Group 5

Fetal Circulation
Abarquez, Raymund
Bartolome, Jan Marc
Divino, Christine
Garcia, Geeniel
Leano, Fides Beatrice
Marin, Rey Arnold
Rafa, Pauline Gayle
Perez, Raymond
Yu, Michelle
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.
• The concentration of hemoglobin in fetal blood is
about 50 % greater than in maternal blood.
• Fetal hemoglobin is slightly different chemically
and has a greater affinity for O2 than maternal
hemoglobin.
▫ At a particular oxygen partial pressure, fetal
hemoglobin can carry 20-30% more O2 than
maternal hemoglobin.
• Blood from the mother enters the fetus through
the vein in the umbilical cord.
• It goes to the liver and splits into three branches.
• The blood then reaches the inferior vena cava, a
major vein connected to the heart.
Inside the fetal heart:
• Blood enters the right atrium, the chamber on the
upper right side of the heart.
• Most of the blood flows to the left side through a
special fetal opening between the left and right atria,
called the foramen ovale.
• Blood then passes into the left ventricle (lower
chamber of the heart) and then to the aorta, (the large
artery coming from the heart).
• From the aorta, blood is sent to the head and upper
extremities.
• After circulating there, the blood returns to the right
atrium of the heart through the superior vena cava.
• About one-third of the blood entering the right atrium
does not flow through the foramen ovale, but, instead,
stays in the right side of the heart, eventually flowing
into the pulmonary artery.
• Because the placenta does the work of exchanging
oxygen (O2) and carbon dioxide (CO2) through the
mother's circulation, the fetal lungs are not used for
breathing.
• Instead of blood flowing to the lungs to pick up oxygen
and then flowing to the rest of the body, the fetal
circulation shunts (bypasses) most of the blood away
from the lungs.
• In the fetus, blood is shunted from the pulmonary
artery to the aorta through a connecting blood vessel
called the ductus arteriosus.
Blood circulation after birth:
• With the first breaths of air the baby takes at
birth, the fetal circulation changes.
• A larger amount of blood is sent to the lungs to
pick up oxygen.
• Because the ductus arteriosus (the normal
connection between the aorta and the
pulmonary valve) is no longer needed, it begins
to wither and close off.
• The circulation in the lungs increases and more
blood flows into the left atrium of the heart.
• This increased pressure causes the foramen
ovale to close and blood circulates normally.
1. Oxygenated blood enters the umbilical vein
from the placenta
2. Enters ductus venosus
3. Passes through inferior venacava
4. Enters the right atrium
5. Enters the foramen ovale
6. Goes to the left atrium
7. Passes through left ventricle
8. Flows to ascending aorta to supply
nourishment to the brain and upper
extremeties
9. Enters superior vena cava
10.Goes to right atrium
11.Enters the right ventricle
12.Enters pulmonary artery with some blood
going to the lungs to supply oxygen and
nourishment
13.Flows to ductus arteriosus
14.Enters descending aorta ( some blood going
to the lower extremeties)
15.Enters hypogastric arteries
16.Goes back to the placenta
Special Structures in Fetal
Circulation
• Placenta – Where gas exchange takes place
during fetal life
• Umbilical Arteries – Carry unoxygenated blood
from the fetus to placenta
• Umbilical Vein – Brings oxygenated blood
coming from the placenta to the fetus
• Foramen Ovale – Connects the left and right
atrium. It pushes blood from the right atrium to
the left atrium so that blood can be supplied to
brain, heart and kidney
• Ductus Venosus - Carry oxygenated blood from
umbilical vein to inferior venacava, bypassing
fetal liver
• Ductus Arteriosus - Carry oxygenated blood
from pulmonary artery to aorta, bypassing fetal
lungs.
Two common defects:
1. Patent ductus arteriosus
 common in females 2-3 times more than males,
unknown reason why … If instead of functional
closure after birth there is patent structure then
aortic blood is shunted into the pulmonary artery.
 Most common congenital anomaly associated with
maternal rubella infection during early pregnancy
(mode of action by virus unclear)
 Premature infants usually have a PDA due to
hypoxia and immaturity.
 Surgical closure of PDA is achieved by ligation and
division of the DA.
2. Patent foramen ovale
 most common form of an Atrial Septal Defects
(ASDs)
 a small isolated patent foramen ovale is of no
hemodynamic significance; but if other defects
present (e.g. pulmonary stenosis or atresia),
blood is shunted through the foramen ovale into
the left ventricle, producing cyanosis, a dark
bluish coloration of the skin and mucous
membranes resulting from deficient oxygenation
of the blood.
 A probe patent foramen ovale is present in up to
25% of people.
 A probe can be passed from one atrium to
the other through the superior part of the
floor of the fossa ovalis.
 Though not clinically significant (usually
small) but may be forced open because of
other cardiac defects and contribute to
functional pathology of the heart.
 Results from incomplete adhesion between
the original flap of the valve of the foramen
ovale and the septum secundum after birth.