Fetal circulation embryology

• How could you define the term of fetal circulation?

• It is a circulatory system of growing intrauterine human life
that consist the entire fetoplacental circulation.
What are the umbilical cord blood vessels
What are the blood shunts present in fetal life
Fetal cardiac output vs adult CO
What are the circulatory changes after birth
Fetal circulation vs neonatal circulation
 Pregnancy
1. ENDOCRINOLOGY OF PREGNANCY
 Human chorionic gonadotropin (hCG)
 Human placental lactogen (hPL)
 Prolactin (PRL)
 Progesterone (PG)
 Estrone, estradiol, and estriol
 PREGNANCY DATING
• The estimated date of confinement (EDC)
is based on the assumption that a woman has a 28-day cycle
with ovulation on day 14 or day 15.
• B. In general, the duration of a normal pregnancy is 280 days
(40 weeks) from the first day of the last
 menstrual period (LMP)

A common method for determining the EDC (Naegele rule)

is to count back 3 months from the first day of the LMP and then
add 1 year and 7 days.
This method is reasonably accurate in women with regular
menstrual cycles
 PREGNANCY MILESTONES
A. First trimester
The first trimester extends from the LMP through week 12.
Important events that occur are:
• At days 8–10, a positive pregnancy test is obtained by hCG
assay.
• At week 12, the uterine fundus is palpable at the pubic
symphysis; Doppler fetal heart rate is first audible.
 B. Second trimester

The second trimester extends from the end of the first

trimester through week 27.
Important events that occur are as follows:
• At weeks 14–18, amniocentesis is performed when
suspicion of fetal chromosomal abnormalities exist.
• At week 16, the uterine fundus is palpable midway between
the pubic symphysis and the umbilicus.
• At weeks 16–18, first fetal movements occur (quickening) in a
woman’s second or higher pregnancy.
• At week 16, the uterine fundus is palpable midway between
the pubic symphysis and the umbilicus.
• At weeks 16–18, first fetal movements occur (quickening) in a
woman’s second or higher pregnancy.
• At weeks 17–20, the fetal heart rate is audible with fetoscope.
• At week 18, female and male external genitalia can be
distinguished by ultrasound (i.e., sex determination).
• At weeks 18–20, first fetal movements occur (quickening) in a
woman’s first pregnancy.
• At week 20, the uterine fundus is palpable at the umbilicus.
• At weeks 25–27, lungs become capable of respiration; surfactant is
produced by typeII pneumocytes.
There is a 70%–80% chance of survival in infants born at the end of the
second trimester.
If death occurs, it is generally as a result of lung immaturity and
resulting respiratory distress syndrome (hyaline membrane disease).
• At week 27, the fetus weighs about 1000 g (a little more than 2
pounds).
 C. Third trimester

• The third trimester extends from the end of the second trimester
until term or week 40.
Important events that occur are as follows:
• Pupillary light reflex is present.
• Descent of the fetal head to the pelvic inlet (called lightening)
occurs.
• Rupture of the amniochorionic membrane occurs, with labor usually
beginning about 24 hours later.
• d. The fetus weighs about 3300 g (about 7–7.5 pounds).
 PRENATAL DIAGNOSTIC PROCEDURES
• Ultrasonography
Ultrasonography is commonly used to:
• a. Date a pregnancy
• b. Diagnose a multiple pregnancy
• c. Assess fetal growth
• d. Determine placenta location
• e. Determine position and lie of the fetus
• f. Detect certain congenital anomalies
Mechanism of normal Labor
 3 P’s
• Power
• Passenger
• Passage
 Power – Uterine Contractions
• Frequency • Duration
– 3-5 in ten minutes – 40-80 secs in later labor
• Intensity
– 200-250 MVU
 Passenger -- Fetus
• Fetal size
• Number of fetuses
• Fetal anomalies
• Fetal lie
– Long-axis
Passenger: Presentation
 Second Stage of Labor
• Time from full dilation of cervix to expulsion
of fetus • Signals that 2nd stage has started
• 2 hours nullip – Increased bloody show
• 1 hour multip – Urge to push
– Urge to defecate
– Nausea/vomiting
 Third Stage of Labor
• Developed countries – 30 minutes too long
• WHO – 60 minutes = retained placenta
• Active management reduces PPH