INSTITUS LATIHAN KEMENTERIAN

KESIHATAN MALAYSIA
KOTA KINABALU

DIPLOMA LANJUTAN KEBIDANAN

AMBILAN MAC 2020

MATA PELAJARAN : MWMS 4013

TAJUK TUGASAN : FETAL CIRCULATION

NAMA PELAJAR : NORDAYANA BINTI YUNUS

NO. IC : 930912155146

NO. MATRIKS : ADMW1/2020(K)079

INTRODUCTION

Before a baby is birth, there a lot of

adaptation that allows baby to take nutrient
and oxygen from mother. The placenta is
the source of oxygenation, nutrition and
elimination of waste for the fetus. There are
several temporary structures in addition to
the placenta and the umbilical cord that
enable the fetal circulation to occur.

DEVELOPMENT OF FETAL HEART

The human heart is the first functional organ to develop. It begins beating and pumping
blood around day 21 or 22, a mere three weeks after fertilization. This emphasizes the critical
nature of the heart in distributing blood through the vessels and the vital exchange of nutrients,
oxygen, and wastes both to and from the developing baby. The critical early development of the
heart is reflected by the prominent heart bulge that appears on the anterior surface of the embryo.

The heart forms from an embryonic tissue called mesoderm around 18 to 19 days after

fertilization. The heart begins to develop near the head of the embryo in a region known as
the cardiogenic area. Then begins to form two strands called the cardiogenic cords. As the
cardiogenic cords develop, a lumen rapidly develops and referred to as endocardial tubes. The two
tubes migrate together and fuse to form a single primitive heart tube. The primitive heart tube
quickly forms five distinct regions. The remainder of the heart development pattern includes
development of septa and valves, and remodelling of the actual chambers. Partitioning of the atria
and ventricles by the interatrial septum, interventricular septum, and atrioventricular septum is
complete by the end of the fifth week, and develop temporary structure.
TEMPORARY STRUCTURE OF FETAL CIRCULATION

As the embryo develops into a fetus, the tube-shaped heart folds and further
differentiates into the four chambers present in a mature heart. The fetal cardiovascular
system also includes circulatory shortcuts, or temporary structure/shunts. A shunt is an
anatomical diversion that allows blood flow to bypass immature organs such as the lungs
and liver until childbirth.

The temporary structure form in fetal circulation in 4 structure:

1. Ductus venosus
- Kind of shortcut or shunt that connect the umbilical vein to the inferior vena cava.
- Oxygenated blood from the placenta travels to the fetus in the umbilical vein. Then
the umbilical vein divides into two branches, one that supplies the portal vein in the
liver and the other is ductus venosus joining the inferior vena cava (IVC).

2. Foramen oval
- Temporary opening in the septum between the right and left atrium.
- Most of the oxygenated blood that enter right atrium passes across the foramen
ovale to the left atrium and from here into the left ventricle, and then to the aorta.
- Foramen oval act as a shunt that directly connects the right and left atria and helps
divert oxygenated blood from the fetal pulmonary circuit.
 3. Ductus arteriosus
- Shunt that connect the main pulmonary artery to the aorta. Leads from bifurcation of
the pulmonary artery to the descending aorta. It protects the lung from circulatory
overloading.
- Act as a shunt in the pulmonary trunk that diverts oxygenated blood back to the
aorta.

4. Hypogastric arteries
- Had 2 arteries as branch off from the internal iliac arteries and become the umbilical
arteries when enter the umbilical cord.
- Deoxygenated blood travels back to the placenta via internal iliac arteries leading into
hypogastric arteries and to the umbilical arteries for oxygenation.

What is the physiological benefit of these temporary structure in the fetal circulatory
system?
Circulatory temporary structure/shunt bypass the fetal lungs and liver, bestowing them with
just enough oxygenated blood to fulfil their metabolic requirements. Because these organs
are only semi functional in the fetus, it is more efficient to bypass them and divert oxygen
and nutrients to the organs that need it more.
 DEFINITION OF FETAL CIRCULATION

MATERNAL FETAL
CIRCULATION CIRCULATION

- During prenatal development, the fetal circulatory system is integrated with the placenta
via the umbilical cord so that the fetus receives both oxygen and nutrients from the
placenta.

- Placenta is where fetal blood and maternal blood meet, but they do not mix. In this
case, the blood flowing from umbilical vein to the fetal heart is Oxygenated because it
comes from the placenta. Then arteries carry Deoxygenated blood to placenta.

- Fetal circulation is the term usually encompasses the entire fetoplacental circulation
which includes the umbilical cord and the blood vessels within the placenta that carry
fetal blood. The respiratory system is immature and cannot yet oxygenate blood on its
own.

- However, after childbirth, the umbilical cord is severed, and the new-born’s circulatory
system must be reconfigured.
THE FETAL CIRCULATION TAKES THE FOLLOWING COURSE:

- Oxygenated blood from placenta travels to the fetus in the umbilical vein, the
oxygenated blood flows toward the inferior vena cava, all but bypassing the immature
liver, via the Ductus Venosus shunt. Blood flows from the inferior vena cava(IVC) to
the right atrium, mixing with fetal venous blood along the way.

