5.

Ductus Arteriosus
FET AL CIRCULATION  Is between the Pulmonary artery and the
Aorta
OUTLINE  In some cases, after delivery it will close
after 3 months, but in other cases, it will not
I. FETAL CIRCULATION close leading to Patent ductus arteriosus
II. FOCUS OF FETAL DEVELOPMENT (PDA) = abnormal connection between the
III. NORMAL ADAPTATION OF PREGNANCY aorta and the pulmonary artery in the heart

Additional notes:

 Foramen Ovale, Ductus Venosus, Ductus

Arteriosus = will close before delivery but in
some cases it will not close (like foramen ovale)
it will lead to disorder of a baby
 Blue baby syndrome = mix of oxygenated and
unoxygenated blood

FET AL CIRCULATION FLOW CHART

 Refer to the fig_

Fig 1: Fetal Circulation
FEATURES IN FETAL CIRCULATION
1. Umbilical Artery
 Transport the blood from the baby to the
placenta going back to the mother
circulation
2. Umbilical Vein
 Transports the blood and nutrients from the
mother to the placenta going to the fetus
 Collection between the mother and fetus
3. Foramen Ovale
 Septum between the right atrium and the
left atrium
 Like prick of a needle but it will allow the
shunting of the blood from right to left
4. Ductus Venosus
 Is the one that carries the blood
 between the umbilical vein and the inferior
vena cava that allows the blood bypassing
the liver
 Oxygenated blood from the placenta returns via the
umbilical vein
 The umbilical vein distributes
o 40% of its flow to the liver
 Inferior vena cava drains into the right atrium
 From the right atrium, the flow splits into right
ventricle and left atrium via foramen ovale
 From the left ventricle, into the aorta
o From the aorta, upper body blood flow
(brain and arms) is purely from the left
ventricle, whereas lower body blood flow is
the combined output of the left ventricle and
right ventricle via the ductus arteriosus
 From the common iliac arteries, via the umbilical
arteries to the placenta
FOCUS OF FET AL DEVELOPMENT
FIRST TRIMESTER
 Organogenesis
SECOND TRIMESTER
 Period of continued growth and development

ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 20

 THIRD TRIMESTER
 Period of most rapid growth and development
NORM AL ADAPT ATION OF PREGNANCY
REPRODUCTIVE SYSTEM
 Undergoes greatest changes in size as well in its
function
 Uterus
o Uterine growth and enlargement
o Length – 6.5 cms to 32 cms
o Width – 4 cms to 24 cms
o Depth – 2.5 cms to 22 cms
o Weight – 50 gms to 1000 gms
o Volume – 1-2 ml to 1000 ml
Additional notes:

