Hydatidiform Mole in Second Trimester

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Questions and Answers

Match each type of gestational trophoblastic disease with its key characteristic:

Complete mole = All trophoblastic villi are swollen and cystic, with no fetal blood present. Partial mole = Embryo and fetal blood may be present; often associated with 69 chromosomes (triploidy). Choriocarcinoma = Can be triggered by elevated hCG levels from a gestational trophoblastic disease. Invasive Mole = Mole penetrates the myometrium.

Match each assessment finding with the corresponding condition:

Painless, bright red vaginal bleeding = Placenta previa Painful, dark red vaginal bleeding = Abruptio placenta (covert) Brownish vaginal bleeding, excessive nausea/vomiting = Gestational trophoblastic disease Hypertension before 20 weeks gestation = Gestational trophoblastic disease (H-mole)

Match the interventions with their primary goal in managing gestational trophoblastic disease:

Curettage and suction = Clear the uterus of molar tissue while preserving fertility if desired. Methotrexate administration = Prevent choriocarcinoma by halting the proliferation of trophoblastic villi. Avoid pregnancy for 6-12 months = Allow for monitoring of hCG levels to detect any residual trophoblastic disease. Hysterectomy = Removal of the uterus when future pregnancies are not desired

Match each placenta previa classification with its description:

<p>Low lying placenta = Placenta implanted in the lower uterine segment, 0.5 to 5.0 cm from the cervical os. Marginal placenta previa = Edge of the placenta approaches the cervical os, but does not cover it. Complete placenta previa = Placenta completely covers the internal cervical os. Vasa Previa = Fetal vessels run unprotected through the membranes over the cervix</p> Signup and view all the answers

Match the management strategies with their rationale in cases of placenta previa:

<p>Strict bed rest in left lying position = To optimize blood flow to the uterus and fetus and prevent further placental separation. Avoid vaginal examinations = To prevent triggering further placental separation and hemorrhage. Continuous fetal heart rate monitoring = To assess fetal well-being and detect signs of fetal distress due to decreased oxygen supply. Administer corticosteroids = Enhance fetal lung maturity if preterm delivery becomes necessary</p> Signup and view all the answers

Match the type of abruptio placenta with its key clinical presentation:

<p>Marginal (overt) abruption = Evident external bleeding with separation beginning at the edges of the placenta. Central (covert) abruption = Bleeding is not immediately evident; concealed hemorrhage behind the placenta. Grade 1 placental separation = Some external bleeding with no fetal distress or maternal shock. Grade 3 placental separation = Internal and external bleeding with maternal shock and fetal death.</p> Signup and view all the answers

Match the assessment findings with their significance in abruptio placenta:

<p>Hard, rigid, firm board-like abdomen = Indicates accumulation of blood within the uterus. Sharp pain over the fundus = Suggests placental separation from the uterine wall. Signs of maternal shock = Reflects significant blood loss and hemodynamic instability. Late decelerations on fetal heart rate monitoring = Indicates fetal distress due to placental insufficiency.</p> Signup and view all the answers

Match the potential causes with the types of placental abruption

<p>Maternal hypertension = Abruptio placenta Scarring of the uterus = Placenta previa Cocaine use = Abruptio placenta Genetic mutation of KHDC3L or NCRP7 = Gestational Trophoblastic Disease</p> Signup and view all the answers

Match the grades with the specific signs and symptoms of placental separation:

<p>Grade 0 = No apparent signs or symptoms of placental separation during pregnancy. Grade 1 = Some external bleeding, but no signs of fetal distress or maternal shock. Grade 2 = External bleeding, moderate placental separation, and signs of fetal distress. Grade 3 = Internal and external bleeding, maternal shock, fetal death, and possible DIC.</p> Signup and view all the answers

Match the potential causes with the specific types of placental problems

<p>Increased parity = Placenta previa Advanced maternal age = Placenta previa Trauma to the uterus = Abruptio placenta Sudden release of amniotic fluid = Abruptio placenta</p> Signup and view all the answers

Match the interventions with their rationale in cases of abruptio placenta:

<p>Monitor for DIC: = Disseminated intravascular coagulation is a severe complication of abruptio placenta. Immediate delivery: = If the mother or fetus is in distress or if bleeding is severe, immediate delivery is necessary. Blood transfusions: = May be necessary to replace lost blood and maintain hemodynamic stability. Oxygen therapy: = Administer oxygen to maintain oxygen saturation levels.</p> Signup and view all the answers

Match the interventions with their potential outcomes in antepartum care:

<p>Strict bed rest: = Can prolong gestational age and improve fetal outcomes in placenta previa Tocolytic medications: = May delay delivery in cases of preterm labor associated with abruptio placenta Corticosteroids: = Improve fetal lung maturity in preparation for preterm delivery. Magnesium Sulfate: = Neuroprotection of the fetus if preterm delivery is imminent.</p> Signup and view all the answers

