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.
So this particular disease is really
results from the production and breakdown of
trophoblastic tissue in the placenta.
So sometimes there's a fetus involved, but it
definitely doesn't develop past the primordial state.
And sometimes the tissue that's
there can become carcinogenic.
So we have to be extremely careful with this one
because it can lead to death of the birthing person.
This occurs in about one out of 1000 pregnancies.
Let's break down the different types
of gestational trophoblastic disease.
We'll start with a partial mole.
So in a partial mole, there is the presence
of maternal and paternal genetic material.
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.
So that creates extra DNA, which causes
lots of problems within fetal development.
So we do have some formation of some fetal
parts but there are lots of anomalies
that make this condition incompatible with life.
In a complete mole, there's absolutely
no maternal genetic material.
So all of this is a result of changes with the sperm.
So there's no fetus,there's no
placenta, and there's no amniotic fluid.
So you can see inside this graphic that we have
no baby at all, and it's all trophoblastic tissue.
So this is going to lead to lots of
bleeding within the uterine cavity.
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.
So someone can actually die from this
type of mole if it's not treated.
Now let's talk about risk factors.
So risk factors for either partial or complete
mole include a previous molar pregnancy.
So if a client has had one before, we
always need to be highly suspicious that
any pregnancy could be a repeat.
Also a maternal age greater than
40, or a maternal age less than 20.
So making sure that when you have
clients on either side of the extreme
that you're on the lookout.
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.
The clients may also present with
really early pregnancy symptoms.
Let's break down the why of that.
So one of the things is that we know
that HCG is produced in the placenta.
Clients with gestational trophoblastic
disease have lots of placenta.
So there's going to be a lot
of extra HCG that is produced.
So any symptoms that are related to HCG
production are going to be exaggerated.
So one of the most common is nausea and
vomiting, so hyperemesis gravidarum.
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.
So any client that presents with hyperemesis
gravidarum, you need to absolutely confirm
that it is not a molar pregnancy.
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.
We can also do an ultrasound.
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.
Thinking about management, the only way
that we're going to be able to manage GTD
is to remove it.
So we're going to prepare the client for a
suction curettage or a suction and evacuation.
We have to get every piece of this
particular placenta so that it does not grow.
It is like a weed so anybody's
ever done any gardening,
you know if you have one here,
tomorrow, you'll have three.
So we have to keep that particular tissue from
dividing, we have to get every single piece.
And in order to know that we've gotten
everything, we'll monitor the HCG levels.
So we'll draw blood at least once a week and
make sure those HCG levels are trending down.
And we will follow them until the
HCG gets to be less than 5.
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.
The newer information is
saying six months may be okay
but we definitely want to talk to them about this.
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.
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.
We need to offer the client support.
Now remember I just said, well, there's
no fetal tissue, there's no baby.
That's not something we necessarily want to
say to the client, because they feel pregnant.
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.
And then the idea of not being able
to try again, for up to a year,
that can be really difficult as well.
So making sure we're offering
support for all of those things.