SY 2020-2021

COLLEGE OF NURSING
Silliman University
Dumaguete City

CONCEPT MAP
ON
HYDATIDIFORM MOLE
NCM 34 C1- LEVEL II

Submitted by:

Reign Justine Tangcay

Jocelle Apreal Roax Tenorio
Joi Owen Teves

February 18, 2021

ANNOTATED READING

Hydatidiform Mole

Hydatidiform moles are type of gestational trophoblastic disease. The condition is also known
as molar pregnancy. It is an abnormal fertilized egg that develops into a hydatidiform mole
instead of fetus. Hydatidiform mole can develop from cells called trophoblast (forms the
placenta and amniotic sac) that remain in the uterus after a miscarriage, full term pregnancy or
ectopic pregnancy. The affected cells grow abnormally and multiply quickly. Hydatidiform
mole rarely develops when there is a living fetus. In some cases, the fetus dies and miscarriage
occurs. It is common in women under 17 and over 35. Hydatidiform moles are almost 10 times
common in Asian countries. About 2-3% of hydatidiform moles develop into choriocarcinoma.
Symptoms of hydatidiform mole include n/v and vaginal bleeding. Complications include
infection, sepsis, shock, hyperthyroidism, tachycardia, preeclampsia and choriocarcinoma.
Hydatidiform mole is completely removed usually by Dilatation and curettage with suction.
Removal of uterus (hysterectomy) is rarely done. Chemotherapy is needed if the mole persists.
Chemotherapy may consist of only one drug (methotrexate or dactinomycin).

The Hydatidiform Mole

The hydatidiform mole (HM) is a placental pathology of androgenetic origin. Placental villi
have an abnormal hyperproliferation event and hydropic degeneration. Three situations can be
envisaged at its origin: 1. The destruction/expulsion of the female pronucleus at the time of
fertilization by 1 or 2 spermatozoa with the former being followed by an endoreplication of
the male pronucleus leading to a complete hydatidiform mole (CHM) 2. A triploid zygote
(fertilization by 2 spermatozoa) leading to a partial hydatidiform mole (PHM) but can also lead
to haploid and diploid clones. The diploid clone may produce a normal fetus while the haploid
clone after endoreplication generates a CHM 3. A nutritional defect during the differentiation
of the oocytes or the deterioration of the limited oxygen pressure during the first trimester of
gestation may lead to the formation of a HM. Numerous risk factors for molar pregnancies
have been suggested, including paternal age, maternal genetic anomalies, blood group, oral
contraceptives, maternal age and environmental factors; in particular vitamin A and the folates.
A deficit of vitamin A or/and of folates during the period of 18 to 21 d of gestation is associated
with an absence of vascularization of the placental villosities, which is observed in the CHM.
It is also noted that a reduction in vitamin A in the food of the patients at the time of their
pregnancy could explain the geographical distribution of these moles.
Hydatidiform Mole
- It is a growth of an abnormal fertilized egg or an overgrowth of tissue from
the placenta.

Medical Management

1. Induced abortion
2. Follow-up care because of the risk for developing choriocarcinoma
3. Weekly monitoring of hCG until they remain normal for 3 consecutive weeks
4. Periodic follow-up for 1 up to 3 years
5. Avoidance of pregnancy until HCG levels are normal
6. Evacuation of the uterus by dilation and curettage.
7. Prophylactic total hysterectomy
8. Prophylactic chemotherapy after evacuation of hydatidiform mole.
9. Consideration of using other uterotonic formulations (eg, Methergine, Hemabate).

Nursing Management

1) Prepare the client for surgery

2) Monitor VS, fluid intake and output and signs of hemorrhage
3) Administer all medications as ordered
4) Stress the need for regular monitoring of hCG levels and X-ray to detect malignant
changes.
5) Advice patient to use contraceptives to prevent pregnancy for 1 year after hCG level
return to normal
6) Encourage the patient and family to express their feelings about the disorder
7) Remember that this might very hard for the patient to accept, make sure to provide
emotional support. Explain to the patient that it is not her fault this happened.
8) After D&C patient is at risk for infection. Make sure the patient has good perineal
hygiene.
References

Pillitteri, A., & Silbert-Flagg, J. (2018). Maternal and Child Health Nursing: Care of the
Childbearing and Childrearing Family. 8th ed. USA. Wolters Kluwer

Ramirez, P., & Salvo, G. (n.d.). Hydatidiform mole - women's health issues. Retrieved February
17, 2021, from https://www.msdmanuals.com/home/women-s-health-issues/cancers-of-the-
female-reproductive-system/hydatidiform-
mole#:~:text=A%20hydatidiform%20mole%20is%20growth,and%20very%20high%20blo
od%20pressure

The Hydatidiform Mole (The hydatidiform mole. (2016). Cell Adhesion & Migration. Retrieved from
https://www.tandfonline.com/doi/full/10.1080/19336918.2015.1093275)
HYDATIDIFORM MOLE (CASE SCENARIO)
Anne, a 17-year-old nulliparous adolescent girl presented with progressive lower abdominal pain and pronounced nausea and vomiting of about a
week’s duration. Her gestational age was 12 weeks and 4 days according to her last menstruation date. Pelvic examination revealed a closed cervical
os and no uterine bleeding. Subsequent ultrasound and magnetic resonance imaging (MRI) depicted a T2- hyperintense, huge intrauterine mass,
numerous cystic spaces, and massive peri-lesion hemorrhage. Immediately after introducing forceps into the uterine cavity for suction curettage, a large
amount of trophoblastic tissue was expelled and sudden gushes of blood with clots were passed. Histological examination resulted in a final diagnosis
of complete hydatidiform mole.
 CUES|EVIDENCES NURSING GOALS NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS

