The Fetal Circulation
The Fetal Circulation
The Fetal Circulation
Helen Wolde
In the fetal circulation ,the right and
left ventricle exist in a parallel circuit
,as opposed to the series circuit of a
newborn or adult
• Ductus venosus
• Foramen ovale
• Ductus arteriosus
Circulatory adaptation
at birth there is an increase in the
conductance of the pulmonary vessels due to;
•Expansion of collapsible pulmonary capillaries as
well as those vessels that are anotomically
‘tethered’ to the pulmonary parenchyma
•As blood gas composition is changed by an
increase in Po2 and a decrease in Pco2 ,further
increase in vascular conductance is achieved
The output from the right ventricle flows
entirely into the pulmonary circulation and the
shunt through DA reverses
The peripheral vascular resistance
increases due to ;
• Increasing of the oxygenation of the
blood
• Loss of umblical circulation
• Cold shock of birth
The left ventricle is now coupled to
the high resistance circulation. There
is a 200% increase in output
This marked increase in left
ventricular performance is achieved
through a combination of hormonal
and metabolic signals
This is the ‘transitional’ phase of the
perinatal circulation
The removal of the placenta from the
circulation results in closure of DV
which becomes ligamentum venosus
The increased volume of pulmonary
blood flow returning to the left
atrium increases the left atrial
volume and pressure sufficiently to
close the foramen ovale functionally
The ductus arteriosus remains open
for some hours
DA constricts under the influence of
prostaglandin interacting with rising
oxygen tension in the blood
This involutional process normally
begins at about 4-24hr postnatally
and is completed by 24hrs
The umbilical arteries constrict
vigorously under the influence of
increased oxygen tension and in
response to stretch of the umbilical
cord
The umbilical arteries close earlier
than the vein resulting in an average
transfer of 15-20ml /Kg of blood to
the fetus
Persistent pulmonary HTN of the
newborn occurs in term and post-
term infants
There is excessively high pulmonary
vascular resistance and the infant
becomes ill in the delivery room or
within the first 24 hrs of life
The patency of this fetal pathways
may either provide a life saving route
for blood to bypass a congenital
defect(PDA ,foramen ovale) or
present an additional stress to the
circulation (PDA)
Therapeutic agents may either
maintain these fetal pathways or
hasten their closure
Summary
1. There is rise and subsequent fall in
systemic resistance
2. A vast decrease in pulmonary
resistance
3. Increase in left ventricular volume
and pressure workload
4. Decrease in right ventricular
workload
5. Closure of DA ,FO ,DA