UNIVERSITY OF EASTERN AFRICA, BARATON

SCHOOL OF NURSING
DEPARTMENT OF NURSING

FETAL CIRCULATION

ASSIGNMENT DONE IN PARTIAL FULFILLMENT OF THE COURSE NRSG 238:

CHILD BEARING FAMILY 1

PRESENTED BY:
MANDELA ELIJA MOGOA
SMANMO2021

INSTRUCTOR:
MS SUSAN HEPZI

DUE DATE:
MONDAY, 30TH JANUARY 2023
FETAL CIRCULATION.
The Umbilical vein carrying 80% saturated oxygenated blood enters the fetus at the umbilicus and
runs of to the liver where it gives off to the left lobe of the liver branches and receives deoxygenated
blood from the Portal vein; the greater portion of the oxygenated blood mixed with some portal
venous blood exits the liver through ductus venosus to enter the Inferior Vena Cava(IVC) off
to the Right atrium reducing the Oxygen content of this mixed blood; the terminal part of the IVC
receives blood from the right hepatic vein.
In the right atrium, 75% saturated oxygenated blood from ductus venosus is directed into the
Foramen Ovale by IVC valve into the Left atrium where it is mixed with venous blood from the
lungs through the Pulmonary veins; after which it is passed on to the Left Ventricle through the
mitral opening. The remainin 25% reaches the Right atrium; from the Cephaliac in the fetus
through the Superior Venacava and Fetal Caudal parts via Inferior Venacava; where it then
passes into the right ventricle via the tricuspid opening.
During ventricular contraction, the Left ventricle pumps blood into the ascending arch of the
aorta where it is distributed to the heart, head, neck, brains and arms. The right ventricular blood
with low oxygen content is discharged to the pulmonary trunk but since resistance in the
Pulmonary arteries during fetal life is very high, the main portion of blood passes directly through
the ductus arteriosus into the descending aorta, bypassing the lungs where it mixes with blood
from proximal aorta.
70% of the cardiac output in the ventricles is carried by ductus arteriosus to the descending
aorta. About 40% of the Complete Output goes to the placenta through the umbilical arteries.
The deoxygenated blood leaves the body by way of two umbilical arteries to reach the placenta
where it is oxygenated and gets ready for recirculation.
CHANGES OF THE FETAL CIRCULATION AT BIRTH.
Cessation of the placental blood flow and Initiation of respiration contribute to the changes in
hemodynamics of the fetal circulation soon after birth.
Some of these changes include:
A) Closure of the Umbilical arteries
Instantaneous Functional closure happens to prevent draining out of the fetal blood whereas
obliteration takes 2-3 months. The distal parts form the Lateral Umbilical Ligaments and
the Proximal parts remain open as Superior vesical arteries.
B) Closure of the Umbilical vein
 Obliteration occurs a little later than arteries allowing extra volume of blood to be received
by the fetus from the placenta. The ductus venosus collapses causing the venous pressure
of the IVC and right atrial pressure to fall. After obliteration, Umbilical vein forms the
Ligamentum teres while the ductus venosus forms the ligamentum venosum.
C) Closure of the Ductus arteriosus
Within few hours of respiration, the muscle wall of the ductus arteriosus contracts probably
in response to rising oxygen tension of the blood flowing through the duct. The effects of
variation of the Oxygen tension on ductus arteriosus are thought to be mediated through
the action of Prostaglandins. Prostaglandin antagonists given to the mother may lead to
premature closure of ductus arteriosus. Whereas functional closure of the ductus may occur
soon after the establishment of pulmonary circulation, the anatomical obliteration takes
about 1-3 months and becomes Ligamentum arteriosum.
D) Closure of the Foramen ovale
This is caused by an increased pressure of the left atrium combined with a decreased
pressure on the right atrium. Functional closure occurs soon after birth but anatomical
closure occurs about 1 year time. During the first few days, the closure may be reversible
as evidenced by the cyanotic look of the baby during crying when there is shunting of the
blood from right to left. Within 1-2 hours after birth, the cardiac output is estimated to be
about 500ml/min and the heart rate 120-140 per minute.
REFERENCE:
DC Dutta et al, Textbook of Obstetrics including Perinatology and contraception, 8th
Edition, Jaypee Brothers Medical Publishers, New Delhi, Pg 49 – 51.