Fetal circulation

Structures involved
1. Umbilical artery - 2 in number
2. Umbilical vein - 2 in number later
changed to one
Lt umbilical vein enters abdomen - travers the edges of
falciform ligament
Reaches hepatic surface of liver
Then joins with lt. br. of portal vein
Inferior venacava---ductus venosus+hepatic vein—rt atrium
|-sup venacava--rtventicle

|
Rt atrium—(foramen ovale)-----------Lt atrium(mixes with
blood from pulmonary vein)
Lt atrium---lt ventricle—aorta(to heart,head,upper
limb,descending aorta)
Rt atrium—Rt ventricle along with small amount gained by
inf.venacava
Rt ventricle---pulmonary trunk—(a small amount to |
pulmonary arteries)
ductous arteriosus--aorta
Blood from aorta and lt ventricle — through descending
aorta
to lower limbs, organs of abdomen, pelvis
Placental role
 respiratory center for the fetus
 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 -oxygenated blood to the
placenta
 Placental role……….
Oxygen then diffuses from the placenta to the
chorionic villus
it is then carried to the umbilical vein.
 About half of this enters the fetal ductus venosus
and is carried to the inferior vena cava
 other half enters the liver proper from the inferior
border of the liver
 The branch of the umbilical vein that supplies the
right lobe of the liver first joins with the portal vein
The blood then moves to the right atrium of the
hearts
 there is an opening between the right and left
atrium (the foramen ovale
 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,
there it is pumped through the aorta into the body

 Some of the blood moves from the aorta through

the internal iliac arteries to the umbilical arteries,
and re-enters the placenta

 carbon dioxide and other waste products from the

fetus are taken up and enter the maternal
circulation.
Some of the blood entering the right atrium does not
pass directly to the left atrium through the foramen
ovale, but enters the right ventricle

 is pumped into the pulmonary artery

 In the fetus, there is a special connection between
the pulmonary artery and the aorta, called the ductus
arteriosus 

 It directs most of this blood away from the lungs

Patent ductus arteriosus (PDA)
The DA normally closes within the first 24 h of birth.
Failure of the DA to close results in a left to right
shunt This is because of the rise in SVR and fall in
PVR that occurs after birth. In other words, the
shunt is in the opposite direction to that in the
fetus. The magnitude of the shunt increases as the
PVR continues to fall. This results in an increased
volume and workload with respect to the LA and LV
and, eventually, left heart failure.
At birth
•In first breathe there is a decrease in the resistance
in the pulmonary vasculature
•pressure in the left atrium to increase relative to the
pressure in the right atrium
• This leads to the closure of the foramen ovale
• it is then referred to as the fossa ovalis
•The increase in the concentration of oxygen in the
blood leads to a decrease in prostaglandins,
•Causes closure of the ductus arteriosus.
Blood pressure
The blood pressure in the fetal aorta is approximately 30
mmHg at 20 weeks of gestation
increases to ca 45 mmHg at 40 weeks of gestation
Ventricular septal defects
•common forms of CHD.
•They are well-tolerated in the fetus, as LV and RV pressures
are equal
• In neonates with a large VSD, as SVR rises and PVR falls, a
significant left to right shunt through the VSD becomes
apparent
• As PVR continues to fall during the first weeks of life, this
shunt increases leading to congestive heart failure.
Tetralogy of Fallot TOF
one of the most common congenital heart
malformations
the two most important features of TOF are
(i) RV outflow obstruction, nearly always infundibular
and/or valvular in location, often associated with a
hypoplastic pulmonary artery
(ii) a large subaortic VSD associated with
malalignment of the conal septum.
Transposition of the Great Arteries (TGA) results from
abnormal rotation and septation of the arterial truncus
during embryogenesis
The aorta arises from the RV and the pulmonary artery
from the LV.
The FO and DA develop as normal and there are no
major circulatory consequences of this lesion in utero
After birth, because the pulmonary and systemic
circulations are arranged in parallel rather than in series,
survival depends on the presence of one or more mixing
points (ASD, VSD or PDA) between the two circulations
in order to achieve an arterial oxygen saturation
compatible with life
Transposition of the Great Arteries (TGA) ……………
Thus, newborns with TGA and an intact ventricular
septum (IVS) who have only a small patent FO (PFO) or
ASD will be severely cyanosed after closure of the DA
Sometimes this severe cyanosis is associated with
acidosis and cardiovascular collapse.
The closed foramen ovale becomes the fossa ovalis.
The ductus arteriosis, which connects the
pulmonary trunk to the systemic circulation,
closes off within 1-2 days after birth.
Once closed, the ductus arteriosus is replaced
by connective tissue and is known as the
ligamentum arteriosum.
If the ductus arteriosus does not completely close it is said to
be patent.
This is a serious birth defect resulting in marked elevation in
pulmonary pressure because blood flows from the left
ventricle to the aorta, through the ductus arteriosus to the
pulmonary arteries.
If not corrected, it can lead to irreversible degenerative
changes in the.heart and lungs.
The fetal blood supply passes to the placenta through two
(2) umbilical arteries from the internal iliac arteries and
returns through an umbilical vein which passes through the
liver, ductus venosus, and joins the inferior vena cava.
When the umbilical cord is cut, no more blood flows
through the umbilical arteries and vein and they
degenerate.
The remnant of the umbilical vein
becomes the round ligament of the liver
and the ductus venosum becomes the
ligamentum venosum