Gestational Trophoblastic disease

Question 1

What is Gestational Trophoblastic Disease (GTD)

Answer 1

The proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid filled, and takes on the appearance of grape like clusters. The embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma, which is a rapidly metastisizing malignancy.

Question 2

What are the two types of GTD?

Answer 2

• Complete Mole
• Partial Mole

Question 3

What are the characteristics of a Complete Mole?

Answer 3

• all genetic material is paternally derived
• the ovum has no genetic material, or is inactive
• the complete mole contains no fetus, placenta, amniotic membranes or fluid
• there is no placenta to receive maternal blood. Hemorrhage into the uterine cavity occurs, and vaginal bleeding reuslts
• 20% of complete moles progress to being a choriocarcinoma

Question 4

What are the characteristics of a partial mole?

Answer 4

• Genetic material is derived both maternally and paternally
• A normal ovum is fertilized by two sperm or one sperm in which meiosis or chromosome reduction and division did not occur
• A partial mole often contains abnormal embryonic or fetal parts, an amniontic sac and fetal blood, but with congwnital abnormalities.
• 6% progress toward being a choriocarcinoma

Question 5

What are the risk factors for GTD?

Answer 5

• Previous molar pregnancy
• Maternal age - early teenage or over 40

Question 6

How does a mother with GTD present?

Answer 6

• Excessive vomiting (hyperemesis) dues to elevated HCG levels
• Rapid uterine growth more that expected for gestation due to the overproliferation of trophoblastic cells
• Anemia from blood loss
• clinical findings of pre-eclampsia before 24 weeks of gestation
• Bleeding often dark brown resembling prune juice or bright red and can be accompanied by passage of vesicles
• Bleeding continues for a few days or intermittently for a few weeks

Question 7

What are the excpected Lab findings for GTD?

Answer 7

Serum HCG is persistently high compared with expected decline after weeks 10-12 of pregnancy

Question 8

What diagnostic procedures are used for GTD?

Answer 8

Ultrasound to reveal growth of molar vesicles.

Question 9

What is the treatment for GTD?

Answer 9

• Suction curettage to aspirate and evacuate the mole
• Post-surgery, RH- clients given rhogam
• follow up pelvic exam and ultrasound
• Serum HCG to be done weekly for three weeks, then monthly up to a year to detect further GTD
• Chemotherapeutic medication on finding of malignant cells indicating choriocarcinoma

Question 10

Nursing Care for GTD

Answer 10

• Measure fundal height
• Assess vaginal bleeding and discharge
• Assess GI status and appetite
• Monitor for manifestations of pre-eclampsia
• administer medications as described
• Advise client to save clots or tissue for evaluation
• Client education and emotional support

Question 11

Patient education for GTD

Answer 11

• Consider pregnancy loss support groups
• Important to use reliable contraceptives for at least a year to avoid pregnancy (but not IUD). so as not to interfere with HCG monitoring
• Follow up is essential to avoid choriocarcinoma