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, sperm fertilizes an empty egg resulting in no fetal development, only the growth of abnormal placental tissue. 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],[2]

Symptoms of GTD include vaginal bleeding, pelvic pain, nausea and vomiting, high blood pressure, and coagulopathy.  A 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, a hydatidiform mole remains in the uterus and does not spread. It is typically treated with dilation and curettage to remove the mass. A hysterectomy is an alternative if the woman does not wish to preserve fertility. Prophylactic methotrexate or actinomycin-D is typically prescribed to prevent gestational trophoblastic neoplasia.^[3],[4]

After treatment, follow-up visits monitor hCG levels. A persistent or rising hCG level can indicate persistent or gestational trophoblastic disease or choriocarcinoma, a type of gestational trophoblastic neoplasia. 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.