Identify the following clinical abnormal condition of the placenta?

NORCET 8 Prelims-2025

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 8 Prelims-2025

Explanation

The image shows the umbilical cord inserting into the fetal membranes, not directly into the placental disc.
The umbilical vessels are seen traveling unprotected within the membranes before reaching the placenta.
This lack of protective Wharton's jelly over the vessels is the defining characteristic of velamentous insertion.
This condition makes the vessels vulnerable to compression and rupture, which can lead to fetal compromise.

Option A: In a marginal insertion (Battledore placenta), the cord inserts directly into the edge of the placental disc, not into the membranes as shown in the image.
Option C: Abruption placenta is the premature separation of the placenta from the uterine wall. It is a bleeding complication, not a structural anomaly of cord insertion.
Option D: Preterm labour is the onset of uterine contractions leading to cervical change before 37 weeks of gestation. It is a timing-of-birth issue, not a placental abnormality.

Visual 1: Diagram - A comparative illustration showing a normal (central) cord insertion, a marginal (Battledore) insertion, and a velamentous insertion. This helps clarify the anatomical differences.
Visual 2: Illustration - An image depicting vasa previa, showing the unprotected fetal vessels from a velamentous insertion crossing the internal cervical os, highlighting the primary danger of this condition.

Clinical Relevance

Nursing practice connection: Knowing Identification of placental and umbilical cord abnormalities helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The primary nursing concern with a known velamentous insertion is vigilant monitoring for fetal distress during labor, as the unprotected vessels are prone to compression.
A critical complication is vasa previa, where these vessels cross the cervix. Any vaginal bleeding, especially after membrane rupture, could signify a torn fetal vessel, which is an obstetric emergency requiring immediate intervention to prevent fetal exsanguination.
What if? If the unprotected vessels were identified via ultrasound as crossing the cervix (vasa previa), the plan of care would change from expectant management to a scheduled cesarean delivery before the onset of labor, typically between 34-36 weeks, to prevent vessel rupture.

How to Approach the Question

First, carefully examine the image provided, focusing on the relationship between the umbilical cord, its vessels, and the main placental disc.
Observe that the cord itself does not attach to the main body of the placenta. Instead, it attaches to the surrounding membranes.
Note the distinct, unprotected blood vessels running through the thin membranes from the cord's insertion point to the edge of the placental disc.
Recall the definitions of placental abnormalities. Match your observation of vessels running through the membranes to the term 'velamentous insertion'.
Differentiate this from 'marginal insertion,' where the cord attaches to the placental edge but directly into the tissue, not the membranes.
Eliminate 'abruption placenta' and 'preterm labour' as they describe different clinical events (separation and timing of labor, respectively) and are not structural insertion anomalies.

Concept Tested & Keywords

Concept Tested: Identification of placental and umbilical cord abnormalities.
Stem keywords: placenta, clinical abnormal condition, identify
Lead-in keywords: Identify
Clinical cues: Image of a gross placental specimen showing abnormal cord insertion.

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