In which type of placental abnormality there is one or more lobes of placenta placed at varying distance from… - DSSSB - 28 August 2019 (Shift-1)

DSSSB - 28 August 2019 (Shift-1)

Obstetrics & Gynaecology

Easy

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Placenta succenturiata is characterized by the presence of one or more accessory lobes of placental tissue located at a distance from the main placental disc.
These lobes are smaller than the main placenta and develop within the fetal membranes.
Fetal blood vessels connect the accessory lobe(s) to the main placenta, traversing the membranes.
The primary clinical risk is the retention of an accessory lobe after delivery, which can lead to significant postpartum hemorrhage or infection.
Another major risk is vasa previa, where these connecting vessels cross the internal cervical os, making them vulnerable to rupture during labor.

Option B: Circumvallate placenta is defined by a structural abnormality on the fetal surface, not by an extra lobe. It features a thick, opaque, whitish ring composed of a double fold of amnion and chorion.
Option C: Placenta membranacea involves the placenta developing as a thin structure that covers a large portion, or nearly all, of the surface of the fetal membranes, rather than forming a discrete disc. It does not involve separate lobes.
Option D: Placenta marginata (corrected from 'maginata') is a variant of extrachorial placentation where a thin, fibrous ring is present at the margin of the chorionic plate. It does not involve a separate, accessory lobe.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Placental abnormalities as background academic context rather than a clinical decision trigger.
The most critical nursing responsibility after delivery is the thorough examination of the placenta and membranes to ensure completeness. A missing piece, indicated by a defect on the maternal surface or a hole in the membranes with torn vessels, suggests a retained succenturiate lobe.
Failure to identify and remove a retained succenturiate lobe is a preventable cause of primary and secondary postpartum hemorrhage (PPH) and puerperal sepsis.
What if? If a succenturiate lobe is identified on a prenatal ultrasound, the location of the connecting vessels must be carefully assessed with color Doppler to rule out vasa previa. If vasa previa is present, a planned cesarean delivery before the onset of labor is necessary to prevent catastrophic fetal hemorrhage.

How to Approach the Question

First, analyze the question stem to identify the key descriptive phrase: "one or more lobes of placenta placed at varying distance from main placental margin."
Next, examine the provided image. Observe the main placental body and a smaller, distinct lobe separate from it, connected by blood vessels. This visual evidence directly corresponds to the description in the question.
Recall the definitions of the different placental abnormalities listed in the options.
Match the description and the visual cue to the correct term. 'Succenturiate' means accessory, which perfectly describes the extra lobe.
Confirm the answer by differentiating it from the other options. Circumvallate involves a ring, membranacea involves a large thin placenta, and marginata involves a fibrous edge, none of which describe a separate lobe.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 11-26

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 62-76