(TEVES) Within my 8-hour care of Independent: At the end of my 8-

Objective: Fluid volume deficit my patient, the patient hour care of my
● Vomiting r/t elevated HCG will be able to maintain ● Measure vital ● To obtain patient, the patient
● Large amount levels from fluid volume at a signs baseline data goal has been met as
of trophoblastic proliferating functional level as evidenced by:
tissue trophoblasts evidenced by: ● Assess skin ● Indicators of
● MRI results turgor and hydration
(intrauterine ● Adequate urinary moisture of status/ degree ● Individually
mass output mucous of deficit adequate
numerous membrane urinary output
cystic spaces ) ● Stable vital signs
● Weight daily ● Sensitive ● Stable vital
Subjective: ● Good skin turgor measurements signs
● The pt of fluctuations
verbalized, ● Prompt capillary in fluid balance. ● Moist mucous
"nars, refill membrane
kasukaon ko ●
perminti" ● Monition I&O ● Decreased ● Skin rapidly
renal output snaps back to
suggests normal
developing position when
dehydration and pinched
need for fluid
replacement. ● Nail bed turns
back to
● To compensate normal (white
● Encourage with fluid color) within 2
fluid intake as volume deficit seconds
tolerated problem

● For vomiting - Goal met -

● Encourage ice episodes
chips on mouth
● Prevent
● Encourage rest unnecessary
energy
expenditure
related to
vomiting (as
 may trigger) or
bleeding (loss
of blood).

● Early
● Observe for identification as
bleeding a result of
tendencies cancer. Allows
prompt
intervention.

CUES/EVIDENCE NURSING OBJECTIVES NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTIONS

(TENORIO) Risk for infection r/t Within my 8-hours of At the end of my 8-

Objective: invasive procedure care, the patient will ● Obtain and monitor ● These are hour care, the goals
● MRI results; of suction curettage identify interventions vital signs of the closely linked are met as evidenced
intrauterine to prevent infections patient to patient’s by:
mass, as evidence by: ● Conduct health status
numerous education after the ● Instructing ● Patient
cystic spaces ● Verbalize operation on the clients on the verbalized
and massive understanding following topics: signs and understanding
peri-lesion of individual - Signs and symptoms of of the risks and
hemorrhage risk factors symptoms of impending possible signs
● Introduced ● Demonstrate infection like infection and symptoms
forceps into technique to increasing gives them or impending
the uterine promote safety body the idea of infection
cavity and safe temperature, what to look ● Patient was
● Histological environment foul-smelling for free from
examination ● Achieve timely discharges immediate infection
resulted in a wound healing from the action and
perineum, intervention
final
moderate to can be
diagnosis of severe sought.
complete abdominal Minimize the
hydatidiform cramps entry of
mole - Advice that harmful
should any microorganis
signs of ms.
infection Tampons
occurs, it increase the
must be risk for
reported infection and
immediately delay tissue
to the nurse healing. To
on duty for allow tissue
validation healing.
and
evaluation ● To maintain
- Good optimal
perineal nutritional
hygiene status
- Use of ● Antibiotic
tampons is agents are
contraindicat either toxic to
ed, use the pathogen
perineal pads or retard the
instead pathogen’s
- No sexual growth
intercourse ● It helps thin
until vaginal out
discharge secretions
stops and replace
● Encourage intake of fluid loss if
protein and calorie having a
rich foods fever
● Administer or teach ● It can reduce
use of antibiotic stress and
drugs as ordered boost
● Encourage increase immune
in the fluid intake system
● Encourage adequate
rest
 CUES/ EVIDENCES NURSING OBJECTIVES NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS

(TANGCAY) Acute pain r/t Within my 8 hours of ● Administer ● To alleviate At the end of my 8-
Objective: hydatidiform mole as care, patient will prescribed acute pelvic hour care, the goals
● Lower evidence by lower demonstrate relief of pain medications as pain are met as evidenced
abdominal pain abdominal pain and as evidenced by: per Doctor’s by:
● MRI results verbalization of order PRN ● A pain score
(huge pelvic pain ● A pain score of 0 ● Assess ● For baseline of 0 out of 10
intrauterine out of 10 patient’s vital data. The tome ● Stable vital
mass and ● Stable vital signs signs at least of monitoring of signs
massive peri- ● Absence of 30 minutes vital signs may ● Absence of
lesion restlessness after depend on the restlessness
hemorrhage) ● Verbalizations of administration peak time of ● Verbalizations
comfort of medication drug of comfort
Subjective: administered ● Ability to sleep
“Sakit na jud kaayo ● Assess for ● To monitor and rest
akong pus-on nars, pain (e.g. pain effectiveness of
gusto ko mulimbag sa scale) at least medical
kasakit.” 30 minutes treatment for
after the relief of
medication pelvic pain.
intake
● Elevate the ● To increase the
head the oxygen level by
patient in allowing optimal
semi-Fowler’s lung expansion
● To provide
● Place the optimal comfort
patient in to the patient
complete bed and avoid risk
rest during for injury
severe
episodes of
pain ● Deep breathing
● Perform non- exercises,
pharmacologic guided imagery
al relief and provision of
measures distractions
such as such as TV or
relaxation radio
 techniques ● To reduce post-
● After surgery, surgical pain
advise the and allow full
patient to have recovery and
no strenuous healing
activity for a
few weeks

Possible Nursing Diagnosis

 Activity intolerance r/t weakness

 Disturbed sleep pattern r/t abdominal pain
 Ineffective tissue perfusion r/t abnormal bleeding
 Risk for shock r/t severe blood loss