Safety
Health care provided all the safety measures and security that the patient needed. This
includes keeping the side rails-up, keeping the patient’s things within reach, assisted in urinating
and changing clothes especially after the D&C procedure.
Oxygenation
The patient’s vital signs are within normal range, no difficulty of breathing and pallor are
noticed.
Nutritional Status
Prior to admission, clients consume three meals a day. Her meals are to be given having gap
of 6 hours within breakfast to lunch and same with dinner. On the other hand, in their home, she
mostly eats nutritious foods like vegetables and fruits and has a balanced diet. The patient has no
allergy to any kind of food.

9. V. ADMITTINGAND/ OR FINALDIAGNOSIS
G1P0 gestational trophoblastic disease, hydatidiform mole, 9
& 6/7 weeks AOG
Admitting Physician: Dr. Domingo & Dr. Domitas

10. Ultrasoundimpression:
Complex Endometrial mass, consider Hydatidiform mole,
Minimal Subchorionic Hemorrhage, Small Intramural myoma,
Normal ovaries.
CHEST X-RAYresult:
Normal cardiopulmonary findings

11. VI.
P
A
T
H
O
P
H
Y
S
I
O
L
O
G
Y
Fertilized haploid ovum
duplicates
Two sperm fertilizes ovum
without nucleus
Two sets of 46XX chromosomes with only
paternal DNA are produced.
Abnormal Fertilization
Increased proliferation of trophoblastic cells. Trophoblast
tissue grows into abnormal masses.
Abnormal masses continuous to duplicate and fill
the uterus.
Complete Hydatidiform Mole
Medications:
Methotrexate
Cefuroxime
Tranexamic Acid
Mefenamic Acid
Clindamycin
Nursing Responsibilities
- Review history of the pregnancy.
-Administer IV fluids as prescribed.
-Provide client and family teaching.
- Addressed emotional and psycho social needs’
- After D&C patient is at risk for infection. Make sure
that the patient has a good perineal hygiene.
Signs and Symptoms:
Vaginal Bleeding
+Pregnancy test
No fetal heartbeat and
movement
Nausea and Vomiting
COITUS

12. VII. PLAN OF CARE
Assessment Nursing
Diagnosis
Planning Nursing Intervention Rationale Evaluation
Subjective:
“ Nasakit
daytuy sugat ko
karu nu
agtutiak”, as
verbalized by
the patient with
rated pain of
7/10 as 1 as
the lowest and
10 as the
highest
Objective:
- Facial
grimace
noted
- Expressed
behavior of
pain such as
moaning
- Constant
position
changes to
relieve pain
- Guarding
Acute pain
related to
post
operative
procedure
Short Term Goal:
After 4 hours of
nursing
intervention the
patient will be able
to verbalize relief
from pain
Long Term Goal:
After 8 hours of
nursing
intervention the
patient will be able
to demonstrate use
of relaxation
skills and is at
ease.
1. Monitor and recorded vital
signs
2. Assess the severity,
frequency and characteristic
of pain.
3. Accept client description of
pain
4. Provide non-
pharmacological intervention
such as and frequent
changing of position.
5. Instruct and encourage to use
of relaxation techniques such
as deep breathing exercises
6. Assist in different position
like sitting and side lying
position.
7. Administer medications such
as NSAID drugs.
8. Encourage patient to report
any changes of the pain.
1. For baseline data
2. Pain is subjective data
therefore, it should be
reported and to
determine patents level
of pain.
3. Pain is subjective
experience and cannot
be felt by others
4. To provide comfort.
5. To distract attention and
to reduced tension.
6. It reduces muscle
tension and fatigue
7. Help to reduce pain
8. For early detection of
problems
Short Term Goal:
Goal was met
after 4 hours of
nursing intervention
the patient was able
to verbalized relief of
pain.
Long Term Goal:
Goal was met after 8
hours of nursing
intervention the
patient will
demonstrate use of
relaxation skills and
is at ease.
Nursing Care Plan 1.

