GESTATIONAL TROPHOBLASTIC DISEASE

HYATIDIFORM MOLE

H-MOLE

I.IntroductionThe purpose of this case study is to be

familiar with Molar Pregnancy. How it is starts, what causes it and what are the signs and symptoms.

A.Definition

is a mass of abnormal rapidly growing trophoblastic tissue in which avascular vesicles hang in grapelike clusters THAT PRODUCE LARGE AMOUNTS OF HCG.

B. Predisposing factors: •17 years old below and 35 yrs. Above•Low socio-economic status•Low protein intake•Previous mole•Higher incidence in Asian women

C. Types:1. COMPLETE MOLE – LACKS AN EMBRYO OR

FETUS 2. PARTIAL MOLE – INVOLVES A

CHROMOSOMALLY ABNORMAL EMBRYO OR FETUS.

- 69 XXX or 69 XXY

D. Causes:1. SPERM + OVUM = 46 (COMPLETE MOLE) (23) (0) 2. SPERM + OVUM = 69 (PARTIAL

MOLE) (46) (23)3. SPERM + SPERM + OVUM = 69 (PARTIAL

MOLE) (23) (23) (23)The cause is not completely understood

although potential causes, e.g., defects of the ovum (egg), abnormalities within the uterus, and/or nutritional deficiencies, have been suggested. The incidence is increased in women under 20 or over 40 years old. Risk factors implicated include low socioeconomic status and diets low in protein, folic acid, and carotene

E. Signs & Symptoms•Rapid increase in uterine size greater than gestational age of the fetus•Marked increase HCG titer•Excessive nausea and vomiting due to elevated HCG•Brownish vaginal discharge around 4th month containing grapelike vesicles•No FHT is detected after 10 to 12 weeks, no fetal movement after 18-20 weeks•No fetal parts•Painless bleeding on the 4th to 5th month of pregnancy

II. BIOPHYSICAL DATA

A.) Patients Personal DataPatients Name: “Patient MJ”

Age: 29 years old

Gender: Female

Civil Status Married

City Address:7947 N.T. Garcia St., Sta Rosa, Laguna

Nationality: Filipino

Educational Attainment: High School Graduate

LMP October 18, 2011

AOG 16-17 weeks (G1P0)

Vital Signs

VITAL SIGNSACTUAL VALUE NORMAL VALUE INTERPRETATION

Blood Pressure

110/70 mm/Hg 120/80 mmHg + Hypotension

Respiratory Rate

24 cycles/minute

12-20 breaths/minute + Tachycardia

Pulse Rate

98 beats/minute

60-100 beats/minute

(-) Tachycardia, within normal limits

Temperature

36.4 degrees celsius

36.5-37.5 degrees celsius

Afebrile, Within Normal Limits

Chief ComplaintsClient complains of “dinudugo po ako” As

verbalized by the subject. B.) History of Present IllnessAround the 1st week of February, the patient experienced brownish vaginal discharge with grapelike vesicles. She was alarmed and went to a clinic for a check up. She was then referred to East Avenue Medical Center then she was told to complete a set of laboratory tests the resident doctor requested. It was only then when she found out that she had Gestational Trophoblastic Hyatidiform Mole. Methotrexate was ordered for 5 days and then D & C.

C.) Past Health HistoryThe patient has no allergy to any drug or any

type of food. According to her, she completed her immunization. She does not usually get coughs or colds but experiences fever at times due to weather conditions.

D.) Family Health History Father Side Mother

SideHypertension (-) (+)

Diabetes (+) (-)

Cancer (-) (+)

Obesity (-) (-)

Cigarettes (-)  

Alcohol (-)  

III. Gordon’s Functional Health Pattern1. Health Perception/Health Management:

The patient rely more on self medicating with over the counter medicines when sick with cough or colds. She also makes use of herbal medicines that can relieve and cure her sickness.

2. Nutrition and Metabolic Pattern3 Day Food Recall

Day 1 Day 2 Day 3

Breakfast: 3-4 pcs of pandesal, 10 grams of peanut butter, 1 cup of coffee & 1 glass of water

Breakfast: A fried egg, 1 cup of fried rice, 2 pcs of dried fish (tuyo), 1 cup of coffee & 1 glass of water

Breakfast: 3-4 pcs of pandesal, 2 slice of cheese, 1 cup of coffee & 1 glass of water

Snack: none Snack: none Snack: none

Lunch: 2 cups of rice A bowl of sinigang with 100 grams of meat and 50 grams of vegetables, 1 glass of juice & 1 glass of water

Lunch: 1 cup of rice, a bowl of 100 grams braised beef, 2 glasses of water

Lunch: 2 cups of rice,1 piece of 150 grams fried fish, 1 piece of banana & 1 glass of water

Snack: none Snack: none Snack: none

Dinner: 1 cup of rice, A bowl of sinigang with 50 grams of meat and 25 grams of vegetables, 1 glass of water

