Which of the following is termed as the fetal blood vessel lying over the internal OS, in front of the presen… - RRB Nsg. Superintendent 21 July 2019 (shift 1st)

RRB Nsg. Superintendent 21 July 2019 (shift 1st)

Obstetrics & Gynaecology

Easy

Appeared in: RRB Nsg. Superintendent 21 July 2019 (shift 1st)

Explanation

Vasa previa is the correct term for when fetal blood vessels, which are not protected by the umbilical cord or placenta, are located over the internal cervical os.
The term 'vasa' refers to vessels, and 'previa' means 'in front of' or 'before,' accurately describing the condition.
These vessels are highly vulnerable to compression by the presenting part or to rupture during labor or when the membranes break.
Rupture of these vessels leads to acute fetal hemorrhage (exsanguination), which is a life-threatening emergency for the fetus.

Option A: Cord prolapse involves the entire umbilical cord, not just the fetal vessels, descending into the vagina or outside the vulva after the membranes have ruptured.
Option B: Cord presentation involves the entire umbilical cord lying in front of the presenting part, but the fetal membranes are still intact.
Option C: Occult cord prolapse is when the umbilical cord is compressed alongside the presenting part but is not palpable on vaginal examination. It doesn't specifically involve vessels lying over the os.

Visual 1: Diagram - Illustrating the anatomical difference between vasa previa, cord presentation, and cord prolapse. The visual should clearly show vasa previa with vessels in the membranes over the os, cord presentation with the cord in front of the head but behind intact membranes, and cord prolapse with the cord descending into the vagina past the head after membrane rupture.

Clinical Relevance

Nursing practice connection: Knowing Obstetrical Emergencies: Differentiating Vasa Previa from Umbilical Cord Complications helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Antenatal diagnosis of vasa previa is critical and is best achieved with transvaginal sonography and color Doppler, especially in high-risk pregnancies (e.g., IVF, placenta previa, bilobate/succenturiate placenta).
Once diagnosed, the standard of care is a planned cesarean delivery between 34 to 36 weeks' gestation to avoid the risks of labor and membrane rupture.
A nurse must be vigilant for the classic sign of vasa previa: painless vaginal bleeding upon rupture of membranes, accompanied by acute fetal distress (bradycardia, sinusoidal pattern). This constitutes a true obstetrical emergency requiring immediate delivery.

How to Approach the Question

First, identify the core components of the question: 'fetal blood vessel,' 'lying over the internal OS,' and 'in front of the presenting part.'
The keyword 'vessel' is the most critical differentiator. This points away from conditions involving the entire 'umbilical cord.'
Analyze the options: Cord Prolapse, Cord Presentation, and Occult Cord Prolapse all describe complications involving the umbilical cord itself.
Recall the definition of 'Vasa Previa.' 'Vasa' means vessels, and 'previa' means going before or in front of. This term directly translates to 'vessels in front.'
Match the definition to the question. Vasa previa is the only condition that specifically describes unprotected fetal vessels lying over the cervix, making it the correct answer.

Concept Tested & Keywords

Concept Tested: Obstetrical Emergencies: Differentiating Vasa Previa from Umbilical Cord Complications
Stem keywords: fetal blood vessel, internal OS, presenting part
Lead-in keywords: termed as
Negative lead-in flag: false

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