INTRODUCTION

In animals that give live birth, the fetal circulation is the circulatory system of a fetus. 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 fetal (prenatal) circulation works differently from normal postnatal circulation, mainly

because the lungs are not in use. Instead, the fetus obtains oxygen and nutrients from the mother

through the placenta and the umbilical cord. The advent of breathing and the severance of

the umbilical cord prompt various neuroendocrine changes that shortly transform fetal

circulation into postnatal circulation. There are several temporary structures in addition to the

placenta and umblical cord that enable the fetal circulation to occur. These are

The ductus venosus which connects the umblical vein to inferior vena cava

The foramen ovale which is an opening between the right and left artria

The ductus arteriousus which leads from the bifurcation of pulmonary artery to the descending

aorta

The hypogastric arteries which branch off from internal iliac arteries and become the

umblical arteries when they enter the umbilicus

FETAL CIRCULATION

During pregnancy, the fetal circulatory system works differently than after birth:

The fetus is connected by the umbilical cord to the placenta, the organ that develops and

implants in the mother's uterus during pregnancy.

Through the blood vessels in the umbilical cord, the fetus receives all the necessary nutrition,

oxygen, and life support from the mother through the placenta.

Waste products and carbon dioxide from the fetus are sent back through the umbilical cord and

placenta to the mother's circulation to be eliminated.

STRUCTURE

The fetal circulatory system uses two right to left shunts, which are small passages that direct

blood that needs to be oxygenated. The purpose of these shunts is to bypass certain body parts in

particular, the lungs and liver that are not fully developed while the fetus is still in the womb.

The shunts that bypass the lungs are called the foramen ovale, which moves blood from the

right atrium of the heart to the left atrium, and the ductus arteriosus, which moves blood from

the pulmonary artery to the aorta.

In the fetus, the placenta does the work of breathing instead of the lungs. As a result, only a small

amount of the blood continues on to the lungs

Oxygenated Blood from the placenta is carried to the fetus by the umbilical vein. The umblical

veins divide into two branches, one that supplies the portal vein in the liver, the other the

ductus venosus joining the inferior vena cava.

In humans, less than a third of this enters the fetal ductus venosus and is carried to the inferior

vena cava, while the rest enters the liver proper from the inferior border of the liver. From the

IVC, the blood then moves to the right atrium of the heart.

In the fetus, there is an opening between the right and left atrium (the foramen ovale), and most

of the blood flows through this hole directly into the left atrium from the right atrium, thus
bypassing pulmonary circulation. The continuation of this blood flow is into the left ventricle,

and from there it is pumped through the aorta into the body. The head and upper extremities,

heart muscle itself in addition to the brain receive approximately 50% of this blood via the

coronary and carotid arteries and the subclavian arteries respectively. The rest of the blood

travel down the descending aorta mixing with deoxygenated blood from the right ventricle.

After circulating in the upper extremities, the blood (deoxygenated) returns through the superior

vena cava to the right atrium of the heart, blood from lower part of the body too enters in to the

right artrium through the IVC. About two thirds of the blood will pass through the foramen

ovale , to the left artrium to the left ventricle and to the descending aorta through the ductus

aretriosus, but the remaining one third will pass into the right ventricle, toward the lungs through

the pulmonary arteries for their development. The blood in the descending aorta, although low in

oxygen and nutrients is sufficient to supply the lower body, through this means some of the

blood (deoxygenated) moves from the descending aorta through the internal iliac arteries  which

leads into the hypogastric ateries and becomes the umbilical arteries in the umbilicus , and re-

enters the placenta, where carbon dioxide and other waste products from the fetus are taken up

and enter the maternal circulation.

Placenta

The circulatory system of the mother is not directly connected to that of the fetus, so the placenta

functions as the respiratory center for the fetus as well as a site of filtration for plasma nutrients

and wastes. Water, glucose, amino acids, vitamins, and inorganic salts freely diffuse across the

placenta along with oxygen. The uterine arteries carry blood to the placenta, and the blood

permeates the sponge-like material there. Oxygen then diffuses from the placenta to the

chorionic villus, an alveolus-like structure, where it is then carried to the umbilical vein.
After birth

Adaptation to extrauterine life

At birth, the umbilical cord is clamped and the baby no longer receives oxygen and nutrients

from the mother. The cessation of umblical blood flow causes a cessation of flow in the ductus

venosus, a fall in pressure in the right artrium with increase in pressure in the left atrium and

closure of the foramen ovale. With the first breaths of life, the lungs begin to expand which

causes a decrease in the resistance in the pulmonary vasculature. As the lungs expand, the alveoli

in the lungs are cleared of fluid. An increase in the baby's blood pressure and a significant

reduction in the pulmonary pressures reduce the need for the ductus arteriosus to shunt blood.
These changes promote the closure of the shunt. The ductus arteriosus also constricts as a result

of bradykinin released from the lungs on initial expansion.

The closure of the ductus arteriosus and foramen ovale completes the transition of fetal

circulation to newborn circulation. These closures prevent blood from bypassing pulmonary

circulation, and therefore allow the neonate's blood to become oxygenated in the newly

operational lungs.

The structural changes become permanent and become as follows;

The umblical vein becomes ligamentum teres

The ductus venosus becomes the ligamentum venosum

The ductus arteriosus becomes ligamentum arteriosum

The foramen ovale becomes fossa ovalis

The hypogastric arteries are known as the obliterated hypogastric arteries except for the first

few centimetres, which remain open as the superior vesical arteries

Closure of the Ductus Venosus:

1. Functional closure occurs within minutes of birth.

2. Structural closure occurs within 3 to 7 days.

3. After it closes, the remnant is known as ligamentum venosum.

4. Closure of ductus venosus is caused by strong contraction of muscle wall of ductus venosus,

but the cause of this contraction is not revealed yet.

Closure of the Ductus Arteriosus:

1. Closure of ductus arteriosus is by smooth muscle contraction.

2. It is further replaced by fibrous tissue, called ligamentum arteriosum.

3. At birth, opposite direction of blood flow from aorta to pulmonary artery supplies more

oxyginated blood than before.

4. This contraction of smooth muscle occurs becuase of the increase in availability of oxygen.

5. The degree of smooth muscle contraction is highly dependant on more availability of oxygen.

Closure of the Foramen Ovale:

1. Before birth the foramen ovale allows most of the oxygenated blood entering the right atrium

from the Inferior Vena Cava to pass into the left atrium.

2. Closes at birth due to decreased flow from placenta and Inferior Vena Cava to hold open

foramen.

3. More importantly because of increased pulmonary blood flow and pulmonary venous return to

left heart causing the pressure in the left atrium to be higher than in the right atrium.

4. The increased left atrial pressure then closes the foramen ovale against the septum secundum

(between right and left atrium).

5. The output from the right ventricle now flows entirely into the pulmonary circulation.

SUMMARY

The Umblical arteries carry Deoxygenated blood.

The Umblical veins carry Oxygenated Blood.

When placental blood flow is cut off, there is sudden hypoxia(deficiency of oxygen) and

hypercapnia(elevation of CO2).

Oxygen in fetal circulation is 15-20 mmHg.

Oxygen after birth increases to 100 mmHg.

The right Ventricular wall is thicker in foetal circulation.

The Left Ventricular wall gets thicker by the end of the first month after birth.

Sometimes these postnatal closures are incomplete or absent. The vessels or cross-

connections remain open (patent), leading to the following conditions:

Patent foramen ovale in the heart

Patent ductus arteriosus in the great vessels

Patent ductus venosus in the great vessels

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