Hydatidiform Mole
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This chapter describes molar pregnancy and its clinical manifestations and treatment. Molar pregnancies are rare but occur as a result of an overproduction of placental cells which produce a mass but not a pregnancy.
Patients will have positive pregnancy signs such as a missed menses, a positive pregnancy test, breast tenderness, and nausea. The patient will also have a larger than gestational age-sized uterus.
Hydatidiform moles are also known as a molar pregnancy. The incidence is 1 in every 1,000 pregnancies and increases with advanced maternal age. The etiology is unknown. It is a form of gestational trophoblastic disease and is a result of a higher than normal production of the cells that originate in the placenta. This overproduction of cells produces a mass instead of a viable pregnancy.
There are two types of hydatidiform moles: complete (or classic) and partial mole. Approximately 10-15% of hydatidiform moles may develop into invasive moles or, more rarely, choriocarcinoma, a malignant form of cancer.
SIGNS AND SYMPTOMSSigns and symptoms are similar to that of an early pregnancy: amenorrhea, breast tenderness, and nausea as well as a positive pregnancy test. Vaginal bleeding may occur at about the 12th week in 95% of all cases. The client may believe she is experiencing a spontaneous abortion. Examination of the client may reveal an abnormal growth in the size of the uterus for gestational size. The client may also have symptoms similar to preeclampsia: hypertension, edema, and proteinuria.
The client may also have symptoms similar to preeclampsia: hypertension, edema, and proteinuria.
DIAGNOSIS AND TREATMENTA pelvic ultrasound confirms the absence of fetal heart tones or gestational sac. β-Human chorionic gonadotropin levels will be high due to the placental cells that comprise the tumor. Upon confirmation that there is no fetus, a dilation and curettage is performed. Tissue is sent to pathology for further examination and confirmation of diagnosis. Serum β-human chorionic gonadotropin levels are monitored until they return to nonpregnant levels.
SECTION V ♦ REVIEW QUESTIONS
1. An ectopic pregnancy can occur:
a. In the fallopian tubes
b. On the ovary
c. In the cervix
d. All of the above
View Answer
1. The answer is d. Rationale: Ectopic pregnancies can occur in the fallopian tube, on the ovary, in the cervix, or the abdominal cavity.
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