2. Molar Pregnancy, Cervical Insufficiency

what are the two types of gestational trophoblastic disease?

• hydatidiform mole: abnormal growth of placental tissue, pregnancy is not viable

• choriocarcinoma: malignant trophoblastic tumor

what is a hydatidiform mole?

abnormal growth of placental tissue

• pregnancy is not viable

• caused by sperm fertilizing an empty egg or 2 sperm fertilizing one egg

what is a choriocarcinoma?

malignant trophoblastic tumor

• high risk for women with hydatidiform mole

how can a partial molar pregnancy develop?

two sperm fertilize one ovum, producing abnormal fetal and placental tissue

what pregnancy changes can occur with a hydatidiform mole?

• bump larger than expected

• very abnormally elevated hCG

• severe nausea and vomiting

how is a hydatidiform mole treated?

prompt evacuation of uterine contents

• done by dilation and curettage (D&C)

what procedure evacuates uterine contents in hydatidiform mole?

dilation and curettage (D&C)

• surgery: dilate the cervix + remove uterine tissue

after a molar pregnancy, _____ are monitored

serial hCG levels

why are serial hCG levels monitored after a molar pregnancy?

persistent or rising hCG can indicate remaining trophoblastic tissue or malignant disease

how long should pregnancy be avoided after a molar pregnancy? *

12 months

• a new pregnancy raises hCG and interferes with monitoring for persistent disease

• educate patient on this!!

what findings help identify gestational trophoblastic disease?

• vaginal bleeding resembling a miscarriage

• abnormal ultrasound findings

• high hCG levels

what nursing care is needed for gestational trophoblastic disease?

• prepare for D&C

• emotional support

• explain treatment and serial hCG monitoring

• explain prophylactic chemotherapy

what is cervical insufficiency?

premature, painless cervical dilation that can cause pregnancy loss or preterm birth

• might be chased by trauma

what activity restrictions may be prescribed for cervical insufficiency?

pelvic rest, avoid heavy lifting

what is a cervical cerclage?

a non-dissolvable suture placed around the cervix to help keep it closed

what findings suggest cervical insufficiency?

• pink-tinged vaginal discharge

• pelvic pressure

• cervical shortening on transvaginal ultrasound

what nursing care is needed for cervical insufficiency?

• closely monitor for preterm labor

• provide emotional support

• teach when to report contractions, bleeding, or fluid leakage