Dinner: 1 cup of rice, a bowl of 100 grams braised beef, 1 glass of water

Dinner:1 cup of rice, 1 piece of 150 grams fried fish, 1 piece of banana & 1 glass of water

Snack: none Snack: none Snack: none

3. Elimination Pattern She has no problem regarding elimination. She has her regular

bowel movements every morning. 4. Activity Exercise PatternHer day typically starts with opening the store and going to market to buy stocks and purchase the dish for the day. After that she cooks and does the house hold chores. She has no particular mention of routine exercise; she considers her daily chores and manning the store as her daily routine of activity pattern.5. Sleep-rest PatternShe has an eight-hour sleep pattern. She hits the sack around 10 o’clock in the evening and wakes up around 6 o’clock in the morning. She has no trouble of initiating sleep.6. Cognitive –Perceptual PatternShe has no defects in the following: eyes, arms and legs and hearing, mental status. Self Perception/Self Concept PatternShe is so concerned with her family and aiming for a peaceful life. She exercises respect among her family members and others. She perceives herself as an ordinary member of the poor society.8. Role relationship PatternShe is friendly, a serious person and understands very well her role to society. She is a newly wed. She is very sweet and caring to her husband.

9. Sexuality-reproductive patternHer normal practice of sexual intercourse is 2-3 times a week. She does not feel any pain or any abnormality when having sex.

10. Coping/StressShe takes problem seriously and tries very hard to cope with it. She can’t settle unless she has resolved the matter/problem. When problems arise she faces it head on with prayer and an open mind.

11. Value benefit and beliefBeing a Roman Catholic by faith, she regularly attends mass every Sunday with her husband. She believes in God as the Supreme Being who is in-charge of guiding us and keeping us safe.

IV. CEPHALOCAUDAL ASSESSMENTGeneral SurveyThe patient was assessed lying on bed in supine position, awake,

conscious and coherent and not in respiratory distress. She was oriented to person, place and time and talks coherently. She was properly groomed. She was cooperative and responsive during the entire assessment.

Head to Toe AssessmentSkin: (-) Pallor, (-) Jaundice, good skin turgorHead: Normocephalic, Symmetrical, (-) MassesEyes: Lids Symmetrical, (-) lesionsEars: Normoset, SymmetricalNose: Symmetrical nasolabial fold, (-) FlaringLips: Pinkish, SymmetricalPharynx: Pinkish mucosa, (-) lesionsChest & Lung: Symmetrical, (-) LesionsHeart: Heart tone within normal limitsBreast & Axillae: Symmetrical, Smooth, (-) LesionsAbdomen: Smooth, Symmetrical, (-) Lesions, (+) distension

hypogastric area, Back & Extremities: Smooth, Symmetrical, (-) Lesions, (-) Spinal

deformity, Extremities w/ good flexion, Pinkish nail beds

V. DIAGNOSTIC EXAM.A. Laboratory Tests and Diagnostic Examinations

Complete Blood CountThe CBC is a series of different tests used to evaluate the blood and the cellular components of RBC’s, WBC’s and platelets. The CBC is used to assess the patient for anemia, infection, inflammation, polycythemia, hemolytic disease, and the effects of ABO incompatibility, leukemia and dehydration status.

UrinalysisUrinalysis (UA) simply means analysis of urine. This is a very commonly ordered test that is performed in many clinical settings such as hospitals, clinics, emergency departments, and outpatient laboratories. Urinalysis is a simple test, which can provide important clinical information, it has a quick turn-around time, and it is also cost effective.Urinalysis is very a useful test in the diagnosis of and screening for many diseases and conditions.diagnosing urinary tract infections (UTIs), diagnosing kidney stones, screening for and evaluating many types of kidney diseases, and monitoring the progression of diseases such as diabetes mellitus and high blood pressure

UltrasoundUltrasound (also termed sonography & ultrasonography) is a non-invasive diagnostic medical technique that uses high frequency sound waves to produce images of the internal structures of the body. Using an ultrasound, a technician or doctor moves a device called a transducer (probe) over part of your body. The transducer emits sound waves which bounce off the internal tissues, and creates images from the waves that bounce back. Different densities of tissues, fluid, and air inside the body produce different images that can be interpreted by a physician, typically a radiologist (a physician who specializes in imaging technologies).

VI. ANATOMY AND PHYSIOLOGYThe uterus is a hollow muscular organ located in the female

pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

External Female Reproductive System Internal Female

Reproductive System

VIII. Treatment & Surgical Procedures

•D and C or D & E to remove the mole. ( If the woman is more than 40 yrs old, hysterectomy is done since she has a higher chance of developing CHORIOCARCINOMA•Monitor HCG for 1 year ( HCG shld be negative 2-6 weeks after removal of H-mole.)•Chest X ray every 3 mos for 6 mos. The lungs are the most common site of metastasis of choriocarcinoma •Chemotherapy ( Methotrexate) if:

-HCG titers are increased for 3 consecutive weeks or double at anytime

-HCG titers remain elevated 3-4 mos. after delivery