H-MOLE

• Other names of H-mole

  • gestational trophoblastic disease or hydatidiform mole
• What trimester does H-mole occur

  2nd trimester
• H-Mole

  • abnormal fertilized egg or an overgrowth of tissue
  • benign neoplasm of the chorion. The chorion fails to develop into a full term placenta and instead degenerates and become fluid filled vesicles
  • proliferation and edema of the chorionic villi
  • fluid-filled villi forms into grape-like clusters of tissues that rapidly grows
• What is the cause of H-mole

  unknown
• Etiology

  • Is unknown. Genetic, ovular or nutritional abnormalities could be responsible for trophoblastic disease
• Pathophysiology

  • Placenta tumor that develops after pregnancy has occurred, it may be benign or malignant. The risk of malignancy is greater with complete h-mole
  • Embryo dies and the trophoblastic cells continue to grow, forming an invasive tumor
  • Blood vessels are absent, as are fetus and an amniotic sac
  • Proliferation of placental villi that become edematous and form grape-like clusters, causing the uterus to be larger than expected for the duration of pregnancy.
• Types of H-mole

  1. COMPLETE H-MOLE
  2. PARTIAL H-MOLE
• COMPLETE H-MOLE


  • Develop from an anuclear ovum – contains no maternal genetic material an “empty ovum’
  • May lead to choriocarcinoma (gestational trophoblastic neoplasm) a life-threatening complication. Invasive malignant trophoblast.
• PARTIAL H-MOLE


  • Macerated embryo may be present with fetal blood in the villi
• RISK FACTORS

  • Increased or decreased maternal age 16 yrs and 35 yrs and above 
  • Low socioeconomic status: poor diet, low protein diet
  • History of abortion
  • CLOMID THERAPY – medication for ovulation
  • Abnormal gametogenesis: cells undergo mitosis and cell division
  • Problems with fertilization
• ASSESSMENT FINDINGS/ CLINICAL SIGNS

  • Uterus large for gestational age, rapid uterine enlargement inconsistent with the age of gestation
  • Persistent bleeding: Dark red or brownish. Intermittent or profuse vaginal bleeding by 12 weeks
  • Ultrasound findings: no fetus, presence of molar growth
  • Symptoms of PIH – becomes visible before 20 weeks – associated with H-MOLE. Excessive angiogenic proteins produced in H-MOLE (NEW BLOOD VESSELS FORMED)
  • Severe nausea and vomiting
• HCG levels in with women with H-mole

  1-2 million IU/L in 24 hours
• Normal HCG levels

  400,000 IU/L
• High levels of HCG will result to?

  Hyperemesis gravidarum
• COMPLICATIONS

  • Choriocarcinoma: most dreaded complication cancer of the placenta which affect the reproductive system – malignant, trophoblastic cancer, usually of the placenta
  • Hemorrhage: most serious during the early treatment phase
  • Uterine perforation – complications in the uterus
  • Maternal infection

   
• TREATMENT

  • evacuation of the mole: D AND C – prevent bleeding
  • HYSTERECTOMY – if patient is above 45 years old and no future desire to be pregnant
  • TABHSO – TOTAL ABDOMINAL BILATERAL HYSTERECTOMY SALPINGO – oophorectomy
  • HCG monitoring for one year – to make sure that the mother is not pregnant again
  • Signs of pregnancy can mask early signs of choriocarcinoma
• HYSTERECTOMY/ TABHSO

  • Hysterectomy: a surgical procedure to remove the womb (UTERUS)
  • TOTAL HYSTERECTOMY – remove the uterus and the cervix. Ovaries and fallopian tubes may or may not be removed
• TREATMENT (2)

  • Medical replacement: blood, fluids, and plasma replacement incase of blood loss
  • Chemotherapy for malignancy: methotrexate is the drug of choice
  • Chest X-ray or CT scan to detect early lung and other organ system it has been affected metastasis
• NURSING MANAGEMENT

  • Admission to the hospital
  • After the surgery: advise bedrest
  • Monitor vital signs, blood loss, intake and output
  • Maintain/ replacement of fluid and electrolyte balance
  • Provide psychological support assess mental status
  • Advise mother – no pregnancy for one year