Fetal Circulation

Fetal Circulation: Overview

Fetal Circulation: Parturition
• Uterine contractions squeeze head and body
thereby expelling fluid from fetal lung.
• Subsequent contractions deliver the placenta
thereby severing connection between fetal and
maternal blood supply.
• During birthing process, placental capillaries are
crushed, and thus the fetal systemic circuit’s
resistance goes up almost 2 fold. (remember:
placental circ. WAS about HALF of TOTAL fetal circ.,
thus removing this parallel circuit would DOUBLE
resistance)
 Fetal Circulation: Parturition Contd.
• Assuming that CO remains the same, doubling
resistance should also double the pressure within
fetal circulation (by P=QR)
• Also, another effect of increasing R is that this
briefly DECREASES movement of blood into the
IVC, which results in a decrease in RIGHT ATRIAL
PRESSURE!
• Now, pressure in LEFT atrium is higher than right,
and so flow of blood through foramen ovale stops!
(See pic to visualize this)
 Fetal Circulation: Parturition Contd.
• Flap of tissue in Left Heart covers up the
Foramen Ovale. Now even LEFT to RIGHT
blood flow (due to reversal of relative atrial
pressure) cannot take place.
• As a result, RV output can ONLY enter the
pulmonary artery.
 Fetal Circulation: First Breath
• Post-birth, pO2 goes down while pCO2 goes up
(this is new to the baby); this is sensed by
chemorecs and initiates first breath.
• Also, breathing may be influenced by gasps due to
“startle reflex”. (baby is startled upon seeing new
things etc…and so gasps, which helps with first
breath too)
• The loss of “immersion reflex” may influence
breathing. (immersion reflex = if underwater, as in
utero, drive to breathe goes down. Post birth, this
inhibition is removed, thus baby tries to breathe)
 Fetal Circulation: First Breath Contd.
• Need to generate 80cm of water worth of
pressure to establish alveolar liquid-air
interface upon first breath.
• Need to therefore decrease INTRATHORAIC
(IT) pressure by a lot via contraction of
diaphragm and external intercostals.
• This decrease in IT pressure not only allows
enough of a pressure gradient to breathe, but
also elicits MAJOR changes in circulation.
 Fetal Circulation: First Breath Contd.
• When IT pressure is decreased, the pressure in
lungs goes down too, SO…there is less pressure
surrounding the pulmonary vessels as well (think
about this…)
• Because of this, there is now a greater difference in
pressure between right ventricle (we didn’t do
much to P here) and pulmonary vessels (P went
down here).
• This difference now allows for more blood to flow
through these vessels since they are now more
dilated
 Fetal Circulation: First Breath Contd.
• Now, vessels exhibit HIGH FLOW and LOW
RESISTANCE properties characteristic of adult
pulmonary circulation.
• Also, since you are now oxygenating the
alveoli, you release the hypoxia-induced
vasoconstrictive tendencies which were
predominant during fetal circulation.
 Fetal Circulation: First Breath Contd.
• As breathing continues, a greater % of blood
from the RV enters the pulmonary circulation.
• This increases FLOW to the LEFT ATRIUM,
which causes an increase in LA pressure. (this
increase in LA pressure also prevents
movement of blood from RA to LA via a patent
foramen ovale…critical because it prevents
venous blood from mixing with arterial
blood!!!)
Fetal Circulation: Ductus Arteriosus (DA)
• Since blood flow through lung increases after
birth, so does return of blood to the LA and,
by extension, to the LV!!!
• Increase in blood flow to LV, via STARLING
FORCES, increases LV contractility.
• This increases aortic systolic pressure.
• Increase in aortic pressure prevents blood
moving from RIGHT to LEFT into the DA (see
pic!!!).
Fetal Circulation: Ductus Arteriosus (DA)
• DA acts like other systemic vessels; that is, when
introduced to high O2 environments, they
CONSTRICT.
• Thus, when pulmonary circulation improves after
birth, P02 increases as well. Thus, the DA
constricts!!!
• Prostacyclins prevent the constriction of the DA.
• One way to treat patent DA is to administer a
prostacyclin synthesis inhibitor such as
INDOMETHICIN.
Fetal Circulation: Ductus Arteriosus (DA)
• LAST NOTE: During fetal circ, RV pressure is higher
than LV pressure because of reasons already
discussed (hypoxic vasoconstriction, we haven’t
decreased IT pressure yet, fluid surrounding the
lungs in utero etc…)
• After birth, this all reverses such that LV pressure is
greater than RV pressure.
• You will therefore see a switch from a thick RV wall
during fetal life to a thick LV wall during adult life.
(ie. Wall thickness reflects pressure levels…since
muscle grows in response to work…and work =
PRESSURE * Volume)