Uterus increases as the baby grows: it can
accommodate
 Uterus is under the influence of estrogen and
myometrial cells as well as the muscle fibers,
undergoes changes: Hypertrophy, with the
process that allows the uterus to enlarge and
stretch as the fetus enlarges also
 Estrogen = cause hypertrophy of uterus and
enhance the uterus contractility, prepares the
muscles during pregnancy; myometrium contracts
 Progesterone = enables the pregnancy to thrive
the effect by relaxation on a smooth muscle,
prevent the labor if the baby is not on full term, help
in the contractility to expel the baby outside,
decrease of progesterone - the baby will be
 Braxton Hicks Contraction
expelled
o Irregular and painless contraction or fetal
movement felt by the mother during the 16
weeks or for 4 months
 Becomes globular (4th month)
o Abdomen, as the baby increase in its size and
 This involves the pelvic joint. The pelvis of the mother
growth the uterus of the mother becomes
globular in shape and seen physically
 Goodell’s sign (4th week)
o Cervix/cervical softening is caused by the
stimulation from the hormone estrogen and
progesterone
ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D
o Increase blood flow in cervix or the vagina that
causes engorgement of the vagina or the cervix
as well, and vulva that produces discoloration
 Hegar’s sign (8th week)
o Cause by an increase of secretion of
estrogen and progesterone that produces a
cervical softening of cervix
o Softening of the lower uterine segment that
is caused by of pelvic congestion
 Chadwick’s sign (8th to 10th week)
o One of the earliest signs of pregnancy that
the discoloration bluish-purple hue that
appears on the cervix, vaginal, and vulva
o estrogen and progesterone
 Ovaries = no ovulation, during pregnancy, the ovary
stops to produce ova but continues to produce
hormone progesterone
 Vagina = more acidic (ph 3.5 to 6) help control the
growth of pathogens in the vaginal canal to prevent
ascending infections like UTI, Leukorrhea = whitish,
yellowish discharge
 Breasts = as the fetus enlarges in the uterus,
estrogen and progesterone produces number of
changes to the mammary glands
Additional notes:
 Melanotropin = a hormone that is secreted
by the pituitary gland that causes the nipple
become tender and darkening of areola
 Colostrum = whitish, appeared in 3rd
trimester, it is creamy whitish yellow liquid
that have antibodies that help create natural
immunity of the baby; encourages baby to
suck the breast of mother to get colostrum
MUSCULOSKELET AL SYST EM
during pregnancy normally relaxes causing a waddling
walk (walking like a duck).
- Waddling walk
- Symphysis pubis may separate slightly
CIRCULATORY SYSTEM
21
 Increased blood volume 40% to 50% - because there
is a need to increase this amount due to metabolic
demands of the new tissues of the growing fetus
 Physiologic anemia- occurs due to hemodilution of the
hemoglobin content of the blood volume. There is
decrease RBC during pregnancy which is term as
PSEUDOANEMIA.
 Heart is displaced upward – to the left because of the
growing fetus.
 Increased cardiac output to 30 % - that is why we ask
the mother to position to left lateral.
 Supine hypotension
- if the CO increase to 30 %.
- It also causes the mother to have difficulty in
breathing.
- They experienced due to the enlarging fetus and the
location of the inferior vena cava.
- The mother has difficulty to lie on supine position
because of compression.
- If the mother is in flat position, it compresses inferior
vena cava that causes Cardiac Venous Return that
decreases cardiac output and that would lead to
Supine Hypotension or Vena Cava Syndrome.
 Increased WBC
 CR & PR increased to 10 -15 beats/min
Fig.2 Growth of baby and enlargement of the uterus.
INTEGUMENT ARY SYSTEM
 Increased pigmentation
ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D
- Darkening of neck, under arms, and color changes
of the palm which termed as Palmar Erythema.
- The breast also darkens especially the areola.
- Abdomen also have a line which is termed as
Linea Negra is the dark streak down midline in the
abdomen
 Chloasma/ Melasma
- darkening of skin especially on the face.
- term as “MASK OF PREGNANCY”
 Stria Gravidarum – this the stretch mark found the
abdomen sometimes due to the scratching of the
mother
 Linea Negra- dark streak down midline in the abdomen
 Increased Perspiration- during pregnancy causes the
mother to take bath several times a day.
G ASTROINTESTINAL SYSTEM
 Morning Sickness
- vomiting in the morning
- Caused by the hormone HCG (Human
chorionic gonadotropin)
- An increased salivary secretion because of
enzyme Ptyalin that helps in mastication but also
causes morning sickness due to increase level
of HCG, Estrogen, and progesterone
 Heartburn
- due to the relaxation of the sphincter between
the stomach and the esophagus that causing a
reflux of the gastric content
- Medical term for heartburn is Pyrosis
 Constipation
- caused by the decrease motility of the
gastrointestinal tract which is brought about by
increased progesterone.
- additional Ferrous sulfate(sulphate) to
increase the RBC content of the body and one
of the side effects of this constipation.
22
 RESPIRATORY SYSTEM
 Increased RR: up to 23 RR
-Normal: 12-16 RR
-Other Factors: Chest Contractions
 Dyspnea – Difficulty in breathing
-diaphragm is being displaced about 2 cm upward.
 Increased tidal volume – amount of air breathe of
the mother per minute
-Caused by the increase of estrogen and
progesterone

*Estrogen increase – causes hypertrophy

Fig. 3 Mask of Pregnancy (Melasma or Chloasma)
(increased muscle cells) and hyperplasia (increase
of cells) of the lung tissue
*Progesterone increase – causes relaxation of
smooth muscle of the bronchi, bronchioles, and
alveoli.

 Increase vital lung capacity – force of respiration is

increased.
 Decreased residual volume

URINARY SYSTEM
 Urinary frequency – compress bladder
 Increased GFR (Glomerular Filtration Rate)
-Caused by increased progesterone:
-Mothers are advised to increase fluid intake during
the day
-includes relaxation of the sphincter
-causes asymptomatic bacteriuria and UTI (urinary
tract infection)
*Careful during this time if there is glycosuria result.
It is the inability of the kidney to reabsorb glucose.

ENDOCRINE SYSTEM
 Increase metabolism of CHON and ChO
-Caused by the pancreas
-Pancreas increase insulin during pregnancy
 Increased insulin production

WEIGHT G AIN
 Weight distribution:
Fetus - 7lbs
Placenta - 1lbs
Amniotic fluid - 1.5lbs
Uterus - 2lbs
Blood Volume - 1lbs

ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 23

 Breast - 1.5 – 3lbs
Fluid - 2lbs REFERENCE:
Fats - 4 – 6lbs
I. Power Point Presentation
Total: - 20 – 25lbs
II. Notes From Discusion

FLOWCHART OF FET AL CIRCULATION

Placenta

Umbilical vein
(oxygenated Blood)

Liver (40% Blood)

Ductus Venosus Hepatic Vein

Inferior Vena
cava

Right Atrium

Foramen Ovale Tricuspid Valve

Ductus Arteriosus
Right Ventricle
Left Atrium
Mitral Valve

Left Ventricle Pulmonary Circulation

Aortic Valve

Ascending Aorta Descending Aorta

Brain and Upper Body Parts Lower Body Parts

Common Iliac Artery

Superior Vena Cava

Umbilical Artery

Umbilical Cord

ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 24