13. Assessment Nursing
Diagnosis
Planning Nursing Intervention Rationale Evaluation
SUBJECTIVE:
“ medyo naangut
jay rumrumwar
ijay pads ko” as
verbalized by the
patient.
OBJECTIVE;
-with minimal
vaginal discharges
-No swelling noted
Vital signs taken as
follows:
BP: 90/60mmHg
Temp: 37.5ºc
CR: 60 bpm
RR: 16bpm
SPO2: 98%
Risk for
infection related
to invasive
procedure
secondary to
dilatation and
curettage
SHORT
TERM:
After 2 hours of
nursing
intervention the
patient will be
aware of the
signs and
symptoms of any
infections.
LONG TERM:
After 8 hours of
nursing
intervention the
patient will be
free from any
signs of
infections.
1. Assess for any signs and
symptoms of infection.
2. Assess for the appearance
of urine.
3. Monitor vital signs
specially temperature.
4. Instruct to practice and
demonstrate proper hand
hygiene.
5. Instruct to practice proper
perineal care and don’t use
tampons.
6. Administer antibiotic
medications.
7. Encourage increase fluid
intake.
8. Encourage to count and
observe the characteristics
of pads every change.
9. Advise to report if swelling
on the private part are
noticed.
1. For early detection of
problems.
2. Cloudy, foul-smelling
urine with visible
sediment is indicative of
UTI.
3. Serve as a baseline data.
Elevated temperature
can indicate presence of
infection.
4. Hand hygiene is the
first-line of defense to
limit the spread of
infection.
5. To prevent infection and
for comfort.
6. Serves as a prophylaxis
or to prevent infection.
7. To prevent urinary tract
infection.
8. Characteristics of
discharges can help
detect if there is an
infection.
9. Swelling can indicate
infection.
SHORT TERM:
Goal was met after 2
hours of nursing
intervention the
patient will be
aware of the signs
and symptoms of
any infections.
LONG TERM:
Goal was met after
8 hours of nursing
intervention the
patient was free
from any signs of
infections as
evidenced by
normal vital signs.
NURSING CARE PLAN 2.

14. Assessment Nursing
Diagnosis
Planning Nursing Intervention Rationale Evaluation
SUBJECTIVE:
“Awan kanu
nabuo, spotting
lang sunga nasakit
ken
masaysayangan
ak” as verbalized
by the patient
OBJECTIVE;
- The patient is
observed to be
silent most of the
time.
- Sad facial
expressions and
social isolation are
observed.
Grieving related
to anticipatory
loss of
significant
other.
Short Term
Goal:
After 8 hours of
nursing
intervention the
patient will
develop and
understand
coping strategies
and skills to help
manage own
emotions and
cope with the
loss.
Long Term
Goal:
After 5 days of
nursing
interventions the
patient will
achieve a sense
of closure and
acceptance by
1. Assess emotional state .
Note cultural beliefs
expectation.
2. Determine as to what stage
is the client grieving.
3. Make time to listen and
encourage patient’s
significant others to
verbalize feelings.
4. Identify spiritual concern
discuss available resources
and encourage participation
in religious activities.
5. Encourage to seek comfort
from significant other.
6. Encourage continuation of
usual activities.
7. Encourage to seek help
from professionals if
needed.
1. Anxiety and depression
are common reaction to
losses associated with
miscarriage pregnancy
loss.
2. To provide appropriate
care.
3. Its is more helpful to
allow feelings to be
express and facilitate
successful resolution of
grief.
4. Involving in religious
activities helps to
improve emotional and
mental well-being.
5. Support from others can
help in dealing with the
situation.
6. This helps in distracting
the mind not to always
think of the situation.
7. This can help to make
sure the patient doesn’t
fall for depression.
Short Term Goal
The goal was met
after 8 hours of
nursing intervention
the patient will
develop and
understand coping
strategies and skills
to help manage own
emotions and cope
with the loss.
Long Term Goal:
The goal was met
after 5 days of
nursing
interventions the
patient will achieve
a sense of closure
and acceptance by
exploring feelings,
NURSING CARE PLAN 3.

