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Fetal Circulation Anatomy and Physiology of Fetal Circulation Umbilical Cord

The document describes fetal circulation and how it differs from newborn circulation. In fetal circulation, the placenta provides oxygen to the fetus through the umbilical cord. Three fetal shunts exist - the ductus venosus, ductus arteriosus, and foramen ovale - which allow blood to bypass the lungs. At birth, clamping the umbilical cord and lung inflation cause closure of the shunts and transition to newborn circulation with gas exchange occurring in the lungs.

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136 views

Fetal Circulation Anatomy and Physiology of Fetal Circulation Umbilical Cord

The document describes fetal circulation and how it differs from newborn circulation. In fetal circulation, the placenta provides oxygen to the fetus through the umbilical cord. Three fetal shunts exist - the ductus venosus, ductus arteriosus, and foramen ovale - which allow blood to bypass the lungs. At birth, clamping the umbilical cord and lung inflation cause closure of the shunts and transition to newborn circulation with gas exchange occurring in the lungs.

Uploaded by

bobtaguba
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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FETAL CIRCULATION

Anatomy and Physiology of Fetal Circulation


Umbilical cord

- 2 umbilical arteries: return non-oxygenated blood, fecal waste, CO2 to placenta


- 1umbilical vein: brings oxygenated blood and nutrients to the fetus
- Fetus depends on placenta to meet O2 needs while organs continue formation
- Oxygenated blood flows from the placenta
- To the fetus via the umbilical vein
- After reaching fetus the blood flows through the inferior vena cava

The differences between fetal and newborn circulation

- The fetus received oxygen from the placenta and through the lungs after birth.
- The fetal liver doesn’t have the metabolic function that it will have after birth because the mother
performs these functions.
Three shunts are present in fetal life:
1. Ductus venosus: connects the umbilical vein to the inferior vena cava
2. Ductus arteriosus: connects the main pulmonary artery to the aorta
3. Foramen ovale: anatomic opening between the right and left atrium.
Fetal Circulation

- Blood travels from the inferior vena cava to the ductus venosis
Ductus Venosis

- Small amount of blood routed to growing liver


- Increased blood flow leads to large liver in newborns
- Blood continues to travel up the inferior vena cava
- Empties into the right atrium of the heart
- The blood then passes to the left atrium through the foramen ovale
- Only about one-third of this blood reaches the lungs (due to high flow resistance since the lungs
are not yet expanded, and due to hypoxic vasoconstriction
A/P Fetal Circulation

- Blood continues journey to the left ventricle blood is then pumped into the aorta
- Blood is circulated to the upper extremities
- Blood then returns to the right atrium
- From the right atrium, the blood goes to the right ventricle then to the pulmonary arteries
- Pulmonary arteries
- Small amount goes to the maturing lungs
- Rest of blood is shunted away from lungs by ductous ateriosus back to aorta
- The placenta will re-supply the blood with oxygen
- Fetal circulation is a low-pressure system
- As a result, the blood supplied to the lower half of the body has a relatively low O2
concentration(O2 saturation = 0.3).
- The majority of this blood returns via the umbilical arteries to the placenta, where it is
oxygenated again
Low pressure system

- Lungs are closed


- Most oxygenated blood flows between the atria of the heart through the foramen ovale
- This oxygen rich blood flows to the brain through the ductus arteriosus
Conversion of Fetal to Infant Circulation
At birth
- Clamping the cord shuts down low-pressure system
- Increased atmospheric pressure(increased systemic vascular resistance) causes lungs to inflate
with oxygen
- Lungs now become a low-pressure system
- Pressure from increased blood flow in the left side of the heart causes the foramen ovale to
close
- More heavily oxygenated blood passing by the ductus arteriosus causes it constrict
- Functional closure of the foramen ovale and ductus arteriosus occurs soon after birth
- Overall anatomic changes are not complete for weeks

What happens to these special structures after birth?

- Umbilical arteries atrophy


- Umbilical vein becomes part of the fibrous support ligament for the liver
- The foramen ovale, ductus arteriosus, ductus venosus atrophy and become fibrous ligaments

Human Fetal Circulation


Overview of Conversion

- Umbilical cord is clamped


- Loose placenta
- Closure of ductus venosus
- Blood is transported to liver and portal system
- Increased systemic resistance
- Pressure in right atrium decreased
- Change from right to left shunting to left to right blood flow
- Increased O2 levels in pulmonary circulation
- Closure of the ductus arteriosus

Loss of placenta also leads to:


1. First breath - Increased systemic resistance
2. Lungs expand and fluid is expelled - Pressure in right atrium decreased
3. Decreased pulmonary resistance - Change from right to left shunting to left to right blood flow
4. Increased pressure in left atrium - Increased O2 levels in pulmonary circulation
5. Closure of foramen ovale - Closure of the ductus arteriosus

Fetal vs. Infant Circulation


Fetal Infant
Low pressure system High pressure system
Right to left shunting Left to right blood flow
Lungs non-functional Lungs functional
Increased pulmonary resistance Decreased pulmonary resistance
Decreased systemic resistance Increased systemic resistance
Shunts
Occur when the foramen ovale or ductus arteriosus remains open, placing a strain on the heart.

- In patent foramen ovale (atrial septum defect), the blood flows from left atrium to right atrium
(left-to-right shunt) lead to right ventricle (volume overload) , lungs and then left atrium.
- In patent ductus arteriosus, the blood flows from aorta to pulmonary artery (= left-to-right
shunt) leads to lungs (pressure overload) and then aorta.

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