Last edited: 9/18/2021

17. DEVELOPMENT OF FETAL CIRCULATION

Embryology | Development of Fetal Circulation Medical Editor: Sohani Kashi Puranic

OUTLINE Consequence
 As the whole pulmonary circuit undergoes
I) OVERVIEW
vasoconstriction,
II) BEFORE BIRTH
III) AFTER BIRTH
IV) PECULIARITIES OF FETAL CIRCULATION
V) CHANGES FROM FETUS TO ADULT o Because of this, Right side of heart (right
VI) ANOMALIES Atrium & ventricle) needs to generate high
VII) SUMMARY pressure to pump blood into the high-
VIII) APPENDIX pressure pulmonary circuit
IX) REVIEW QUESTIONS
X) REFERENCES

I) OVERVIEW
The circulation in fetuses is slightly different compared to Pressures in heart:
that seen in adults
Right side > Left side
Placenta is the organ responsible for gas exchange
Various remnants are present in adults, which represent
fetal structures of the fetal circulation

II) BEFORE BIRTH

(A) CONDITION OF LUNGS

In utero, that is before birth, the lungs are still developing

(B) HYPOXIC VASOCONSTRICTION

(1) Consequence of Hypoxia
Figure 1. Hypoxic Vasoconstriction
Due to hypoxia in the lungs, the pulmonary vasculature
undergoes vasoconstriction (C) STRUCTURES & PATHWAY
(1) Placenta
REMEMBER Plays a role in exchange of gases
The placenta is connected with the fetus through
Effect of Hypoxia on:
Umbilical cord
Systemic Vessels- Vasodilation Functions of Placenta
Pulmonary Vessels- Vasoconstriction Exchange of gases
 Occurs by simple diffusion
 O2 delivery to fetus is by placental blood flow
(2) Reason for Vasoconstriction in Hypoxia
Exchange of nutrients & electrolytes
The pulmonary capillaries near hypoxic alveoli undergo
vasoconstriction  Occurs rapidly
 Increases as pregnancy advances

Transmission of maternal antibodies

 IgG
By this, alveoli with more O2 concentration will receive  Provides PASSIVE I MMUNITY to fetus
better blood supply for effective ventilation
Hormone production
(3) Hypoxic Vasoconstriction in Fetus
 Progesterone
Condition in Fetus  Estriol
 hCG (human Chorionic Gonadotropin)
 Pulmonary circuit vasoconstriction normally occurs  Somatomammotropin/ hPL (human Placental
around hypoxic alveoli Lactogen)
 In Fetus- all alveoli have ↓O2 concentration
 This results in intense vasoconstriction throughout Protection
the pulmonary circulation  Protects fetus from damaging agents
 However, many drugs & viruses pass through
placenta easily

DEVELOPMENT OF FETAL CIRCULATION EMBRYOLOGY: Note #1. 1 of 8

 (3) Umbilical Vein to IVC

Ductus Venosus
 It is a structure that shunts blood from (Left)
Umbilical Vein DIRECTLY into IVC

Sphincter Mechanism of Ductus Venosus

Regulates blood flow from Umbilical Vein
During uterine contraction:

Figure 2. Placenta
(2) Umbilical Cord

Components
Hepatic Sinusoids
(a) Blood Vessels  Umbilical vein also drains into the sinusoids of the
liver
(i) 2 Umbilical Arteries  These drain into the Hepatic portion of IVC
(ii) 1 Umbilical Vein (left)
 Carries Oxygenated blood
 85% O2 SATURATION (4) Right Atrium of Heart
(b) Wharton’s Jelly
o Mucopolysaccharide
 Rich in proteoglycans
 Provides insulation
 Protects the blood vessels

Figure 3. Structure of Umbilical Cord Figure 5. Openings in Right Atrium

(c) Remnant of vitelline duct Openings
(a) IVC (Inferior Vena Cava)
• Receives blood from:

