B.

Sc DEGREE COURSE IN NURSING (BASIC)

MIDWIFERY AND OBSTETRICAL NURSING

UNIT-II
REVIEW OF ANATOMY AND PHYSIOLOGY OF FEMALE
REPRODUCTIVE SYSTEM AND FETAL DEVELOPMENT

FETAL CIRCULATION

Prof. SOPHIA
Dr. LATHA VENKATESAN,PRINCIPAL

Date:22.4.2020,Afternoon Session
 OBJECTIVES

The Students will be able to

• Describe the normal foetal circulation

• Mention the changes that occur in it at placental

stage and after birth.

 INTRODUCTION

In utero, the placental gas exchange provides the fetus with

relatively oxygenated blood; the partial pressure of oxygen (Po2) in

the umbilical vein is approximately 30 mm Hg, and in the umbilical

arteries it is approximately 16 mm Hg. The fetal lungs are fluid filled

and only minimally perfused (10% to 15% of the cardiac output).

 FETAL CIRCULATION

Fetus:
It is the term used to refer to a prenatal mammal between it’s
embryonic state and it’s birth.
The Placenta:
The organ in human mother responsible for the supplying of
oxygen and nutritive material to the fetus and for the elimination of
CO2 and nitrogenous waste out of the fetus.
The Umiblical Cord

A flexible cord-like structure containing blood vessels and

attaching a human to the placenta responsible for the supplying and

elimination of CO2 and O2.

Foetal Circulation

The circulation of oxygenated

blood, de-oxygenated blood,
nutritive material etc in the foetus
is termed as foetal circulation
FLOW CHART OF FETAL CIRCULATION
THE DEVELOPMENT OF THE FETAL
CARDIOVASCULAR SYSTEM -

• Begins to develop toward the end of the third week

• Heart starts to beat at the beginning of the fourth week

• The critical period of heart development is from day 20 to day
50 after fertilization.
 Contd-

• Many critical events occur during cardiac development, and any

deviation from this normal pattern can cause congenital heart
defects, if development of heart doesn’t occur properly.
 Placental Role in Foetal Circulation
The circulatory system of the mother is not directly connected to that of
the fetus, so the placenta functions as the respiratory center for the
fetus as well as a site of filtration for plasma nutrients and wastes
Foetal Lungs
Pulmonary vascular resistance is the resistance offered to blood
through lungs. The resistance is very high in fetus because of the non-
functioning of fetal lungs. Because of this high pressure, the blood is
diverted from pulmonary artery into aorta
1. Blood Vessels In Foetus:
• The blood vessels responsible for
foetal circulation are:
• Umblical Vein.
• Umblical Artery.
1.Umblical Vein
• It carries the
oxygenated blood from
the placenta to the
growing fetus.
• The blood pressure
inside the
umbilical vein is
approximately 20
mmHg.
2. Umblical Artery:
• It is a paired artery that is found in the pelvic and abdominal region
of the fetus which extends into the umblical cord.
• Supplies de-oxygenated blood from the fetus to the placenta.
• They surround the urinary bladder and then carry all the de-
oxygenated blood out of the fetus.
 SHUNTS INVOLVED IN FOETAL CIRCULATION

There are three shunts present in a fetus, they are:

•Ductus Venosus.

•Ductus Arteriosus.

•Foramen Ovale.
Ductus Venosus:
• The Ductus Venosus shunts the portion of left umblical vein
blood flow directly to the inferior vena cava.
• Allows oxygenated blood from the placenta to bypass the
liver.
Ductus Arteriosus:
• Also called Ductus Botalli.
Connects the pulmonary artery to the proximal descending
aorta.
• It allows most of the blood from the right-ventricle to bypass
the
fetus’ fluid-filled non-functioning lungs
Foramen Ovale:
• It is an opening in the intra-atrial septum.
• It allows the blood to enter the left atrium from the right atrium
• It is also called False Septi.
 Steps Of Foetal Circulation :
Step.1:

