Hydatidiform Mole

Hydatidiform Mole Nursing Diagnosis Interventions and Care Plans

Hydatidiform Mole Nursing Diagnosis Interventions and Care Plans

Nursing Study Guide for Hydatidiform Mole

Gestational trophoblastic disease is a group of medical conditions arising from proliferation of abnormal cells inside a patient’s uterus.

Hydatidiform mole is one of these conditions wherein trophoblasts abnormally grow in the womb.

Instead of maturing into a normal pregnancy, this hydatidiform moles, or molar pregnancies, resemble fluid-filled cysts (called “moles”) that occupy the womb.

There are two forms of these pregnancies and they are either true molar pregnancies (complete) and partial molar pregnancies.

With complete molar pregnancies, the fetus and placenta fail to develop completely, and are characterized as cysts or moles.

In partial molar pregnancy, normal placental tissues may be present together with the abnormal moles.

If with fetal development, the fetus is not carried to term and is miscarried later in the pregnancy.

Signs and Symptoms of Hydatidiform Mole

Signs and symptoms of these molar pregnancies initially resemble normal pregnancies but are more pronounced.

  • First trimester bleeding, usually dark brown to bright red in color
  • Hyperemesis – severe nausea and vomiting
  • Passage of grape-like cysts
  • Pressure or pain of the pelvis
  • Anemia
  • Rapid uterine growth – too large for gestational age
  • Preeclampsia – hypertension in pregnancy
  • Proteinuria – heightened levels of protein in the urine
  • Hyperthyroidism – patients present with signs and symptoms of hyperthyroidism due to excess circulating HCG 
  • Pelvic pain

Causes and Risk Factors of Hydatidiform Mole

Human cells contain 23 pairs of chromosomes, one chromosome coming from both the father and mother.

Hydatidiform mole pregnancy arises from an abnormally fertilized egg. In complete molar pregnancy, the chromosomes of the mother are missing and the father’s chromosome is duplicated.

All of the genetic material is supplied by the father. In incomplete molar pregnancy, the mother’s genetic material remains but has two chromosomes set supplied by the father.

This results in the abnormal chromosome count of 69 instead of 46 resulting in errors in cell proliferation, and thus the development of hydatidiform moles.

Statistically, 1 in 1000 or about 0.1% of pregnancies is diagnosed a molar pregnancy.

Maternal age and previous history of molar pregnancy predisposes a patient to develop the condition.  

Complications of Hydatidiform Mole

1. GTN. In some instances, even after molar tissue is removed, the tissue continues to proliferate. This condition develops into persistent gestational trophoblastic neoplasia or GTN. This condition develops in approximately 15-20% of true molar pregnancies and 5% from incomplete molar pregnancies. One sign of GTN is elevated levels of HCG or human chorionic gonadotropin after the molar tissue is eradicated. This complication will continue to invade the surrounding uterine wall and will cause vaginal bleeding. Persistent GTN can be treated by either medical or surgical interventions. Treatment options involve administering chemotherapy or surgical resection of invasive molar tissue thru hysterectomy (surgical removal of the uterus).

2. Choriocarcinoma. Rarely, choriocarcinoma will develop. This condition arises mostly from complete molar pregnancies and can be treated by chemotherapy.

Diagnosis of Hydatidiform Mole

  1. Laboratory studies
  2. beta-HCG levels – extreme elevations of this pregnancy hormone may suggest molar pregnancy (greater than 100,000 mIU/ml)
  3. Complete blood count – to check for anemia and bleeding
  4. Clotting function tests – to exclude coagulopathy or its development
  5. Liver function tests
  6. Blood urea nitrogen and serum creatine levels – to check for excessive protein in the blood brought about by molar pregnancy
  7. Blood type and Rh factor
  8. Thyroxine levels – to check for development of hyperthyroidism brought about by the stimulation of abnormal molar tissue
  9. Serum inhibin and activin A levels – In molar pregnancies, values are 7 to 10 times higher when compared to patients with normal pregnancies of the same gestational age.
  10. Imaging : Ultrasonography – Observing for the presence of snowstorm pattern is one of the classic features of hydatidiform moles when using ultrasound. For high-resolution machines, landmark feature shows a complex mass composed of many small pockets or cysts.
  11. Histologic findings
  12. In complete molar pregnancy, several growth factors like c-myc, epidermal growth factor and c-erb B-2 are abundant when compared to normal placental tissues.
  13. In partial molar pregnancy, the cells are positive from the paternally imprinted genes like p57 and PHLDA2 and will show once tested for this.