Match each condition with the appropriate diagnostic method:

<p>Vasa Previa = Transvaginal ultrasound with color Doppler Placenta previa = Transvaginal ultrasound Abruptio placenta = Clinical assessment and ultrasound Gestational trophoblastic disease = Serum hCG levels and ultrasound</p> Signup and view all the answers

Match the risk factors with the complication they are most likely to cause in the third trimester of pregnancy:

<p>Previous cesarean section = Placenta previa Maternal Hypertension = Abruptio placenta Polyhydramnios = Abruptio placenta Multiple gestations = Abruptio placenta</p> Signup and view all the answers

Match each nursing intervention with the rationale for a patient admitted for vaginal g bleeding at 32 weeks gestation:

<p>Initiate continuous fetal monitoring = Monitor the fetal heart rate and variability to evaluate the fetal response to potential hypoxia Assess maternal vital signs frequently = Monitor for signs of hypovolemic shock due to blood loss Administer intravenous fluids = Maintain adequate hydration and support circulatory volume Administer packed red blood cells = Hemoglobin level is less than 7mg/DL</p> Signup and view all the answers

Match each statement about abruptio placenta with the correct classification:

<p>Placenta separates completely, significant bleeding and fetal death = Severe abruptio placenta Partial placental separation, minimal external bleeding and no fetal distress = Mild abruptio placenta Placenta separates, no external bleeding but maternal abdomen becomes rigid = Moderate abruptio placenta Placental separation, causes disseminated intravascular coagulation = Severe abruptio placenta</p> Signup and view all the answers

Match the maternal symptoms with the appropriate antepartum condition:

<p>Painless vaginal bleeding in the third trimester = Placenta previa Sudden onset abdominal pain in the third trimester with dark vaginal bleeding = Abruptio placenta Hypertension, blurred vision and epigastric pain in the third trimester = Preeclampsia Unilateral pelvic pain and spotting during the first trimester = Ectopic pregnancy</p> Signup and view all the answers

Match each description with the correct diagnosis related to 3rd trimester complications.

<p>Placenta implanted in the lower uterine segment near or over the internal cervical os = Placenta previa Premature separation of the placenta from the uterine wall = Abruptio placenta Gestational HTN with proteinuria = Preeclampsia Multiple gestation pregnancies = Associated with abruptio placentia.</p> Signup and view all the answers

Match the conditions with their appropriate interventions

<p>Placenta Previa = Monitor bleeding and fetal heart rate Abruptio Placentia = IV fluids and oxygen Gestational Trophoblastic Disease = Chemotherapy with Methotrexate Ectopic Pregnancy = Prepare for salpingectomy</p> Signup and view all the answers

Match key interventions with the appropriate rationales concerning 3rd-trimester bleeding emergencies

<p>Administer IV fluids and blood products as prescribed = Correct hypovolemia and prevent shock Continuously monitor uterine contractions, fetal heart rate, and maternal vital signs = Immediately assess for signs of fetal distress or maternal compromise, guiding decisions for delivery timing Provide oxygen via face mask = Increase oxygen availability to the fetus to prevent hypoxia Prepare for immediate delivery, possibly via cesarean section = Prevent fetal death</p> Signup and view all the answers

Flashcards

Gestational Trophoblastic Disease

Proliferation and degeneration of trophoblastic villi, forming grape-like vesicles and producing high HCG levels.

Complete Mole

All trophoblastic villi swell and become cystic; embryo absent or dies early; no fetal blood present.

Partial Mole

Embryo and fetal blood may be present; caused by genetic mutation or triploid formation.

Assessment Findings in H-Mole

Brownish vaginal bleeding, excessive nausea/vomiting, hypertension before 20 weeks, uterine enlargement, and absence of fetal heart tones.

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Nursing Management for H-Mole

Avoid pregnancy for 6-12 months, monitor HCG levels, administer blood replacement, and provide emotional support.

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Choriocarcinoma Risk

Elevated HCG levels in H-Mole can lead to this cancer

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Methotrexate Use

Medication used to prevent choriocarcinoma in women

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Placenta Previa Causes

Scarring from C-sections or curettage and advanced maternal age

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Low Lying Placenta Previa

Implantation in the lower uterus, 0.5 to 5.0 cm from the cervical os.

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Marginal Placenta Previa

Placenta edge approaches the cervical os.

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Complete Placenta Previa

Placenta completely covers the cervical opening.

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Placenta Previa Assessment

Abrupt, painless, bright red vaginal bleeding.

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Placenta Previa Management

Strict bed rest in left lateral position, monitoring VS and FHR, and avoiding vaginal exams.

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Abruptio Placentae

Premature separation of a normally implanted placenta.

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Abruptio Placentae Causes

Maternal hypertension, advanced maternal age, trauma, or cocaine use.

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Marginal (Overt) Abruptio Placentae

Evident external bleeding; separation begins at the edges.