15. VIIi. Drug study
Drug
Nomenclatur
es
Drug
Classification
Mechanism
of Action
Indication and
Contraindication
Side Effects and /or Adverse
Effects
Nursing Actions
Generic
Name:
Cefuroxime
Brand Name:
Axetil
Dosage:
500 mg
Frequency:
BID
Therapeutic
Classification:
Antibiotics
Pharmacologic
classification:
Second
generation of
cephalosporin
Cephalosporins
work as
bactericidal
antibiotics that
binding to
penicillin
binding
protein,
inhibits the last
step of
bacterial cell
wall synthesis.
Indication:
Treatment for variety
of infection like skin
infection, gonorrhea,
UTI, and impetigo.
Contraindication:
Hypersensitive to
drugs and other
cephalosporins,
hypersensitive to
penicillin
Phlebitis, diarrhea. Nausea and
vomiting, pain, anaphylaxis,
temperature elevation.
• Monitor signs and
symptoms of
superinfection,
diarrhea, and
treat accordingly.
• Don’t confuse
drug with other
cephalosporins
that sound alike.
• Drug may
increase INR and
risk for bleeding.
Drug Study 1.

16. Drug Study 2.
Drug
Nomenclatures
Drug
Classification
Mechanism of
Action
Indication and
Contraindication
Side Effects and /or Adverse
Effects
Nursing Actions
Generic Name:
Mefenamic Acid
Brand Name:
Mefenamic
Ponstell
Dosage: 500 mg
Frequency:
3 times a day
Member of the
fenamate group of
nonsteroidal anti
inflammation
drugs (NSAID)
Mefenamic Acid
binds the
prostaglandin
synthetase
receptors,
inhibiting the
action of
prostaglandin
synthetase. As
these receptors
have a role as a
major mediator of
inflammation
and/or a role for
prostanoid
signaling and
activity dependent
elasticity, the
symptoms of pain
are temporarily
reduced.
Indication:
The treatment of
heredity
angioedema,
cyclic heavy
menstrual bleeding
in premenopausal
females and other
instance of
significant
bleeding in the
context of
hyperfibrinolysis.
Blurred vision, unexplained weight
gain, fever, rash, itching, hives,
pale skin, fast heartbeat, exclusive
tiredness.
• Notify physician if
persistent GI
discomfort, sore throat ,
fever, and malaise
occur.
• Educate patient
regarding desired and
adverse effects of the
drug
• Assess for the
occurrence of GI ulcer
after taking the drugs.
• Advice the patient to
take in medicine after
meals.

17. Drug Study 3.
Drug
Nomenclatures
Drug
Classification
Mechanism of
Action
Indication and
Contraindication
Side Effects and /or
Adverse Effects
Nursing Actions
Generic Name:
Methotrexate
Brand Name:
Trexall
Chemotherape
utic and
immunosuppre
ssant agent.
Methotrexate’s
mechanism of
action is due to
inhibition of
enzymes
responsible for
nucleotide
synthesis
including
dihydrofolate
reductase,
aminoimidazole
carboxamide
ribonucleotide
transformylase
(AICART) , and
aminopropyl
ribosyl transferase.
Inhibition of
nucleotide
synthesis prevents
cell deviation.
Indication:
gestational
choriocarcinoma
destruens, hydatidiform
mole, breast cancer,
leukemia, auto-immune
disease, Crohn’s disease
Contraindication:
Pregnancy, alcoholic liver
disease, chronic liver
disease,
immunodeficiency
syndromes, preexisting
blood dyscrasias.
Redness of skin, excess uric
acid in the blood, swollen
tongue, nausea and
vomiting, diarrhea, fever,
headache, loss of appetite,
sore throat, rash, fatigue,
dizziness, chills..
• Assess if the patient has
liver disorders,
immunodeficiency
syndrome, preexisting
blood dyscrasias
• Inform the patient on
the side effect that she
may feel.

18. Drug Study 4.
Drug
Nomenclatures
Drug
Classification
Mechanism of
Action
Indication and
Contraindication
Side Effects and /or
Adverse Effects
Nursing Actions
Generic Name:
Tranexamic Acid
Brand Name:
Hemostan
Route: IV
Dosage: 1g
Frequency:
Every 8 hours
Anti-
fibrinolytic
Diminishes
dissolution of
hemostasis fibrin,
which decreases
bleeding.
Indication:
Short term management
of hemorrhage
Contraindication:
Hypersensitivity active
thromboembolic disease.
History of intrinsic risk of
thrombosis or thrombo-
embolism, including
retina vein or artery
occlusion.
Use of combination
hormonal contraception.
Visual and ocular
disturbance, retinal vein
and artery occlusion,
ligneous conjunctivitis,
thromboembolic event
convulsions.
• Administer medication
slowly
• Stabilize IV catheter to
minimize
thrombophlebitis
• Be alert for bleeding of
gums unusual bleeding
or bruising
• Caution patient to
make position changes
slowly to avoid
orthostatic
hypotension.