(i) Ductus Venosus

(ii) Liver sinusoids
• Drains into Right Atrium

(b) SVC (Superior Vena Cava)

Figure 4. Umbilical Cord
• Receives blood from head, neck & upper
extremities
Termination of Umbilical Vein • Drains into Right Atrium
• Derived from Right Common Cardinal Vein
 Umbilical vein
ultimately pours its Pathways from Right Atrium
oxygenated blood
from placenta into  Blood from the right atrium can go to the following
IVC (Inferior Vena structures:
Cava)
(a) Left Atrium
 There are 2
pathways for the (b) Right Ventricle
blood from Umbilical
vein to IVC

Figure 4. Umbilical Vein &

Ductus Venosus

2 of 8 EMBRYOLOGY: Note #17. DEVELOPMENT OF FETAL CIRCULATION

 (5) Left Atrium of Heart
70% of the blood from Right Atrium goes to Left Atrium
The connection between the Right & Left atria is
Foramen Ovale

Foramen Ovale

Figure 7. Formation of Umbilical Arteries

• This communication is called Foramen Ovale
Placenta
 Blood from Umbilical arteries drain into placenta,
where CO2 is given out
 O2 is taken up in the placenta, and oxygenated
blood is delivered to fetus via Umbilical vein

(8) Pathway from Right Ventricle

Blood to right ventricle:
i. Majority of Deoxygenated blood from SVC
ii. 30% of Oxygenated blood from IVC
Figure 6. Foramen Ovale
Blood from right ventricle is pumped into Pulmonary
(6) Right Ventricle of Heart
Trunk
The remaining 30% of blood from Right Atrium flows into From pulmonary trunk, it follows 2 pathways:
Right Ventricle
Ductus Arteriosus
Why majority of blood flows into Left Atrium  It is a structure that connects Pulmonary Artery
to Aorta

Blood flows from

High Pressure to Low Pressure
 It shunts the deoxygenated blood

Right side of heart: HIGH pressure

 Due to hypoxic vasoconstriction

Left side of heart: LOW pressure

 Relatively lower than right side

HENCE , MAJORITY OF B LOOD FROM

RIGHT ATRIUM (HIGH P RESSURE ) FLOWS INTO LEFT ATRIUM
(LOW PRESSURE ),
& NOT RIGHT VENTRICLE
(7) Pathway from Left Atrium
Blood from right atrium passes through Foramen Ovale to
reach the left atrium. From there, it goes to different
structures, in the following order:
Figure 8. Ductus Arteriosus
Pulmonary Arteries
 ↓↓↓ blood flows through Right & Left Pulmonary
arteries
 This blood reaches the developing lung
Why majority of blood flows through Ductus Arteriosus

Left Ventricle
Ascending Aorta, Arch of Aorta
Blood flows from
Descending Aorta
High Pressure to Low Pressure
Common Iliac Artery
Internal Iliac Artery
Umbilical Artery
Pulmonary Artery: HIGH pressure
 Carries Oxygenated blood mixed with
 Due to hypoxic vasoconstriction
Deoxygenated blood
 58% O2 SATURATION Aorta: LOW pressure
 Relatively lower pressure in left side of heart & aorta

HENCE , MAJORITY OF B LOOD FROM

PULMONARY ARTERY (HIGH PRESSURE ) FLOWS INTO AORTA
(LOW PRESSURE ),
& NOT THROUGH BOTH PULMONARY ARTERIES TO LUNG

DEVELOPMENT OF FETAL CIRCULATION EMBRYOLOGY: Note #1. 3 of 8

,

Structures that shunt blood AWAY from

Pulmonary Circulation:
Foramen Ovale
Ductus Arteriosus

III) AFTER BIRTH

(A) EVENTS RIGHT AFTER BIRTH

(1) Umbilical Cord is cut
Connection between Placenta & Fetus is broken Figure 10. No hypoxic vasoconstriction

