Hydatidiform Mole (Molar pregnancy)
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Hydatidiform Mole (Image)
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Hydatidiform Mole (Molar Pregnancy) (Picmonic)
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Outline
Overview
- Abnormal fertilization
- The developing cells outside of the fertilized egg (ovum) develop abnormally, creating a nonviable pregnancy and noncancerous tumor
- The cells that divide to make the placenta abnormally divide and cause the molar pregnancy.
Nursing Points
General
- Mole = clump of growing tissue
- Abnormal fertilization
- Doesn’t contain original maternal nucleus
- Two sperm, one ovum
- Not correct genetic material
- Grape-like appearance – caused by the distention of the chorionic villi
- Grape like clusters in the uterus
- Almost always results in a miscarriage
- Can develop into choriocarcinoma
Assessment
- No fetal heart rate
- High blood pressure
- Vaginal bleeding in first trimester
- Grape like clusters
- Dark brown/bright red bleeding
- hCG levels higher than expected
- Fundal height greater than expected
- Rapid division→ fast uterine growth
Therapeutic Management
- Pregnancy is nonviable and it can turn into a malignancy, therefore it must be removed
- D&C
- Vacuum aspiration
- Hysterectomy
- D&C
- Oxytocin is given to contract uterus after mole is removed
- Monitor for hemorrhage and infection
- Sending to lab for pathology is ESSENTIAL to see if there are any signs of malignancy
- Trophoblastic disease
- Methotrexate treatment
- Trophoblastic disease
- Watch hCG levels
- Monitor until pre-pregnancy levels reached
- Monitoring might continue for 6 months to a year
- No pregnancy during this time
- Contraception
- No pregnancy during this time
Nursing Concepts
- Coping
- Lab values
- Reproduction
Patient Education
- Resources for coping after loss of pregnancy
- Help them understand why the pregnancy is nonviable
- Educate on methotrexate use
- Educate on the need for contraception
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Transcript
We are going to be talking about hydatidiform mole pregnancy, also known as a molar pregnancy. I am going to explain what exactly this is and your role in caring for this patient.
With a hydatidiform mole there is abnormal fertilization. It is not viable. So let’s talk about how this happens. It can form in two ways. Either there is an ovum that has no maternal DNA or one ovum is fertilized with two sperm. This created a non viable and non cancerous tumor. A molar pregnancy can either be complete or incomplete. A complete means there is no fetal material. Partial means there might be some fetal material but there is never a fetal heart rate.
So what is the “Mole”. The mole is the clump of growing tissue. The molar pregnancy takes on a grape-like appearance that is caused by the distention of the chorionic villi that would normally implant and create the placenta. As you can see in this image there are clusters. This is the grape like clusters that fill up the uterus. The molar pregnancy will almost always result in a miscarriage but there is rarely fetal material so the miscarrying is of all this extra tissue and grape like clusters. Usually a D&C will need to occur to clean everything out from the uterus. It can develop into choriocarcinoma. Molar pregnancy are mostly all benign tumors. If they become invasive though it can be malignant cancer.
On assessment there will ever be a larger then expected fundal height because of the increased and quick cell division. This is going to cause fast uterine growth. There will be no fetal heart rate detected. Patients can have a high blood pressure. There will be vaginal bleeding reported by the patient. This bleeding will be grape like clusters of bright red to dark brown bleeding. hCG levels will be rising very quickly and higher than expected. hCG levels rise quick and are higher than expected which can cause a lot of nausea because of the rise in hormones.
Let’s discuss what management looks like for this patient. So D&C. Remember the pregnancy is not viable and can turn into a malignancy so it must be removed. The mole must be sent to pathology because we need to make sure it has not become malignant which is called trophoblastic disease. Oxytocin will also be given to contract the uterus after mole is removed. Methotrexate is medication that will be given IM to inhibit the rapid cellular division. hCG levels will be monitored until pre-pregnancy levels are reached and sometimes even for 6 months to a year. If levels continue to rise or more molar tissue is suspected then a hysterectomy might be necessary to remove everything. A huge piece of our management of this patient is to make sure there is no pregnancy during this time. Contraception must be used for at least one year.
What do we want to educate on? We want to to give resources for coping after the loss of pregnancy. We need to offer explanation on why it is not viable and what is happening. This is a confusing thing. Its rare so a lot of patients haven’t heard of it. It is different then a regular miscarriage so we want them to really understand. We also need to educate on methotrexate use. How often they need it and that it is an IM injection. The biggest education item is contraception. We need to educate on the need for contraception and to avoid pregnancy for a year so that the molar pregnancy can be completely resolved.
Nursing concepts are coping because this patient had a positive pregnancy test and thought she was pregnant so we need to help her cope through this hard time. Lab values are another concept because we are monitoring hCG levels. Reproduction is another concept because this has occured because of a problem with reproduction.
So if you understand these key points it will help you have a really good understanding of molar pregnancies. IA hydatidiform mole is a non viable pregnancy. There is no fetus. Very rarely there are fetal pieces but no heart rate which means no viability. It forms from improper fertilization. So there is either 1 ovum and 2 sperm that fertilize or an empty ovum so no maternal DNA and 1 sperm. Rapid cell division occurs causing rapid uterine growth. The uterus fills up with clusters of blood. There is passage of grapelike clusters of blood. This blood is dark brown and bright red. Treatment is IM methotrexate to inhibit the rapidly dividing cells. Patients need to use contraception for 1 year to prevent pregnancy.
Make sure you check out the resources and cheat sheets attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.
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Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
IADLS (Instrumental Activities of Daily Living) Nursing Mnemonic (SCUM)
Increase MAP Nursing Mnemonic (VAK)
Inflammation- Signs and Symptoms Nursing Mnemonic (HIPER)
Insulin Mnemonic (Ready, Set, Inject, Love)
Interventions for Aphasia Nursing Mnemonic (PROP)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Mnemonic for Organ Systems (MR DICE RUNS)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction Nursing Mnemonic (MONATAS)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OLD CARTS Mnemonic (OLD CARTS)
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Nursing Care and Pathophysiology for Parkinsons
Asthma
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pharmacokinetics Nursing Mnemonic (ADME)
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Hemorrhage (PPH)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Prostate Nursing Mnemonic (FUN)
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Safety Check Nursing Mnemonic (MADLE)
SBAR Communication Nursing Mnemonic (SBAR)
Schizophrenia
Scleroderma Symptoms Nursing Mnemonic (CREST)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Documentation Nursing Mnemonic (TDOC)
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Stages of Hepatitis Nursing Mnemonic (PIP)
Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Steps in the Nursing Process 2 Nursing Mnemonic (AAPIE)
Steps In The Nursing Process 3 Nursing Mnemonic (SOAPIE)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoke Assessments Nursing Mnemonic (FAST)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
TB Drugs Nursing Mnemonic (RIPE)
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Triage Nursing Mnemonic (START)
Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasospasm Therapy Nursing Mnemonic (Triple H Therapy)
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Vitamins – Fat Soluble Nursing Mnemonic (All Dogs Eat Kibble)
Vitamins – Water Soluble Nursing Mnemonic (Birth Control)
Walkers Nursing Mnemonic (Wandering Wilma Always Late)
Who Needs Dialysis Nursing Mnemonic (AEIOU)