Gestational Trophoblastic Disease – Early Pregnancy Bleeding (Nursing)

00:01 Now let's talk about gestational trophoblastic disease, also known as GTT, also known as hydatidiform mole, or molar pregnancy, they're all the same.

00:10 So this particular disease is really results from the production and breakdown of trophoblastic tissue in the placenta.

00:17 So sometimes there's a fetus involved, but it definitely doesn't develop past the primordial state.

00:23 And sometimes the tissue that's there can become carcinogenic.

00:27 So we have to be extremely careful with this one because it can lead to death of the birthing person.

00:33 This occurs in about one out of 1000 pregnancies.

00:38 Let's break down the different types of gestational trophoblastic disease.

00:42 We'll start with a partial mole.

00:44 So in a partial mole, there is the presence of maternal and paternal genetic material.

00:49 So we have an egg and sperm getting together, except in this case instead of one egg and one sperm, we have one egg and two sperm.

00:59 So that creates extra DNA, which causes lots of problems within fetal development.

01:05 So we do have some formation of some fetal parts but there are lots of anomalies that make this condition incompatible with life.

01:15 In a complete mole, there's absolutely no maternal genetic material.

01:20 So all of this is a result of changes with the sperm.

01:25 So there's no fetus,there's no placenta, and there's no amniotic fluid.

01:30 So you can see inside this graphic that we have no baby at all, and it's all trophoblastic tissue.

01:37 So this is going to lead to lots of bleeding within the uterine cavity.

01:42 What's really important to understand is that with this particular type of mole, 20% of them will go on to develop into a carcinoma.

01:50 So someone can actually die from this type of mole if it's not treated.

01:54 Now let's talk about risk factors.

01:56 So risk factors for either partial or complete mole include a previous molar pregnancy.

02:01 So if a client has had one before, we always need to be highly suspicious that any pregnancy could be a repeat.

02:08 Also a maternal age greater than 40, or a maternal age less than 20.

02:13 So making sure that when you have clients on either side of the extreme that you're on the lookout.

02:19 How does it present? Well, we may notice dark brown bleeding, so it looks kind of like old blood, want to pay attention to that.

02:27 The clients may also present with really early pregnancy symptoms.

02:32 Let's break down the why of that.

02:34 So one of the things is that we know that HCG is produced in the placenta.

02:39 Clients with gestational trophoblastic disease have lots of placenta.

02:44 So there's going to be a lot of extra HCG that is produced.

02:48 So any symptoms that are related to HCG production are going to be exaggerated.

02:53 So one of the most common is nausea and vomiting, so hyperemesis gravidarum.

02:59 This is someone who really can't keep any food down, and they're displaying changes of an electrolyte imbalance because of their inability to eat and keep things down.

03:08 So any client that presents with hyperemesis gravidarum, you need to absolutely confirm that it is not a molar pregnancy.

03:15 So without an ultrasound, where you see an intrauterine pregnancy, or following an HCG, or any of those other things, you want to make sure that you do not have a mole before you continue.

03:27 We can also do an ultrasound.

03:28 So if we have any suspect that we're not sure what is going on, then an ultrasound will allow us to see inside the uterine cavity and diagnose whether we have a molar pregnancy or not.

03:42 Thinking about management, the only way that we're going to be able to manage GTD is to remove it.

03:48 So we're going to prepare the client for a suction curettage or a suction and evacuation.

03:53 We have to get every piece of this particular placenta so that it does not grow.

03:58 It is like a weed so anybody's ever done any gardening, you know if you have one here, tomorrow, you'll have three.

04:04 So we have to keep that particular tissue from dividing, we have to get every single piece.

04:10 And in order to know that we've gotten everything, we'll monitor the HCG levels.

04:14 So we'll draw blood at least once a week and make sure those HCG levels are trending down.

04:19 And we will follow them until the HCG gets to be less than 5.

04:24 We're going to have to spend a lot of time educating the client both about the fact that this is not a normal pregnancy, the seriousness of it and then making sure that they know they need to avoid pregnancy for up to a year.

04:36 The newer information is saying six months may be okay but we definitely want to talk to them about this.

04:42 And why? because if there are any particular cells that are left that we missed, if they get a whiff of HCG from a new pregnancy, they'll start to divide all over again.

04:52 And specifically in the case of the complete mole and knowing that can go on and become carcinogenic, then we absolutely do not want that to happen.

05:01 We need to offer the client support.

05:03 Now remember I just said, well, there's no fetal tissue, there's no baby.

05:07 That's not something we necessarily want to say to the client, because they feel pregnant.

05:11 They're explaining, they're experiencing all the symptoms, and everything else so we have to be sensitive to our word choice and supporting the client through this process.

05:20 And then the idea of not being able to try again, for up to a year, that can be really difficult as well.

05:26 So making sure we're offering support for all of those things.