(B) CHANGES AFTER BIRTH

(1) Closure of Foramen Ovale
Pressure in left side of heart ↑

This is called the FUNCTIONAL closure of Foramen

Ovale
Figure 9. Umbilical Cord is cut after birth
(2) Lungs Anatomical closure occurs by fusion of Septum
secundum & Septum primum
Baby cries right after birth
 Allows for air to flush into lung
 O2 floods into alveoli

Consequence of no vasoconstriction

o Because of this, pressure on Right side of

heart (right Atrium & ventricle) ↓

OPPOSITE pressure gradient to that

seen before birth Figure 11. Fossa Ovalis

REMEMBER
Closure of Foramen Ovale:

Functional- Immediately after birth

Pressures in heart: Anatomical- 1 year after birth

Left side > Right side

Figure 12. Pulmonary Circulation

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 (2) Pulmonary Circulation Pathway for oxygenated blood:
There is now ↑ blood flow through the pulmonary circuit Pulmonary Veins
Pulmonary Arteries Left Atrium
 Carry deoxygenated blood from right ventricle to (2) Left Side of Heart
lungs
Left Atrium
Pulmonary Capillaries Left Ventricle
 Supply alveoli which are now well-ventilated Aorta
 Exchange of gases occurs at alveoli
(3) Systemic Circulation
Pulmonary Veins
Oxygenated blood is supplied to different organs via the
 Carry oxygenated blood from lungs to left atrium Aorta and its branches
(3) Closure of Ductus Arteriosus At the tissues,

 This means blood is deoxygenated

Pathway for deoxygenated blood:

Blood from lower extremities: Iliac Veins → IVC

Blood from head, neck, upper extremities: SVC
(4) Right Side of Heart
Figure 13. Closure of Ductus Arteriosus
IVC, SVC → Right Atrium
Ductus Arteriosus closes due to: Right Ventricle
O2 ↑ Pulmonary Trunk
PGE2 ↓
1
𝑂𝑂2 ∝
𝑃𝑃𝑃𝑃𝑃𝑃2 Ductus Arteriosus is closed. Before
closure, for a very short period,
Bradykinin ↑ blood is shunted to Aorta.
Hypoxia and ↑ PGE2 keep Ductus Arteriosus patent &
open before birth

(5) Pulmonary Circulation

After birth, the DA remains open for Pulmonary Trunk

a very short period of time before it Pulmonary Arteries
closes Pulmonary Capillaries
 Gas exchange occurs at alveoli, where the
deoxygenated blood is oxygenated

IV) PECULIARITIES OF FETAL CIRCULATION

(A) SHUNTING
Blood is shunted along its course at 3 points:

Ductus Venosus
 To direct blood to IVC by bypassing liver, without
losing O2 content
Figure 14. Factors affecting patency of DA
Foramen Ovale
(C) STRUCTURES & PATHWAY
 To equalize distribution to each half of heart, and
(1) Pulmonary Circulation more oxygenated blood to upper half vital organs
With air entering alveoli, and production of surfactant, the Ductus Arteriosus
lungs are now functional
Gas exchange occurs at alveoli where:  To direct blood to placenta for oxygenation by
bypassing lungs
[IB Singh]

 This means blood is oxygenated

DEVELOPMENT OF FETAL CIRCULATION EMBRYOLOGY: Note #1. 5 of 8

 (B) MIXING VI) ANOMALIES
During its course from placenta to the organs of the fetus,
blood in the Umbilical vein gradually loses its high oxygen (A) PATENT FORAMEN OVALE
content as it mixes with deoxygenated blood. [Langman] Foramen Ovale doesn’t close
Places where mixing occurs:
Table 1. Sites of mixing of Oxygenated & Deoxygenated Blood
Oxygenated Deoxygenated
Site
Blood Blood

