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.