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Central (Covert) Abruptio Placentae

Bleeding not evident; separation at the center; painful dark red vaginal bleeding.

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Signs of Abruptio Placentae

Hard, rigid abdomen; tenderness; sharp fundal pain; signs of shock; fetal distress.

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Grade 0 Abruptio Placentae

No s/sx; diagnosed after delivery with a dark clot on the placenta.

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Grade 1 Abruptio Placentae

External bleeding, no fetal distress/shock, slight placental separation.

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Study Notes

  • Complications that occur during the second trimester include Gestational Trophoblastic Disease (Hydatidiform Mole).
  • This is marked by the proliferation and degeneration of trophoblastic villi alongside the formation of grape-like vesicles, leading to high HCG production.

Types of Hydatidiform Mole

  • Complete mole: All trophoblastic villi swell and become cystic; if an embryo forms, it dies at 1-2 mm with no fetal blood present. It occurs due to the absence of chromosomes in the ova, but the sperm fertilizes it.
  • Partial mole: An embryo and fetal blood may be present, resulting in 69 chromosomes (triploid formation), and it is caused by a genetic mutation of KHDC3L or NCRP7.

Assessment of Hydatidiform Mole

  • Brownish vaginal bleeding and excessive nausea/vomiting due to elevated HCG levels are key indicators.
  • Hypertension (pre-eclampsia), which occurs before 20 weeks specifically with H-mole, distinguishes it from typical pre-eclampsia that arises after 20 weeks postpartum.
  • Other signs include uterine enlargement and absence of fetal heart tones.

Management of Hydatidiform Mole

  • Focus on maintaining fluid and electrolyte balance due to excessive nausea and vomiting.
  • Pregnancy should be avoided for 6 months to 1 year to monitor trophoblastic villi and HCG levels, as elevated HCG can lead to choriocarcinoma.
  • Blood replacement may be necessary due to vaginal bleeding, and emotional support is essential.
  • Procedures include curettage and suction for patients wanting future pregnancies and hysterectomy if no future pregnancies are planned.
  • Methotrexate is administered to prevent choriocarcinoma and inhibit the proliferation of trophoblastic villi, thus controlling HCG levels.

Complications: Third Trimester

  • Placenta Previa: a low implantation of the placenta.
  • Causes include: scarring of the uterus (C-section, increased parity, uterine curettage), advanced maternal age, decreased vascularity of the upper uterine segment, and cocaine use.

Types of Placenta Previa

  • Low-lying: implantation in the lower uterus (0.5 to 5.0 cm from the cervix).
  • Marginal: the placenta edge approaches the cervix.
  • Complete: the placenta covers the entire cervical opening.
  • Bleeding in placenta previa typically occurs around week 30 as the lower uterine segments differentiate, posing a hemorrhage risk for the mother and potentially impairing fetal oxygenation.

Assessment and Management of Placenta Previa

  • Key signs include abrupt, painless, bright red vaginal bleeding.
  • Management involves monitoring vital signs, bleeding (via perineal pads), and fetal heart rate.
  • Strict bed rest in the left lying side position is recommended.
  • Vaginal examinations should be avoided unless infective endocarditis is indicated; if necessary, perform in a double setup environment.
  • Cesarean section can be performed immediately if the DR form is signed. In cases of severe bleeding, perform a classical C-section with a vertical incision in the uterus.
  • Provide emotional support.

Abruptio Placenta

  • This involves the abrupt separation of a normal placenta, which can result from maternal hypertension, advanced maternal age, multiple pregnancies, trauma to the uterus, or sudden amniotic fluid release.
  • Other causes include a short umbilical cord and cocaine use.

Types of Abruptio Placenta

  • Marginal (overt): Characterized by evident external bleeding with separation beginning at the edges, accompanied by painful BRIGHT RED vaginal bleeding.

  • Central (covert): The bleeding is not immediately evident as the placenta separates at the center resulting in painful DARK RED vaginal bleeding.

Signs and Symptoms of Abruptio Placenta

  • A hard, rigid, firm, board-like abdomen caused by blood accumulation is a key sign.
  • Other symptoms include abnormal tenderness due to uterine distention with blood, sharp pain over the fundus during placental separation, signs of shock, and fetal distress.

Classification of Placental Separation

  • Grade 0: no apparent signs or symptoms of placental separation, diagnosed after delivery upon examination of the placenta, which reveals a dark, adherent clot on its surface.
  • Grade 1: some external bleeding is present, but there are no signs of fetal distress or shock, and only slight placental separation.
  • Grade 2: external bleeding, moderate placental separation, uterine tenderness, and fetal distress.
  • Grade 3: internal and external bleeding, maternal shock, fetal death, and disseminated intravascular coagulation (DIC).
  • DIC symptoms include: uncontrollable bleeding from multiple sites, bruising, confusion, memory loss, behavioral changes, dyspnea, and fever.

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