The placenta accepts the bluest blood (blood without oxygen)

from the fetus through blood vessels that leave the fetus through the
Umbilical Cord (Umblical Arteries).
Step.2:
When blood goes through the placenta it picks up oxygen and
becomes Red.
Step:3
The red blood then returns to the fetus via the umbilical cord
(umbilical vein).
Step: 4
The red blood that enters the fetus passes through the fetal liver
and enters the right side of the heart.
Step:5
Foramen Ovale allows the reddest blood to go from the right
atrium to left atrium and then to the left ventricle and out the aorta.
As a result the blood with the most oxygen gets to the brain.
Step:6

• Blood coming back from the fetus’s body also enters the
right atrium, but the fetus is able to send this blue blood
from the right atrium to the right ventricle (the chamber that
normally pumps blood to the lungs).
• Most of the blood that leaves the right ventricle in the fetus
bypasses the lungs through the second of the two extra
fetal connections known as the ductus arteriosus.
Step :7
• The ductus arteriosus sends the bluer blood to the
•. organs in the
lower half of the fetal body.
• This also allows for the bluest blood to leave the fetus
through the umbilical arteries and get back to the
placenta to pick up oxygen
OXYGEN STAURAION DURING FETAL CIRCULATION
The Circulatory Changes After Birth:
1.The Placenta is replaced by the Lungs as the organ of
respiratory exchange.
2.The lungs and pulmonary vessels expand thereby
significantly lowering the resistance to blood flow.
3.Subsequently the pressure in the pulmonary artery and the
right side of the heart is decreased.
4.The pressure of the left side of the heart increases
5.The increasing pressure of blood in the left side of the
heart decreases the vascular resistance of the lungs,
therefore, the blood now enters the lungs as a respiratory
exchange.
What happens to the shunts at birth?

• Closure of the Ductus Venosus.

• Closure of the Foramen Ovale.
• Closure of the Ductus Arteriosus
 Ѡ Closure of the Ductus Venosus:

• Functional closure occurs within minutes of birth.

• Structural closure occurs within 3 to 7 days.
• After it closes, the remnant is known as ligamentum venosum.
• Closure of ductus venosus is caused by strong contraction of
muscle wall of ductus venosus, but the cause of this contraction
is not revealed yet.
 Ѡ Closure of the Ductus Arteriosus
• Closure of ductus arteriosus is by smooth muscle contraction.
• It is further replaced by fibrous tissue, called ligamentum arteriosum.
• At birth, opposite direction of blood flow from aorta to pulmonary artery
supplies more oxyginated blood than before.
• This contraction of smooth muscle occurs becuase of the increase in
availability of oxygen.
• The degree of smooth muscle contraction is highly dependant on more
availability of oxygen.
 Ѡ Closure of the Foramen Ovale
• Before birth the foramen ovale allows most of the oxygenated blood entering the
right atrium from the Inferior Vena Cava to pass into the left atrium.
• Closes at birth due to decreased flow from placenta and Inferior Vena Cava to hold
open foramen. More importantly because of increased pulmonary blood flow and
pulmonary venous return to left heart causing the pressure in the left atrium to be
higher than in the right atrium.
• The increased left atrial pressure then closes the foramen ovale against the
septum secundum (between right and left atrium).
• The output from the right ventricle now flows entirely into the pulmonary
circulation.
‽ The Umblical arteries carry Deoxygenated blood.
‽ The Umblical veins carry Oxygenated Blood.
‽ When placental blood flow is cut off, there is
sudden hypoxia(deficiency of oxygen) and
hypercapnia(elevation of CO2).
‽ Oxygen in fetal circulation is 15-20 mmHg.
‽ Oxygen after birth increases to 100 mmHg.
‽ The right Ventricular wall is thicker in foetal
circulation.
‽ The Left Ventricular wall gets thicker by the end of
the first month after birth.
 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
 REFERENCES

• Annamma Jacob A comprehensive text book of midwifery and

Gynecological Nursing 3rd edition jaypee publication.

• American Academy of Pediatrics; Committee on Infectious Diseases

and Committee on Fetus and Newborn.

• D C Dutta text book Obsteterics 9th edition Hiralal Kumar publication

New Delhi.