L4 - Gestational Trophoblastic Disease (Hydatidiform mole)

Capacitation

1ST PHASE
Sperm cells undergo biochemical changes in the female tract to become “activated” and swim faster

Acrosome reaction

2ND STAGE
Sperm release enzymes to digest a path through the egg’s outer layers (Corona radiata and Zona Pellucida

Cortical Reaction

3RD STAGE
The moment the first sperm touches the egg membrane, the egg releases granules that harden its shell to block all other sperm (polyspermy block)

Meiosis II

4TH STAGE
The egg completes its final stage of cell dividion, discarding a “polar body” to make room for the new DNA

Syngamy

5TH STAGE FUSION
The DNA from the sperm (23 chromosomes) and egg (23 chromosomes) merge to form a single cell

Zygote

RESULT
A new, unique diploid cell (2n=46 chromosomes) is officially created

Gestational Trophoblastic Disease

is abnormal proliferation and then degeneration of the trophoblastic villi

Gestational Trophoblastic Disease

The embryo fails to develop beyond a primitive start.

Gestational Trophoblastic Disease

As the cells degenerate, they become filled with f luid and appear as clear fluid-filled, grape-sized vesicles

PHYSIOLOGY OF FERTILIZATION

Choriocarcinoma

Abnormal trophoblast cells must be identified because they ___, malignancy

Proliferation

multiplication and generation or cell death

Choriocarcinoma

cells that are considered as cancerous

Age >35

RISK FACTOR: The quality of the eggs can decrease. A molar pregnancy often happens because a "faulty" or "empty" egg

with no active genetic material

What is a faulty or empty egg

Age >35

There are no instructions from the mother’s side to grow a baby, the father’s DNA just keeps making placental tissue over and over

Low Protein & Vitamin A

RISK FACTOR: When a person is Low at __ & _

Protein and Vitamin A

the "quality control" team for cell division and are important component in cell division

Protein

is needed to build healthy DNA.

Vitamin A (Carotene)

helps cells decide what they are supposed to become

Genetic & Immunological Factors

RISK FACTOR: In certain pairings (like A and O), the mother’s immune system may fail to recognize and "check" the rapidly dividing foreign trophoblastic cells, allowing them to proliferate unchecked into vesicles.

Genetic & Immunological Factors

The link to Asian heritage and specific blood groups suggests a genetic predisposition.

COMPLETE HMOLE PATHOPHYSIOLOGY

Maternal DNA

is essential for the development of the fetus (the baby).

Paternal DNA

is responsible for the development of the placenta and membranes

Androgenetic mole

has only paternal DNA, it results in massive, abnormal overgrowth of placental tissue (the "mole") but no embryo or fetal parts.

PARTIAL PATHOPHYSIOLOGY

exceed normal size for gestational age

Rapid trophoblast proliferation causes the uterus to

1-2 million IU

Extremely high hCG levels ___ occur due to overgrowing cells, far surpassing the typical 400,000 IU seen in normal pregnancies.

Strongly positive

Levels remain __ after day 100 (when they normally decline), though this can also occur with multiple placentas (twins), that is why a thorough assessment is required.

Severe Hyperemesis

ASSESMENT: Marked nausea and vomiting due to abnormally high hCG levels.

Early onset-hypertension

Symptoms like edema and proteinuria appearing before 20 weeks (earlier than typical pregnancy-induced hypertension)

Snowflake pattern

Ultrasound reveals a characteristic ___ of dense growth with no fetal development.

Absent

Fetal Heart Tone is

Ranges from dark brown spotting to profuse fresh blood

Vaginal bleeding in approx Week 16 appears

fluid-filled cysts (vesicles)

Passage of clear, __. This is the key finding that distinguishes the condition from a standard miscarriage.

Suction Curettage

What is the Therapeutic Management to evacuate the mole

Baseline Post-Op

After doing Suction Curettage the nurse must perform

• initial

• maintenance

• malignancy

hCG Monitoring Schedule has 3 phases

Initial Phase

Tested every 2 weeks until levels return to normal. (4,000 IU)

Maintenance Red Flags

Tested every 4 weeks for the following 6 to 12 months.

plateau (3 consecutive times) or increasing

Malignancy Red Flags that can be cancerous

12 months

Duration of the Mandatory Contraception

Prevents a new pregnancy from causing a rise in hCG,because hCG can make malignancy indistinguishable

Why is Oral contraception required

Methotrexate

The primary drug for choriocarcinoma (malignancy). It is sometimes used prophylactically, though it carries a risk of leukopenia (low white blood cell count).

Methotrexate

Blocks the cell from using Folic Acid. The cell cannot make the DNA "ingredients" it needs. Cancer cells stop growing and die because they can't divide

Dactinomycin

Added to the treatment regimen if metastasis occurs

DNA Strand

What does Dactinomysis targets

Dactinomycin

It physically wedges itself inside the DNA helix. It acts as a permanent roadblock, stopping the cell from "reading" its genetic instructions. The cell’s machinery completely shuts down. — it will not multiply anymore

Early ultrasound screening

Women with a history of gestational trophoblastic disease have a higher risk of a second molar pregnancy that is why early __ is essential in all pregnancies