Fetal Circulation

Dr. Mohanad R. Alwan SMS 1053

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Anatomy and Physiology
 Fetus

depends on placenta to meet O2 needs while organs continue formation  Oxygenated blood flows from the placenta  To the fetus via the umbilical vein  After reaching fetus the blood flows through the inferior vena cava

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The Placenta

Facilitates gas and nutrient exchange between maternal and fetal blood.  The blood itself does not mix.

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Anatomy and Physiology Fetal Circulation
 Umbilical

cord

2 umbilical arteries: return non-oxygenated blood, fecal waste, CO2 to placenta 1umbilical vein: brings oxygenated blood and nutrients to the fetus

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Fetal Circulation

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How does the blood move??
 Umbilical

VEIN carries oxygenated blood and nutrients from the placenta to the fetus  Where does the vein enter??

At the navel and ascends into the liver

How is the blood dispersed??

½ of the blood enters the liver while the other half comes into the ductus venous and then into the inferior vena cava
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Foramen Ovale
Blood is shunted from right atrium to left atrium, skipping the lungs.  More than one-third of blood takes this route.  Is a valve with two flaps that prevent back-flow.

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Ductus Arteriousus
The blood pumped from the right ventricle enters the pulmonary trunk.  Most of this blood is shunted into the aortic arch through the ductus arteriousus.

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Fetal Circulation
 Blood

continues to travel from the inferior vena cava to the ductus venosis  Ductus Venosis
 

Small amount of blood routed to growing liver Increased blood flow leads to large liver in newborns

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What happens to the blood after it reaches the right atrium??
 Blood

flows right into the left atrium through the foramen ovale. What is that?
Small opening in the septum of the heart

 Here

again it mixes with a smaller amount of deoxygenated blood from the pulmonary veins.  After it proceeds to the left ventricle where it is pumped to the heart and brain
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Fetal Circulation

Foramen ovale
 

Small opening in the septum of the heart Completely bypasses the non-functioning lungs

Blood continues journey to the left ventricle blood is then pumped into the aorta  Blood is circulated to the upper extremities  Blood then returns to the right atrium

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What about the rest of the blood??

The blood still in the right atrium goes into the right ventricle then to the pulmonary artery. Once there most of the blood bypasses the lungs and heads to the aorta through the ductus arteriosus. About 15% of the blood flows through lungs to the right atrium by way of the pulmonary veins Pulmonary arteries  Small amount goes to the maturing lungs Rest of blood is shunted away from lungs by ductous ateriosus back to aorta
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What is happening further down??
 Common

iliac arteries branch into the external and internal iliacs.  The blood in the internal iliacs come into the umbilical arteries and flow back to the placenta to gather oxygen and to get rid of the waste products

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Fetal Circulation
 Low
 

pressure system

Lungs are closed Most oxygenated blood flows between the atria of the heart through the foramen ovale This oxygen rich blood flows to the brain through the ductus arteriosus

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What happens after birth?

 once

the baby is born and the lung, renal, digestive and liver functions are working the fetal circulation undergoes some changes since they are no longer needed

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Conversion of Fetal to Infant Circulation
 At

birth

 

Clamping the cord shuts down low-pressure system Increased atmospheric pressure(increased systemic vascular resistance) causes lungs to inflate with oxygen Lungs now become a low-pressure system Pressure from increased blood flow

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Conversion: Fetal to Infant Circulation
   

In the left side of the heart causes the foramen ovale to close More heavily oxygenated blood passing by the ductus arteriosus causes it constrict Functional closure of the foramen ovale and ductus arteriosus occurs soon after birth Overall anatomic changes are not complete for weeks

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Conversion (cont)
 What
 

happens to these special structures after birth?
Umbilical arteries atrophy Umbilical vein becomes part of the fibrous support ligament for the liver The foramen ovale, ductus arteriosus, ductus venosus atrophy and become fibrous ligaments

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Overview of Conversion
 Umbilical

cord is clamped  Loose placenta  Closure of ductus venosus  Blood is transported to liver and portal system

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Fetal vs. Infant Circulation
    

Fetal Low pressure system Right to left shunting Lungs non-functional Increased pulmonary resistance Decreased systemic resistance

    

Infant High pressure system Left to right blood flow Lungs functional Decreased pulmonary resistance Increased systemic resistance

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