- Most of the oxygenated blood enters the right atrium passes across the Foramen
Ovule to the left atrium and to left ventricle, and then to the aorta. The head and upper
extremitis receive about half blood supply via coronary and the carotid arteries, and
subclavian arteries. The remainder of blood travels in the descending aorta, mixing with
the deoxygenated blood from the right ventricle.

- Deoxygenated blood collected from the upper parts of the body returns to the right
atrium in the superior vena cava (SVC). Blood that has entered right atrium from IVC
and SVC passes into right ventricle. A small amount of blood travels to the lungs in the
pulmonary artery. Even though, the fetal lungs are non-functional. Only a small volume
of oxygenated blood passes through the immature pulmonary circuit, for their
development.

- Most blood passes through the Ductus Arteriosus into the descending aorta.
Deoxygenated blood travels back to the placenta via internal iliac arteries leading into
Hypogastric Arteries which lead to the umbilical arteries.

- Thus, the two umbilical arteries carry blood low in oxygen and high in carbon dioxide
and fetal wastes. This blood is filtered through the placenta, where wastes diffuse into
the maternal circulation. Oxygen and nutrients from the mother diffuse into the placenta
and from there into the fetal blood, and the process repeats.
CHANGES AT BIRTH IN THE FETAL CIRCULATION

With birth, a change from parallel flow

through the heart to a serial one gradually
takes place. The following changes must
occur:

1. The gas exchange takes place in the

baby's lungs.
2. By cutting the umbilical cord, the
placental circulation system is
switched off.
3. The fetal heart shunts become closed.

- With the activation of breathing this create a negative thoracic pressure thus sucking more blood
from the pulmonary artery into the lungs and diverting it from ductus arteriosus which gradually
close. The foramen ovale is a valvular opening, the valve functioning from right to left. With
increase of atrial pressure made this valve close and become fossa ovalis.

- On the other hand, with the cutting of the umbilical cord following birth, the placental low
resistance area also disappears, and the peripheral resistance increases in the systemic
circulation. The pressure in the aorta is now higher and the right-left shunt via the ductus
arteriosus that is present before birth is turned around into being a left-right shunt.

- The pO2 pressure in the aorta increases since the blood is now oxygenated directly in the baby's
lungs. This increase in pO2 triggers a contraction of the smooth musculature in the wall of the
ductus arteriosus and thereby to a functional seal. After a few weeks or months this shunt via the
ductus arteriosus is definitively obliterated and the remnant is known as the ligamentum
arteriosus.

- The cutting of the umbilical cord leads to the obliteration of the umbilical vessels, primarily
through active constriction of their muscular layer. Only the proximal part of the umbilical
arteries stays open as the superior vesical artery. The distal part forms the medial umbilical
ligament on both sides in the anterior abdominal wall. The umbilical vein transforms itself into
the ligamentum teres.
AS THESE TEMPORARY STRUCTURE BECOME PERMANENT, THE FOLLOWING
FETAL STRUCTURES ARISE:

CHANGES IN FETAL NEWBORN

GAS EXCHANGE Placenta Lungs
DOMINANT VENTRICLE
Right To Left Left To Right
AND BLOOD FLOW

TEMPORARY STRUCTURE ADULT REMNANTS

 becomes the ligamentum teres.
The Umbilical Vein
 becomes the ligamentum venosum.
 within several minutes after birth
The Ductus Venosus
 anatomical closure 3-7 days after birth.

 becomes the ligamentum arteriosum.

 Its close from 10-96hrs after birth.
The Ductus Arteriosus
 Anatomical closure within 2-3 week after birth.

 becomes the fossa ovalis.

 its close within several minutes after birth.
The Foramen Ovale
 Anatomical closure within one year after birth.

 become the obliterated hypogastric arteries except for

the first few centimetres, which remain open and are
The Hypogastric Arteries
known as the superior vesical arteries.
SUMMARY

During in uterus, the fetus depends on its maternal circulation for nourishment, oxygen and
excreted fetal waste. Since the fetus doesn’t breathe air, fetal blood circulates differently than it
does after birth. While the baby is still in the uterus, lungs are not being used. The baby’s liver is not
fully developed. Circulating blood bypasses the lungs and liver by flowing in different pathways and
through special openings called temporary structure such as ductus venous, ductus arterious,
foramen ovale and hypogastric arteries. 
At birth, major changes take place. The umbilical cord is clamped and the baby no longer
receives oxygen and nutrients from the mother. With the first breaths of air, the lungs start to
expand, and the ductus arteriosus, ductus venosus and the foramen ovale close. The baby's
circulation and blood flow through the heart now function like adults which is gas exchange in lungs
and the dominant ventricle and the blood flow from left to right.
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