18.13 Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) is a general term for rare tumors that can develop during pregnancy when trophoblast cells, which normally support the fertilized egg, grow abnormally and form a tumor instead of a fetus. The most common type of GTD is a hydatidiform mole, also called a molar pregnancy. There are two main types of molar pregnancies: complete and partial. During a complete molar pregnancy, the ovum is fertilized by a sperm, but the genetic material from the father is lost during conception. As a result, no fetus or normal placental tissue forms but just a mass of cysts develops. During partial molar pregnancy, two sperm fertilize a single egg, leading to an abnormal embryo with too many chromosomes. Some fetal tissue may develop, but it is not viable and there is abnormal placental tissue.^[1]

Symptoms of GTD include vaginal bleeding, pelvic pain, nausea and vomiting, high blood pressure, and coagulopathy. Hydatidiform mole is diagnosed by pelvic ultrasound and high serum levels of human chorionic gonadotropin (HCG). Although some types of GTD can become metastatic cancer, hydatidiform mole remains in the uterus and does not spread. It is typically treated with surgery to remove the mass and may also include hysterectomy, if indicated.^[2]

After treatment, follow-up visits monitor hCG levels. A persistent or rising hCG level can indicate persistent or recurrent gestational trophoblastic disease. Genetic counseling is often recommended because of the risk of a recurrent molar pregnancy. Molar pregnancies can be emotionally challenging due to the loss of a pregnancy, as well as concerns about future pregnancies. Nurses provide health teaching about molar pregnancies and provide emotional support to assist the client and her partner to cope with the diagnosis.