H-MOLE

What is gestational trophoblastic disease?

"Abnormal proliferation and degeneration of trophoblastic villi."

What happens to trophoblastic villi in GTD?

"They degenerate and become fluid-filled grape-like vesicles."

What is the appearance of molar vesicles?

"Clear, grape-sized fluid-filled cysts."

What happens to the embryo in complete molar pregnancy?

"It fails to develop beyond a primitive stage and dies early."

What serious condition is GTD associated with?

"Choriocarcinoma, a rapidly metastasizing malignancy."

What is the incidence of GTD?

"About 1 in 1,000 pregnancies."

Who is at higher risk for GTD?

"Women under 15, over 35, low animal fat diet, and Asian heritage."

What are the two types of molar pregnancy?

"Complete mole and partial mole."

What characterizes a complete mole?

"All villi are swollen and cystic with no fetal blood."

What is the chromosome pattern of a complete mole?

"46XX or 46XY from paternal origin only."

How does a complete mole form?

"Empty ovum fertilized or duplication of paternal chromosomes."

What characterizes a partial mole?

"Some normal villi with abnormal swollen trophoblastic tissue."

What is the chromosome pattern of a partial mole?

"Triploid (69XX or 69XY)."

How does a partial mole form?

"Two sperm fertilize one ovum or abnormal meiosis."

Does partial mole usually form a fetus?

"Yes, briefly, but it becomes nonviable and macerates."

Which type has higher risk of cancer?

"Complete mole."

Which type has lower hCG levels?

"Partial mole."

Why is hCG elevated in GTD?

"Due to overgrowth of trophoblastic cells."

What is the typical hCG level in GTD?

"1 to 2 million IU (very high)."

What is normal hCG in pregnancy?

"About 400,000 IU."

Why is uterus size important in GTD?

"It grows faster than expected for gestational age."

What is a classic ultrasound finding in GTD?

"Snowflake or snowstorm pattern with no fetus."

What is absent in GTD on ultrasound?

"Fetal growth and fetal heart tones."

What symptom often appears early?

"Severe nausea and vomiting (hyperemesis gravidarum)."

Why does hyperemesis occur in GTD?

"Very high hCG levels."

What early complication may appear before 20 weeks?

"Gestational hypertension signs."

What are symptoms of gestational hypertension?

"Edema, increased BP, proteinuria."

What is a common bleeding presentation?

"Dark brown spotting or profuse vaginal bleeding."

What may be passed during bleeding in GTD?

"Fluid-filled vesicles resembling grapes."

Why should tissue passed in miscarriage be examined?

"To detect GTD if vesicles are present."

What is first-line treatment for GTD?

"Suction curettage."

What is done after evacuation?

"Baseline exam and serial beta-hCG monitoring."

How often is hCG checked initially?

"Every few days for 2 weeks."

What is long-term hCG monitoring schedule?

"Weekly until negative, then monthly for 1–3 months."

What does rising or plateauing hCG indicate?

"Possible malignant transformation (choriocarcinoma)."

Why should pregnancy be avoided during follow-up?

"To avoid confusion with rising hCG levels."

What contraception is recommended during follow-up?

"Oral estrogen/progesterone contraceptives."

When is patient considered low risk after GTD?

"After 3 months of negative hCG levels."

Why is chemotherapy not given routinely?

"Not needed unless malignancy develops."

What drug is used if choriocarcinoma occurs?

"Methotrexate."

What is used for high-risk neoplasia?

"Combination chemotherapy."

How long is follow-up after malignancy?

"Up to 1 year before pregnancy is allowed."

What emotional response is common in GTD patients?

"Grief, anger, and feeling of unfairness."

Why do patients feel loss in GTD?

"They believed they were pregnant despite no viable fetus."

What reproductive concern do patients have?

"Fear of infertility or recurrence."

What is recurrence risk of GTD?

"Increased risk of another molar pregnancy."

What is recommended in future pregnancies?

"Early ultrasound screening."

What is a key nursing diagnosis?

"Anxiety or powerlessness related to pregnancy loss and possible malignancy."

What is priority nursing support?

"Emotional support and education about follow-up care."