Fetal Circulation

Prepared by: Mrs. Mahdia Samaha

Alkony
 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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 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 differences between fetal and newborn
circulation
• The fetus received oxygen from the placenta and through the
lungs after birth.
• The fetal liver doesn’t have the metabolic function that it will
have after birth because the mother performs these functions.
Three shunts are present in fetal life:
1. Ductus venosus: connects the umbilical vein to the inferior
vena cava
2. Ductus arteriosus: connects the main pulmonary artery to the
aorta
3. Foramen ovale: anatomic opening between the right and left
atrium.

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 Fetal Circulation

• Blood travels 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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 Fetal Circulation

• Blood continues to travel up the inferior vena cava

• Empties into the right atrium of the heart
• The blood then passes to the left atrium through the
foramen ovale
• Only about one-third of this blood reaches the lungs (due to
high flow resistance since the lungs are not yet expanded,
and due to hypoxic vasoconstriction

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 A/P Fetal Circulation

• 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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 A/P Fetal Circulation

• From the right atrium, the blood goes to the right

ventricle then to the pulmonary arteries

• 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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 A/P Fetal Circulation

• The placenta will re-supply the blood with

oxygen

• Fetal circulation is a low-pressure system

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• As a result, the blood supplied to the lower
half of the body has a relatively low O2
concentration(O2 saturation = 0.3).

• The majority of this blood returns via the

umbilical arteries to the placenta, where it
is oxygenated again

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 A/P 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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 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

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 Conversion: Fetal to Infant
Circulation
– Pressure from increased blood flow 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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• 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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 Human Fetal Circulation

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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
• Increased systemic resistance
• Pressure in right atrium decreased
• Change from right to left shunting to left to right blood
flow
• Increased O2 levels in pulmonary circulation
• Closure of the ductus arteriosus
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 Loss of placenta also leads to:

1. First breath • Increased systemic

resistance
2. Lungs expand and fluid
is expelled • Pressure in right atrium
decreased
3. Decreased pulmonary
• Change from right to left
resistance shunting to left to right
4. Increased pressure in left blood flow
atrium • Increased O2 levels in
5. Closure of foramen ovale pulmonary circulation
• Closure of the ductus
arteriosus
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 Fetal vs. Infant Circulation
Fetal Infant
• Low pressure system • High pressure system
• Right to left shunting • Left to right blood flow
• Lungs non-functional • Lungs functional
• Increased pulmonary • Decreased pulmonary
resistance resistance
• Decreased systemic • Increased systemic
resistance resistance
 Shunts
Occur when the foramen ovale or ductus arteriosus remains
open, placing a strain on the heart.

• In patent foramen ovale (atrial septum defect), the blood

flows from left atrium to right atrium (left-to-right shunt)
lead to right ventricle (volume overload) , lungs and then
left atrium.

• In patent ductus arteriosus, the blood flows from aorta to

pulmonary artery (= left-to-right shunt) leads to lungs
(pressure overload) and then aorta.
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 Flow Chart of Fetal Circulation

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