Gestational Trophoblastic Disease (Hyadtidiform)

Gestational Trophoblastic Disease

Abnormal proliferation and then degeneration of the trophoblastic villi.

Partial Mole

• Abnormal Placenta

• Some Fetal Development

• Forms when sperm fertilizes a normal egg and there are two sets of DNA from the father Rin the fertilized egg

Complete Mole

• Abnormal Placenta

• No Fetus

• Forms when sperm fertilizes an egg that does not contain the mother’s DNA

GTD | Stage 1

Disease is only in the uterus

GTD | Stage 2

GTD extends outside the uterus but is limited to the genital structures

GTD | Stage 3

GTD extends to the lungs and may or may not involve the genital tract

GTD | Stage 4

GTD has extended to the other distant sites

Risk of Gestational Trophoblastic Disease

• Age

• Prior molar pregnancy

• Prior miscarriage

• Birth control pills

• Family history

• Blood type

GTD Clinical Manifestation

• Uterus grows faster than gestation age

• Elevated hCg levels beyond normal pregnancy ranges

• Severe nausea and vomiting due to high hCg levels

• Symptoms of gestational hypertension can appear earlier than 20 weeks

• Vaginal Bleeding, which may begin as spots

• Unexplained weight loss

GTD Clinical Prevention

Only way (DO NOT GET PREGNANT)

Gestational Trophoblastic Disease Complications

• Rapid Uterine Growth

• Persistently Elevated hCH Levels

• Severe Nausea and Vomiting

• Early-Onset Gestational Hypertension

• Vaginal Bleeding and Explusion of Vesicles

• Malignant Transformation

• Emotional and Psychologist Impact

• Recurrence Risk

Rapid Uterine Growth

Abnormal trophoblasts cells grow rapidly, causing the uterus to exam faster than usual. This may mimic multiple pregnancy or a miscalculated gestational age, leading to potential delays in diagnosis

Persistently Elevated hCG Levels

hCG level sin GTD are abnormally high (up to 1-2 million IU compared to 400,000 IU in normal pregnancies

Severe Nausea VVomiting

Markedly elevated hCG levels are associated with extreme nausea and vomiting, exacerbating symptoms of early pregnancy

Vaginal Bleeding and Expulsion of Vesicles

By the 16th week, vaginal bleeding often occurs, starting as dark-brown spotting or a profuse fresh flow. Also accompanied with clear fluid filled vesicles

Malignant Transformation

If hCh levels plateau or rise after riverine evacuation, it suggests malignant, specifically choriocarcinoma. Metastasis may occur of not detected and treated promptly.

Emotional and Psychological Impact

Women may feel a profound sense of loss and inadequacy, as GTD mimics pregnancy but results in no viable fetus

Recurrence Risk

Women with GTD have an increased risk of experiencing a second molar pregnancy

Diagnostic Tests of GTD

• hCG test

• Ultrasound

Ultrasound

No fetal growth, only a snowflake pattern, no heart sounds.

hCG test

Abnormal trophoblast cells cause elevated hCG levels, detectable after 100 days of pregnancy.

Therapeutic Managnment/Treatment

• Pharmacologic Therapy

• Surgical Management

Pharmacologic Therapy

• Methotrexate

• Acinomycin D

• Cyclophosphamide

• Etoposide

• Cisplatin

• Leucovorin

Surgical Movement

• Suction dilation and currtage

• Hysterectomy

• Simple hystectomy

• Supracervical hysterectomy

Nursing Implementation

Assess abdominal girth and signs of hypertension in pregnant women.