JIPMER Nursing Office…: The type of abnormality where the umbilical cord is attached to membranes is called?

JIPMER Nursing Officer-2024

Obstetrics & Gynaecology

Easy

Appeared in: JIPMER Nursing Officer-2024

Explanation

A velamentous insertion is an abnormality where the umbilical cord inserts into the fetal membranes (chorion and amnion) instead of the central mass of the placenta.
In this condition, the umbilical vessels travel unprotected through the membranes before reaching the placental disc.
This lack of protection from Wharton's jelly makes the vessels highly susceptible to compression or tearing, which can cause fetal hemorrhage and distress.
The question specifically describes the cord attaching to the membranes, which is the definition of a velamentous placenta.

Option B: This is not a recognized medical term in obstetrics and serves as a distractor.
Option C: A circumvallate placenta is an abnormality of placental shape, where the fetal membranes fold back on the fetal side, creating a thick ring. It does not relate to the umbilical cord's insertion site.
Option D: Placenta marginata, also known as a battledore placenta, is a condition where the umbilical cord inserts at the margin or edge of the placental disc. The cord is still attached to the placenta itself, not the membranes.

Visual 1: Diagram - A comparative illustration showing a normal central cord insertion, a marginal (battledore) insertion, and a velamentous insertion. This will help visualize the difference in attachment points.
Visual 2: Illustration - A detailed view of a velamentous insertion, highlighting the unprotected umbilical vessels running through the fetal membranes before reaching the placental mass.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Placental and Umbilical Cord Abnormalities as background academic context rather than a clinical decision trigger.
Identifying a velamentous cord insertion, especially when it results in vasa previa (vessels crossing the cervix), is critical for safe delivery planning.
Nurses should be aware that patients with this condition are at high risk for sudden, severe fetal bleeding, especially during membrane rupture or labor.
Management often involves increased fetal surveillance and a planned cesarean delivery before the onset of labor to prevent vessel rupture and fetal exsanguination.

How to Approach the Question

First, identify the key phrase in the question stem: 'umbilical cord is attached to membranes'.
This is a factual recall question that requires knowledge of different types of placental and cord abnormalities.
Evaluate each option based on its definition.
Option A, 'Velamentous placenta', describes the cord inserting into the membranes.
Option C, 'Circumvallate placenta', describes the shape of the placenta, not the cord insertion.
Option D, 'Placenta marginata', describes the cord inserting at the edge of the placenta, not the membranes.

Concept Tested & Keywords

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