The cord that is inserted into the membranes some distance from the edge of the placenta is known as

Appeared in: RRB Nsg. Superintendent-20 July 2019 (Shift-2)

Explanation

The question describes the umbilical cord inserting into the fetal membranes at a distance from the placental edge.
This is the definition of a velamentous insertion of the cord.
In this condition, the umbilical vessels travel within the membranes, unprotected by Wharton's jelly, before they reach the placental disc.
This lack of protection makes the vessels vulnerable to compression and rupture, which can lead to fetal distress or hemorrhage.

Option A: Battledore insertion refers to the umbilical cord inserting directly at the margin or edge of the placenta, not into the membranes away from the edge.
Option B: A succenturiate placenta is a morphological abnormality where one or more accessory placental lobes develop separately from the main placenta. It does not describe the cord insertion.
Option C: A circumvallate placenta is a placental shape variant where the fetal membranes fold back upon themselves on the fetal side of the placenta, creating a thick ring. It is an abnormality of the chorionic plate, not the cord insertion.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Anatomical abnormalities of the umbilical cord and placenta as background academic context rather than a clinical decision trigger.
Identifying a velamentous cord insertion, often via ultrasound, is crucial for antenatal planning.
The primary risk is vasa previa, where the unprotected vessels lie over the cervix. If these vessels rupture during labor or membrane rupture, it can cause rapid fetal exsanguination. This often necessitates a planned cesarean delivery.
Even without vasa previa, the exposed vessels are at risk for compression by the fetus, which can lead to intermittent fetal hypoperfusion and acidosis during labor.

How to Approach the Question

First, read the question carefully to identify the key features of the abnormality being described. The stem specifies the cord is 'inserted into the membranes some distance from the edge of the placenta'.
This is a factual recall question that requires knowledge of placental and cord abnormalities.
Evaluate each option based on its definition.
Option A, Battledore insertion, is at the margin, not away from it in the membranes.
Option B, Succenturiate placenta, refers to an extra lobe, not the cord insertion.
Option C, Circumvallate placenta, refers to the shape of the placental edge, not the cord insertion.

Concept Tested & Keywords

QL2yNUmLxdSYFpx7UdvS8N

E6 Obstetrics Williams pp. 13-28, 10-26

E6 Anatomy Grays 43e Vol 1 Part 2 p. 12-14

Practise the full RRB Nsg. Superintendent-20 July 2019 (Shift-2)

Attempt every question from this paper in a timed mock, then review the full solution for each one.