Fetal Circulation

Dr. Mohanad R. Alwan

SMS 1053

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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 Placenta

 Facilitates gas and

nutrient exchange
between maternal
and fetal blood.
 The blood itself does
not mix.

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 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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Fetal Circulation

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How does the blood move??
 Umbilical VEIN carries oxygenated blood and
nutrients from the placenta to the fetus
 Where does the vein enter??
 At the navel and ascends into the liver

 How is the blood dispersed??

 ½ of the blood enters the liver while the other half
comes into the ductus venous and then into the
inferior vena cava
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Foramen Ovale

 Blood is shunted from

right atrium to left
atrium, skipping the
lungs.
 More than one-third of
blood takes this route.
 Is a valve with two
flaps that prevent
back-flow.
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 Ductus Arteriousus

 The blood pumped

from the right
ventricle enters the
pulmonary trunk.
 Most of this blood is
shunted into the aortic
arch through the
ductus arteriousus.

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 Fetal Circulation

 Blood continues to travel 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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 What happens to the blood after it
reaches the right atrium??
 Blood flows right into the left atrium through
the foramen ovale. What is that?
 Small opening in the septum of the heart
 Here again it mixes with a smaller amount of
deoxygenated blood from the pulmonary
veins.
 After it proceeds to the left ventricle where it
is pumped to the heart and brain

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 Fetal Circulation

 Foramen ovale
 Small opening in the septum of the heart
 Completely bypasses the non-functioning lungs
 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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 What about the rest of the
blood??
 The blood still in the right atrium goes into the right
ventricle then to the pulmonary artery.
 Once there most of the blood bypasses the lungs and
heads to the aorta through the ductus arteriosus.
 About 15% of the blood flows through lungs to the right
atrium by way of the pulmonary veins
 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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 What is happening further down??

 Common iliac arteries branch into the

external and internal iliacs.
 The blood in the internal iliacs come into the
umbilical arteries and flow back to the
placenta to gather oxygen and to get rid of
the waste products

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 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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 What happens after birth?

 once the baby is born and the lung, renal,

digestive and liver functions are working the
fetal circulation undergoes some changes
since they are no longer needed

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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
 Pressure from increased blood flow

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 Conversion: Fetal to Infant
Circulation

 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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 Conversion (cont)

 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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 Overview of Conversion

 Umbilical cord is clamped

 Loose placenta

 Closure of ductus venosus

 Blood is transported to liver and portal

system

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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

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