FETAL CIRCULATION

The specific structures associated with fetal circulation include the placenta, the umbilical
vein, the ductus venosus, the foramen ovale, the ductus arteriosus, and the umbilical
arteries. Blood rich in nutrients and oxygen, supplied via the placenta, flows through the
umbilical vein to the ductus venosus.

Blood flows from the ductus venosus into the inferior vena cava, up to the right atrium.

This blood mixes with blood returning to the heart from the upper body via the superior
vena cava, and from the lower body via the inferior vena cava.

Once in the right atrium, some of the blood flows to the right ventricle and some of the
blood flows through the foramen ovale, through the left atrium, and into the left ventricle,
where it is then pumped out into the aorta to the body.

Blood that flows into the right ventricle is then pumped into the pulmonary artery. Because
the lungs are fluid-filled instead of air-filled, the vessels in the lungs are narrow, creating
higher resistance to blood flow into the lungs. Due to this high resistance to blood flow in
the pulmonary circulation and the low resistance to blood flow in the systemic circulation,
blood pumped into the pulmonary artery by the right ventricle is more likely to flow into the
ductus arteriosus and then into the aorta.

Due to the high blood flow from the superior vena cava and the inferior vena cava up to the
right atrium, pressures in the right atrium are higher than in the left atrium.

This promotes blood flow through the foramen oval at the atrial level. Only 8% of right
ventricular output flows into the lungs, providing nutrients for the developing lung tissues.

Most of the blood passes through the ductus arteriosus into the aorta and out to the body.

The umbilical arteries allow blood to flow from the body back to the placenta to be enriched
with oxygen and nutrients. Once the baby is born and takes a breath, the umbilical cord is
clamped and the placenta is removed from the systemic circulation.

Immediately, the transition from fetal to postnatal circulation begins. With the elimination
of the placenta from the circulation, systemic vascular resistance begins to rise. With each
breath, more alveoli in the lungs expand, and the vessels surrounding them dilate in
response to the presence of oxygen. Pulmonary pressures begin to decrease. Although
pulmonary pressures are lower than systemic pressures, within minutes after birth it is six to
eight weeks before pulmonary vascular resistance decreases to normal. In the postnatal
circulation, blood no longer flows through the foramen ovale or the ductus arteriosus. The
increase in left atrial pressure after birth forces the septum primum against the septum
secundum, functionally closing the foramen ovale. Within three months, the foramen ovale
permanently closes as fibrin deposits fuse the layers of septal wall together.

Point of clarification. While the patent foramen ovale, or PFO, may close by this time, it also
may not. Autopsy studies in adults indicate that 15 to 25% of adults have a patent foramen
ovale which never closed. The shunt via the PFO after birth is usually small. The ductus
arteriosus begins to close shortly after birth, once the infant begins to breathe. Normally the
ductus closes completely in 4-10 days. The ductus venosus is open at the time of birth,
making central venous access possible through the umbilical vein.
As fibrin infiltrates the ductus venosus, it usually closes within 3-7 days. After it closes, the
remnant is known as ligamentum venosum. Within a week after birth, the umbilical vein and
umbilical arteries are infiltrated with fibrin and also become ligaments.

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nnmm

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