Treatment for Hydatidiform Mole

Treatment options include multiple approaches and they are listed below:

  1. Medical care
  2. Treatment for presence of anemia
  3. Stabilizing the hemodynamic status of the patient
  4. Treating preeclampsia
  5. Anticipating for the development of thyroid storm – a complication of uncontrolled hyperthyroidism
  6. Administration of Rh immune globulin – to address complications of Rh incompatibilities of RhD-negative patients with incomplete molar pregnancies displaying the RhD antigen.
  7. Consultation with gynecologic oncologist for addressing risk of developing malignancy
  8. Activity adjustment thru pelvic rest of 2-4 weeks post evacuation of the hydatidiform mole and to plan pregnancy 6 months after.
  9. Monitoring of Hcg levels to identify development of malignancy. Monitoring after treatment is done at least 6 months to one year to ensure all molar tissues are eradicated.
  10. Surgical Interventions
  11. Dilatation and curettage – involves dilating the cervix and surgical resectioning the molar tissue inside the uterus
  12. Hysterectomy – only recommended for patients with high probability of developing Gestational trophoblastic neoplasia (GTN) and have no desire for future pregnancies

Nursing Care Plans for Hydatidiform Mole

Nursing Care Plan 1

Nursing Diagnosis: Deficient Fluid Volume related to heavy vaginal bleeding secondary to hydatidiform mole / molar pregnancy, as evidenced by an average blood pressure level of 85/50, body weakness, decreased urinary output, and pale, clammy skin

Desired Outcome: The patient will re-establish a functional body fluid volume and a balanced input and output status.

InterventionRationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.Edema, headaches, low blood pressure, and pain are associated with the patient’s blood loss. Fluid retention may be evident if the patient has an unexplained weight gain.
Start input and output monitoring.To monitor circulatory blood volume. To ensure that the patient has adequate oral hydration or if there is a need to commence IV hydration therapy.  
Speak to the patient and family about the need for hospitalization for the treatment of serious hemorrhage and the need for surgery.To treat the vaginal bleeding and deficient fluid volume related to hydatidiform mole in the appropriate setting.
Prepare the patient for the surgical intervention for hydatidiform mole. Place the patient on a nothing by mouth (NBM or NPO) status.Salpingostomy is the surgical removal of the unruptured hydatidiform mole from the fallopian tube utilizing laparoscopic technique. Salpingectomy is the surgical resection of the unruptured hydatidiform mole and the involved fallopian tube through laparoscopy.  Placing the patient on “Nothing By Mouth” (NBM or NPO) is necessary to prepare the patient for emergent delivery.
Prepare for blood transfusion as required.To increase blood volume.  
Encourage the patient to have a low salt intake.Consuming salt between 2 to 4 g per day is ideal as a very low salt intake may increase dehydration.

Nursing Care Plan 2

Nursing Diagnosis: Risk for Injury

Desired Outcome: The patient will maintain safety and participate in measures that will protect self during the treatment.

          Interventions                       Rationale
Assess the patient’s mental status. Hydatidiform mole may cause the patient to have low mood, depression, or negative emotional state, which puts her at risk for injury.
Monitor the patient’s level of consciousness using AVPU.  Heavy vaginal bleeding may result to hypotension and lower level of consciousness. Using AVPU scale (i.e.  Alert, Voice, Pain stimuli, or Unresponsive/unconscious) can help determine the urgency of surgical treatment and increased risk for injury.
Prepare the patient for surgical intervention for the removal of the hydatidiform mole.There are 2 surgical interventions for molar pregnancies: Dilatation and curettage – involves dilating the cervix and surgical resectioning the molar tissue inside the uterus Hysterectomy – only recommended for patients with high probability of developing Gestational trophoblastic neoplasia (GTN) and have no desire for future pregnancies  
Place the patient in complete bed rest if there is evidence of severe bleeding.To reduce pain and keep the patient safe

Nursing Care Plan 3

Nursing Diagnosis: Acute Pain related to hydatidiform mole as evidenced by pain score of 10 out of 10, verbalization of pelvic pain, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed pain medications.To alleviate the symptoms of acute pelvic pain.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of pelvic pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed and position the patient in semi Fowler’s.To increase the oxygen level by allowing optimal lung expansion.
Place the patient in complete bed rest during severe episodes of pain. Perform non-pharmacological pain relief methods such as relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.To provide optimal comfort to the patient.
Prepare the patient for surgery.There are 2 surgical interventions for molar pregnancies: Dilatation and curettage – involves dilating the cervix and surgical resectioning the molar tissue inside the uterus Hysterectomy – only recommended for patients with high probability of developing Gestational trophoblastic neoplasia (GTN) and have no desire for future pregnancies  
Post-surgery, advise the patient to: Have no strenuous activity for a few weeks.Apply support on the abdomen when coughing, laughing, or moving by placing a pillow over the pelvic areaInform the healthcare team if the pain medications are not workingTo reduce post-surgical pain and allow full recovery and healing.

Other Nursing Diagnoses:

  • Risk for Shock
  • Risk for Infection
  • Powerlessness

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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