In which condition, the umbilical cord is attached to the margins of the placenta?

AIIMS Raipur - 2017 (Shift-3)

Obstetrics & Gynecology

Easy

Appeared in: AIIMS Raipur - 2017 (Shift-3)

Explanation

Battledore placenta is a morphological abnormality where the umbilical cord inserts at the very edge or margin of the placenta, rather than centrally.
This condition is also known as marginal cord insertion.
The name 'battledore' comes from its resemblance to a battledore, which is an old type of racquet similar to a table tennis bat.
The provided image clearly shows this type of insertion in diagram B, confirming the visual characteristic of the condition.

Option B: A circumvallate placenta is an abnormality of the placental shape where the chorionic plate on the fetal side is smaller than the basal plate on the maternal side. This causes the fetal membranes to fold back on themselves, creating a thickened ring at the placental margin. It is not defined by the location of the cord insertion.
Option C: Placenta membranacea is a rare condition where the chorionic villi cover all or nearly all of the fetal membranes, resulting in a placenta that is abnormally thin but has a very large surface area. The defining feature is its size and shape, not the specific site of cord insertion.
Option D: In a velamentous placenta, the umbilical cord inserts into the fetal membranes (chorion and amnion) rather than directly into the placental disc. The fetal vessels then travel unprotected within the membranes to reach the placenta. This is a different type of abnormal insertion.

Visual 1: Diagram - An illustration comparing normal, battledore (marginal), velamentous, and succenturiate lobe placental variations. This helps to visually differentiate the types of cord insertions and placental shapes.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Placental abnormalities and umbilical cord insertion as background academic context rather than a clinical decision trigger.
While often having no adverse outcomes, a battledore placenta can increase the risk of fetal distress during labor, especially if the cord is compressed against the maternal pelvis or cervix.
It is sometimes associated with preterm labor, fetal growth restriction, and low birth weight, warranting closer monitoring of fetal well-being during pregnancy and labor.
What if? If the cord inserted into the membranes instead of the margin, it would be a velamentous insertion. This is far more dangerous as the unprotected vessels could rupture during labor or membrane rupture, leading to rapid fetal exsanguination, a condition known as vasa previa.

How to Approach the Question

First, read the question carefully to identify the key terms: 'umbilical cord attached to the margins of the placenta'.
Next, analyze the provided image. Diagram B clearly shows the cord inserting at the edge of the placenta, which visually represents a marginal insertion.
Recall the definitions of different placental abnormalities. 'Marginal' insertion is the key feature of a Battledore placenta.
Evaluate each option: 'Battledore placenta' directly matches the description. 'Circumvallate' relates to the placental edge shape, 'membranacea' to the placental surface area, and 'velamentous' to insertion into the membranes.
Conclude that Battledore placenta is the only correct match based on the definition and the visual evidence.

Concept Tested & Keywords

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