Name of students : Miss.

Sonali moreshwar dikondwar

Venue :pooja nursing college bhandara

Date :

Group : 4th year BSc

Topic : vesicular mole

Method of teaching : Demonstration method

Audio visual aids : chart, board, bulletin board ,leaflet

Previous knowledge : The students have somewhat previous knowledge regarding the vesicular mole
Sr Specific Teaching
No Time Objective Content Learning A.V. Aids Evaluation
Activity

1 2 min Introduction of Hydatidiform (Vesicular) Lecture cum board Students will

vesicular mole able to tell
Mole discussion introduction

It is a benign neoplasm of the chorionic villi.

• Incidence:
1:2000 pregnancies in United States and
Europe, but 10 times more in Asia. The
incidence is higher toward the beginning
and more toward the end of the
childbearing period. It is 10 times more
in women over 45 years old.
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Activity

2 5 min Describe Lecture cum board Students will

pathophysiology able to tell
discussion
Pathology pathophysiology

• The uterus is distended by thin walled,

translucent, grape-like vesicles of
different sizes. These are
degenerated chorionic villi filled
with fluid.
• There is no vasculature in the
chorionic villi leads to early death and
absorption of the embryo.
• There is trophoblastic proliferation,
with mitotic activity affecting both
syncytial and cytotrophoblastic
layers.This causes excessive secretion
of hCG, chorionic thyrotrophin and
progesterone.On the other hand,
oestrogen production is low due to
absence of the foetal supply
Sr Specific Teaching
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Activity

precursors. Lecture cum board

• High hCG causes multiple theca discussion

lutein cysts in the ovaries in about

50% of cases. It also results in
exaggeration of the normal early
pregnancy symptoms and signs
Sr Specific Teaching
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4 10 min Describe types Lecture cum Bulletin Students will

board able to tell
Types>Hydatidiform (Vesicular} Mole discussion types
• Complete mole:
• Partial mole:

Complete mole:

• The whole conceptus is transformed

into a
mass of vesicles.
• No embryo is present.
• It is the result of fertilisation of
anucleated ovum (has no chromosomes)
with a sperm
which will duplicate giving rise to
46 chromosomes of paternal
origin only.
Sr Specific Teaching
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Partial mole: Lecture cum

discussion
• A part of trophoblastic tissue only shows
molar changes.
• There is a foetus or at least an amniotic
sac.
• It is the result of fertilisation of an ovum
by 2 sperms so the chromosomal number
is 69 chromosomes.
Sr Specific Teaching
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Activity

5 5 min Describe diagnostic Lecture cum chart Students will

evaluation able to tell
discussion diagnosis

DIAGNOSIS
Symptoms
• Amenorrhoea: usually of short period (2-3
months).
• Exaggerated symptoms of pregnancy
especially
vomiting.
• Vaginal bleeding which is usually dark
brown and may
be associated with passage of vesicles.
• Abdominal pain: may be, o dull-aching
due to rapid distension of the uterus, o
colicky due to starting expulsion, o
sudden and severe due to perforating
mole.
Sr Specific Teaching
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Lecture cum

Signs discussion

* General examination:
> Pre-eclampsia develops in 20%
of cases,
usually before 20 weeks' gestation.
>Hyperthyroidism develops in
10% of cases manifested by enlarged
thyroid gland, tachycardia and
elevated plasma thyroxin level.
>Breast signs of pregnancy
Abdominal examination:

> The uterus is larger than the period

ofamenorrhoea in50% of
 cases, correspondsto it in 25% and
smaller in 25% with inactive or
dead mole.
> The uterus is doughy in
consistency
> Foetal parts and heart sound
cannot be
detected except in partial mole *
Local examination:
> Passage of vesicles (sure sign).
>Bilateral ovarian cysts (5-20 cm)
in 50% OF CASES

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Activity
6 5 min Enlist investigation Lecture cum board Students will
able to tell
discussion investigation

Investigations

"' Urine pregnancy test: is positive in high

dilution. 1/200 is highly suggestive, 1/500 is
surely diagnostic. In normal pregnancy it is
positive in dilutions up to 1/100.