Liver Umbilical
Portal system
vein

IVC Umbilical Lower

vein extremities

Right Umbilical
+ Upper
Atrium vein blood
extremities
from IVC

From Right
Left Atrium
Atrium through From Lungs
Foramen
Ovale Figure 15. Patent Foramen Ovale
[mayoclinic.org]
Ductus Pulmonary
Aorta
Arteriosus Trunk (B) PATENT DUCTUS ARTERIOSUS
Ductus Arteriosus doesn’t close
(C) NICE TO KNOW
IVC carries the most oxygenated blood in fetus
More oxygenated blood is delivered to Upper Limbs

Upper limbs > Lower Limbs

V) CHANGES FROM FETUS TO ADULT

Table 2. Postnatal occlusion of vessels/ structures & their
remnants
Structure
Left Umbilical Vein
Umbilical Arteries
i. Proximal part
ii. Distal part
Ductus Venosus
Ductus Arteriosus
Foramen Ovale
Remnant
Ligamentum Teres Hepatis
i. Superior Vesical
Artery
ii. Medial Umbilical
Ligament
Ligamentum Venosum
Ligamentum Arteriosum
Fossa Ovalis

REMEMBER
Remnant of:
Figure 16. Patent Ductus Arteriosus
UmbilicAL Arteries- MediAL Umbilical Ligaments [Netter’s Atlas]
Allantois (Urachus)- Median Umbilical Ligament
(C) PORTAL HYPERTENSION
Ligamentum teres hepatis recanalizes

6 of 8 EMBRYOLOGY: Note #17. DEVELOPMENT OF FETAL CIRCULATION

 VII) SUMMARY

Figure 17. Development of Fetal Circulation

VIII) APPENDIX

Figure 18. Fetal Circulation & Transition to Post-natal Circulation

[Netter’s Atlas]

DEVELOPMENT OF FETAL CIRCULATION EMBRYOLOGY: Note #1. 7 of 8

 IX) REVIEW QUESTIONS X) REFERENCES

1) Which is NOT essential for maintenance of fetal Cochard, L. R., & Netter, F. H. (2002). Netter's atlas of human
circulation? embryology. Teterboro, N.J: Icon Learning Systems.
Inderbir Singh, Pal GP. Human Embryology. 8th ed. India: Mac
a) Foramen ovale
Millan Publishers Limited; 2007.
b) Ductus arteriosus Sadler TW. Langman's Medical Embryology. Philadelphia:
c) Renal veins Wolters Kluwer; 2019.
d) Inferior Vena Cava Le T. First Aid for the USMLE Step 1 2020. 30th anniversary
edition: McGraw Hill; 2020.
Marieb EN, Hoehn K. Anatomy & Physiology. Hoboken, NJ:
Pearson; 2020.
2) Which structure carries the most oxygenated blood Boron WF, Boulpaep EL. Medical Physiology.; 2017.
in fetus?
a) Umbilical vein
b) Renal vein
c) Inferior vena cava
d) Umbilical artery

3) What is the remnant of umbilical arteries?

a) Ligamentum arteriosum
b) Superior vesical artery
c) Ligamentum teres hepatis
d) Ligamentum venosum

4) What is the concentration of oxygen in Umbilical

Artery?
a) 15%
b) 28%
c) 58%
d) 85%

5) Ductus arteriosus connects pulmonary artery to

which of the following?
a) Pulmonary vein
b) Foramen ovale
c) Subclavian artery
d) Aorta

6) Before birth, blood is shunted:

a) Away from pulmonary circulation
b) Towards pulmonary circulation
c) No shunts present
d) Both a & b, according to respiration

7) What is the remnant of urachus?

a) Medial umbilical ligament
b) Lateral umbilical ligament
c) Median umbilical ligament
d) Ligamentum teres

8) Ductus arteriosus is sensitive to all EXCEPT:

a) Prostaglandins
b) Leukotrienes
c) Oxygen
d) Bradykinin

CHECK YOUR ANSWERS

8 of 8 EMBRYOLOGY: Note #17. DEVELOPMENT OF FETAL CIRCULATION