Fetal Circulation

Burhanuddin Iskandar
Pediatric Cardiology Division
Pediatric Department,Medical Faculty
Hasanuddin University Makassar
 SIRKULASI JANIN
Tanda-tanda :
 Sirkulasi sistemik dan sirkulasi paru  paralel
 Tekanan ventrikel kanan = ventrikel kiri
 Foramen ovale dan ductus Botalli, ductus venosus terbuka
 Atrium kanan lebar, sirkulasi didalammnya menyilang
 Jantung, kepala & anggota gerak atas disuplai darah kaya
oksigen
 Sirkulasi paru minim sekali (paru-paru belum berfungsi)
 Plasenta : pertukaran gas (respirasi), nutrisi, ekskresi

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 SIRKULASI JANIN / BAYI
 Bayi lahir : - Paru berfungsi
- Sirkulasi plasenta berhenti
 Sirkulasi sistemik dan sirkulasi paru  seri
 Tekanan ventrikel kiri > ventrikel kanan
 Fungsi vaskularisasi paru mulai berlangsung  tahanan sirkulasi paru-
paru berkurang
 Kadar oksigen meninggi  suplai oksigen pd seluruh tubuh
 Tidak ada sirkulasi silang di atrium kanan
 Foramen ovale, ductus Botalli & ductus Venosus  menutup

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 Fetal circulation

Fetal circulation Infant and children

Gases exchange

Placenta Lung
 In fetal circulation, there 4 shunts :
Placenta
Ductus venosus
Foramen ovale
Ductus arteriosus
 Fetal Circulation
Fetal Circulation: four shunts
 Placenta
► Receives55% of total CO
► Lowest vascular resistance
 Ductus venosus
► From placenta: has 70% sats
► Highest PO2: umbilical vein
(30)
 Foramen ovale
► 1/3 of RA return goes to LA
 Oxygenate brain and
coronaries better (PO2=28)
 Lower body: PO2=24
 Ductus arteriosus
► PA=> Descending Aorta =>
placenta
 Neonatal Circulation
 Change in gas exchange from placenta to
lungs
• Increase in systemic vascular resistance due to
absence of placenta and closure of DA due to
presence of increased PO2

• Reduction of PVR after lung expansion due to

oxygen, increased LA return, fall in RA pressure
due to DA closure and increase in systemic
pressure => closure of foramen ovale

• Rapid initial fall, slower fall by 6-8 weeks and

then after 2 years
 DA closure
 Within 10-15 hours of birth
 Postnatal increase in Oxygen is the strongest
stimulus for closure.
 PGE2 decreases after birth due to loss of placenta
and increased pulmonary blood flow to wash it off.
 Indomethacin closes PDAs
 Maternal ingestion of ASA can cause Persistent
Pulmonary Hypertension of the Newborn
(premature closure of DA and poor development of
arterioles)
 PGE1 keeps DA open.
 Fetal cardiac output
 Cardiac output in adult, if heart rate
decreased  stroke volume 

 In fetal cardiac output, if heart rate

decreased  stroke volume is unable
to increase so is easy develop fetal
distress
 Changes in circulation after birth
 Removal placenta SVR 

Ductus venosus closure

 Lung expansion
PVR ↓ RA pressure ↓

Foramen ovale closure PDA closure

LA pressure  SO2 

PBF  Venous return to LA

 Closure of the ductus
 Fungsional closure 10-15 h
 Anatomic closure 2-3 wk

Oxygen, Protaglandin E2, Maturity

Bradykinin
Acethylchloline
 Oxygen ~ the ductus
  SO2 systemic circulation is the
strongest stimulus for ductal closure
 Premature infant less responsiveness
to oxygen than full-term infant
 Decreased responsiveness of
immature ductus may also due to
persistently high level of PGE2
 PGE2 ~ the ductus
PGE2 level ↓ aft birth  ductal constriction

Removal of the placenta

Removal PGE2 from circulating due to PBF 

■ Constricting effect of Indomethacine and

dilator effect of PGE2 are greater in
immatur fetus than term fetus
Prolonged patency of PDA Closed sinificant PDA

Synthetic
Synthetic PGE 1/ iv
PGE1/iv Indomethacine
 Premature Newborn
The ductus arteriosus is more likely to remain
open after birth due to :

◑ Ductal smooth muscle doesn’t have fully

developed contrictor response to oxygen

◑ Persistent high level of PGE2

PVR more rapid fall in premature infant and this is lead

to early L  R shunt and CHF
 Premature Newborn
The ductus arteriosus is more likely to remain
open after birth due to :

◑ Ductal smooth muscle doesn’t have fully

developed contrictor response to oxygen

◑ Persistent high level of PGE2

PVR more rapid fall in premature infant

 Respone PA and DA to
various stimuli

Hypoxia and acidosis

Symphatetic stimulation

DA DA relaxes constricts PA
 Oxygen

DA constricts relaxes PA
 Vagal stimulation
ß-adrenergic block
Bradykinin

Dilated PA