• Serum -hCG level: is highly elevated (>100000

mlU/ml).

* Ultrasonography reveals:
o The characteristic intrauterine
"snow storm"
appearance,
o no identifiable foetus, o bilateral
ovarian cysts may be detected.
• X-ray: shows no foetal skeleton.
7 5min List down Students will
complication
Complications • Lecture
cum
chart
able to tell
Haemorrhage. complication
discussion
• Infection due to absence of the
amniotic sac.
• Perforation of the uterus.
• Pregnancy induced hypertension
• Hyperthyroidism. Subsequent
development of choriocarcinoma
Treatment

• As soon as the diagnosis of vesicular

mole
is
established the uterus should be
evacuated.
• The selected method depends on the
size of the uterus, whether
 partial expulsion has already
occur or not, the patient's age and
fertility desire.
• Cross - matched blood should be
available
before starting.
Sr Specific Teaching
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Activity
8 10 min Describe Lecture cum board Students will
management able to tell
discussion management
Suction evacuation

>It is carried out under general anaesthesia, but

not that which relax the uterus as halothane
as it may induce severe bleeding.
> An infusion of 20 units oxytocin in
500 ml of 5% glucose should be
maintained throughout the
procedure.

>Dilatation of the cervix is done up to a Hegar's

number equal to the period of amenorrhoea
in weeks e.g. No. 10 Hegar for 10 weeks'
amenorrhoea. The suction canula used will
be of the same size als
 Lecture cum board
discussion
Suction evacuation cont.....

>A suction canula which may be metal

or a disposable plastic preferred) is
introduced into the uterine cavity
.> The canula is connected to a suction
pump adjusted at negative pressure of
300-500 mm Hg according to the
duration of pregnancy.
> Although some recommended a gentle
sharp curettage to the uterus after
evacuation, it is preferable to wait one
week for fear of uterine perforation.
Hysterotomy

• It may be needed for

 evacuation of a large mole to
minimise and facilitate
control of bleeding.

Hysterectomy:lt should be
considered in women over 40
years who have completed their
family for fear of developing
choriocarcinoma.
Sr Specific Teaching
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Medical indication Lecture cum board

• Oxytocins and/ or prostaglandins may be discussion
used to encourage expulsion of the mole
but must always be followed by surgical
evacuation
FOLLOW UP
• As choriocarcinoma may complicate the
vesicular mole after its evacuation,
detection of serum B-hCG by
radioimmunoassay for 2 years is
essential. Detection is done
every:
> 2 weeks after evacuation to ensure
regression
of b -hCG level then,
> every month for one year then,
• every 3 months for another year
o recurrent or persistent vaginal
bleeding,
o amenorrhoea,
o failure of uterine involution,
o persistence of ovarian enlargement.
Sr Specific Teaching
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Activity

9 BIBLIOGRAPHY Lecture cum

discussion
1. DC Dutta’s “TEXT BOOK OF OBSTETRICS AND
GNNACOLOGY” 7th edition
Jaypee brother’s publication pvt Ltd page no-158 to
177.
2. Nima Bhaskar “TEXT BOOK OF MIDWIFERY AND
OBSTETRICAL NURSING”
2nd edition Emmess medical publishers Page no-
3. Kamini Rao “TEXT BOOK OF MIDWIFERY AND
OBSTETRICS FOR NURSES”
Elesevir publication page no- 291 to 295.
4. DC Dutta’s “TEXT BOOK OF OBSTETRICS INCLUDING
PERINATOLOGY
AND CONTRACEPTION” Jaypee brother’s publication
pvt Ltd page no-159 to 168.
5. Mudaliar and menon’s “TEXT BOOK OF CLINICAL
OBSTETRICS” 12thedition universities press page no-138
to 146.
6. Tushar kar “TEXT BOOK OF DO’S AND DONT’S IN
OBSTETRICS AND
GYNACOLOGY PRACTICE” Jaypee brother’s publication
page no-
7. Annamma Jacob “A COMPREHENSIVE TEXTBOOK OF
MIDWIFERY &