19. IX.CONCLUSION
A complete hydatidiform mole(H-mole) occurs when an enucleated ovum
was fertilized by two sperms, also it happens when a haploid ovum was
fertilized by a normal sperm then duplicated, resulting in a complete
absence of genetic material from the mother.
The patient experienced signs and symptoms of normal pregnancy such as
vaginal bleeding, nausea, and vomiting.
A factor that influenced the patient to develop the disease was her age,
because this disease is more common in women who are 35 years old and
older.
Laboratory tests and diagnostics were done to confirm the patient's
diagnosis.
To treat H-mole, a surgical procedure (dilatation and curettage) was done to
remove the molar pregnancy, followed by surveillance of serial human
chorionic gonadotropin (hCG) levels .

20. X.RECOMMENDATION
From the conclusions, the following recommendations are hereby suggested:
a. Inform patient that there is a bleeding for about a week after the D&C. The amount of
bleeding should be similar to a normal period.
b. Instruct the patient not to have sex or use tampons.
c. Instruct patient to use birth control methods until its safe to get pregnant again.
d. Inform patient on the proper perineal care and check for any signs of infections.
e. Advise pelvic rest for at least 2-4 weeks after evacuation of uterus.
f. Instruct to not become pregnant within a year after the removal of hydatidiform mole.
g. Advise to regularly visit her obstetrician for early detection of problems.
h. Encourage to eat nutritious foods for faster recovery.
i. Advise patient to seek emotional support from her significant other.
j. Advise patient to seek help from professionals if she feels depressed.

21. xI. NURSINGIMPLICATION
A. Health Education
-This case study is helpful for development and addition of
knowledge. This can establish, strengthen or weaken a historical
explanations of the case and in certain circumstances. It can aid
awareness to students for the particular case. Also, it serves as a
reference for the learning of the students especially in the case of
gestational trophoblastic disease(hydatidiform mole). Furthermore,
it may help in disseminating and educating students regarding
management and preventive measures leading to this kind of
illness. In this way it would help not only students but also people
around us.

22. B. Nursing Practice
-The said case study is an essential basis in the
nursing care of patients with trophoblastic disease. It
may help in disseminating and educating patients
regarding management and preventive measures in
adherence to medication. In this way it would help out
nurses to enhance their practice suited to the case of
their patients. Moreover, it implies a need of skilled
and knowledgeable health care provider.

23. C. Nursing Research
-The purpose of this case study is to review
background, treatments, physical therapy interventions
and outcomes of a patient with h-mole. This may
provide broad knowledge to learners willing to know
the case. The complexity of the case study implies a
deeper analysis on how to treat and manage patient
with similar cases efficiently and effectively.

24. xII. REFERENCE
Bruce,S. (2022).Gestational Trophoblastic Disease.Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK470267/
Msdmanuals.com (July 2015). Molar Pregnancy-Women’s Health. Retrieved from:
https://www.msdmanuals.com/home/women-s-health-issues/cancers-of-the-female-reproductive-
system/molar-pregnancy
Uptodate.com (February 23, 2023). Hydatidiform Mole-Treatment and Follow up. Retrieved from:
https://www.uptodate.com/contents/hydatidiform-mole-treatment-and-follow-up
Thewomens.org. (July 2017). Methotrexate treatment for hydatidiform mole. Retrieved from:
https://www.thewomens.org.au/images/uploads/fact-sheets/Methotrexate-treatment-for-your-
hydatidiform-mole.pdf
Tobing M.,et. Al (March 23, 2021). Excessive Proliferation of Trophoblast Cells.
Retrieved from:
https://www.dovepress.com/relationship-of-histopathological-representation-of-excessive-
proliferation-of-trophoblast-cells

25. Thank you very much!
OBSTETRICS WARD
GROUP 9 MEMBERS:
Angalan, Maylyn
Balag-ay, Queenie
Bumakil, Janelle Haze
Cayamdas, Myrna
Dao-asen, Marie Rose
Guibak, Joy
Linggayo, Chris Ivan
Mangay-at, Judy Ann
Padiwan, Aesha
Pilamon, Sabrina
Siw-angan, Zyra
Wangdali, Nordkyn

26. Thank you !