Obstetrics and gynaecology

1. SEMINAR
ON
“GESTATIONAL TROPHOBLASTIC DISEASE”
PRESENTED BY –
PREETI KULSHRESTHA
M.SC NURSING FINAL YEAR

2. MEANING
• Gestational = pregnancy
• Tropho = nutrition
• Blast = bud/ early developmental cell
• Disease = illness

3. DEFINITION
• Gestational Trophoblastic Disease refers to the spectrum of
proliferative abnormalities of the trophoblast associated with
pregnancy.
• It is also known as Molar Pregnancy.

4. .

5. CLASSIFICATION
GESTATIONAL TROPHOBLASTIC DISEASE
BENIGN MALIGNANT
HYDATIDIFORM MOLE 1. GESTATIONAL TROPHOBLASTIC NEOPLASIA
COMPLETE / CLASSIC PERSISTENT TROPHOBLASTIC DISEASE
INCOMPLETE / PARTIAL PLACENTAL SITE TROPHOBLASTIC TUMOR
INVASIVE MOLE DISEASE
CARCINOMA
2.NON METASTATIC
3.METASTATIC

6. HYDATIDIFORM MOLE (H. MOLE)
DEFINITION –
• “HYDATIDIFORM MOLE is an abnormal condition of the
placenta where there are partly degenerative and partly proliferative
changes in the young chorionic villi”.
• “This is an abnormal high risk pregnancy where chorionic villi are
transformed into mass of translucent vesicles like bunch of grapes.”

7. INCIDENCE-
• In India, the incidence is 1 in 500
• In Philippines, the incidence is high that is 1 in 80
• In European countries, the incidence is low that is 1 in
752
• In USA, the incidence is 1 in 2000

8. ETIOLOGY / RISK FACTORS -
• Cause is unknown.
• Ovular defects
• Hemorrhagic pregnancies
• Pregnancies in woman above 35 yrs. of age
• Faulty nutrition
• Low diet
• Disturbed maternal immune mechanisms.
• H/o hydatidiform mole.
• Cytogenic abnormality – 1. complete = 46xx,46xy (diploid)
2. partial = 69xxy,69xxx,69xyy (triploid)

9. TYPES -
There are two types of H.mole –
1. COMPLETE OR CLASSIC H.MOLE : -
It results from fertilization of an egg whose nucleus has been lost or
inactivated.
It contains fetus, placenta, amniotic membrane of fluid.
No placenta, no embryo
May be progress toward carcinoma.
2. INCOMPLETE OR PARTIAL MOLE : -
Embryonic or fetal part and amniotic sac are present.
Congenital anomalies are usually present.

10. PATHOGENESIS -

11. PATHOGENESIS -

12. CLINICAL FEATURES
• SIGNS :-
Pt looks more ill.
Pallor is present.
Pre-eclampsia
• SYMPTOMS :-
Vaginal bleeding
Varying degree of lower abdominal pain.
Pt appears sick
Vomiting in pregnancy
Dyspnea due to pulmonary embolism
H/o quickening is absent
Morning sickness
ptyalism

13. Contd.
• PER ABDOMEN :-
Size of uterus is more than gestational period.
Firm uterus
No fetal part
No FHS
• VAGINAL EXAMINATION :-
Unilateral/bilateral enlargement of the ovary.
Vesicles in vaginal discharge.
Opened cervical Os

14. INVESTIGATION -
Full blood count
ABO and Rh grouping
Hepatic, renal and thyroid function test
Sonography
X-ray abdomen
HCG immunoassay
CT scan and MRI

15. COMPLICATION -
There are divided into two :
1. IMMEDATE COMPLICATION :-
 hemorrhage and shock
Uterine sepsis
Uterine perforation
Pre-eclampsia
Acute pulmonary insufficiency
Coagulation failure
2. LATE COMPLICATION :-
Development of choriocarcinoma

16. MANAGEMENT -
PRINCIPLES :-
• Supportive therapy.
• Suction evacuation of uterus.
• To minimize infection.
• Counseling for regular follow up.

17. MEDICAL MANAGEMENT
• In women aged over 35, pt. is given daily tab. ferrous sulphate 20 mg 3
months
• Anti D immunoglobulin 100 micro gm. IM is given to Rh negative
woman.
• Advise mother to use contraceptives devices for 1 yr. to trace HCG level
• If the beta HCG level fails then chemotherapy is started with :-
- inj. Methotrexate 50mg IM alternate days for 5 days.
- repeat course every 2weeks till HCG becomes negative .
• Check for vaginal bleeding. If present, ergometrine 0.5 mg is given IM.

18. NURSING MANAGEMENT -
• Quickly mother’s blood, ABO and Rh is estimated.
• Fluid infusion is started.
• Blood transfusion is given in blood loss.
• Uterus can be quickly emptied of mole by suction.
• After evacuation vital sign of pt. are noted every half hourly.

19. Surgical management -
• In case of women wishes to have child in future S&E is done.
• Hysterectomy is done if the pt. is over 40 yrs.

20. NURSING DIAGNOSIS –
• Acute pain related to uterine contraction .
• Risk for fluid volume deficit related to excessive vascular
loss.
• Ineffective uteroplacental tissue perfusion related to
abnormal trophoblastic proliferation.
• Risk for maternal injury related to blood loss, abnormal
blood profile, impaired immune system.
• Fear related to fetal loss and outcome of pregnancy.