F E TA L
C IR C U L A TIO N
INTRODUCTION
In the fully developed human, the heart serves
two main purposes.
The right heart pumps blood to the lungs for
oxygenation and the left heart pumps oxygenated
blood to rest of the body.
In the embryo and fetus, the lungs do not
oxygenate the blood.
Fetal circulation is consequently quite
different than that of a breathing baby or
adult.
When a baby is born and takes its first breathes,
the ducts close and blood is rerouted to the lungs.
D E F IN ITIO N
The fetal circulation is the circulatory system of a
human fetus, often encompassing the entire
fetoplacental circulation which includes the umbilical
cord and the blood vessels within the placenta that
carry fetal blood.
P ATH WAY
Ductus Arteriosus
Arch of Aoarta
Right Lung
Left Atrium
Foramen Ovale
Right Left
AIntfreiruimor V entricle
DVuecntaucsavVaen
osus Right
Liver Ventricle
Umbilical Vein
Portal Vein
Placenta
U mbilical
Arteries
Umbilical Cord
2 umbilical arteries:
return non-oxygenated blood, fetal
waste, CO2 to placenta
1 umbilical vein:
brings oxygenated blood and nutrients to the fetus
Foetal circulation consequently differs
from the adult one predominantly due to
the presence of 3 major vascular shunts:
Three shunts are present in fetal life:
1. Ductus venosus: connects the umbilical vein
to the inferior vena cava
2. Ductus arteriosus: connects the main
pulmonary artery to the aorta
3. Foramen ovale: anatomic opening between
the right and left atrium.
T H E M A I N F U N C T I O N O F T H E S E S H U N T S I S TO
R E D I R E C T OX YG E N AT E D B L O O D AWAY F R O M T H E
LUNGS, LIVER AND KIDNEY ( W H O SE F U N C T I O N S A R E
P E R F O R M E D BY T H E P L AC E N TA ).
U M B I L I C A L C I R C U L AT I O N
Pairof umbilical
arteries carry
deoxygenated blood &
wastes to placenta.
Umbilicalvein carries
oxygenated blood and
nutrients from the
placenta.
T H E P L A C E N TA
Facilitates
gas and
nutrient exchange
between maternal and
fetal blood.
Theblood itself does not
mix.
P L A C E N TA L R O L E
The core concept behind fetal circulation is that
fetal hemoglobin has a higher affinity for oxygen
than does adult hemoglobin, which allows a
diffusion of oxygen from the mother's circulatory
system to the fetus.
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.
IMAGE D E P I C T S F E TA L C I R C U L AT I O N . NOTE THE AREAS OF
O X YG E N AT E D B L O O D ( RED ) A N D D E O X YG E N AT E D B L O O D
( BLUE ) MIXING ( P U R P L E ) T H R O U G H F E TA L S H U N T S
PATHW
AYfrom the placenta
Oxygenated blood
through umbilical vein
fetus
liver
Receives deoxygenated blood from the portal vein
through
ductus venosus
Inferior vena cava
Right atrium of heart
through
foramen ovale
Left atrium of the heart
During ventricular systole
Left ventricular blood Right ventricular blood
pumped with < o2 content
Ascending aorta and distributed is discharged
by their branches to the heart, Pulmonary arteries
head,neck,brain,arms. Ductus arteriosus
Descending aorta
Hypogastric arteries
Umbilical arteries
Placenta
During fetal life
350ml per kg per
min
Cardiac Output
Following birth
500ml per min
Heart Rate 120-140per
min
F E TA L C I R C U L AT I O N
By the third month of
development, all
major blood vessels
are present and
functioning.
Fetus must have blood
flow to placenta.
Resistance to blood
flow is high in lungs.
D I F F E R E N C E B E T W E E N A D U LT AND F E TA L
C I R C U L AT I O N
Criteria Adult Circulation Fetal Circulation
Artery Carries Carries Non-oxygenated blood
oxygenated blood away from the fetal heart
away from the
heart
V eins Carries non- Carries oxygenated blood back to
oxygenated blood the heart
towards the heart
E xchange Takes places in Takes place in the placenta
of Gases the lungs
Pressure Increase pressure Increase pressure on the right
on the left side of side of the heart
the heart
F E TA L C I R C U L AT I O N S E Q U E N C E
Exchange of gases
occurs in the
placenta.
Oxygenated blood
is carried by the
umbilical vein
towards the fetal
heart.
The ductus venosus directs part of the blood
flow from the umbilical vein away from the
fetal liver (filtration of the blood by the liver
is unnecessary during the fetal life) and
directly to the inferior vena cava.
Blood from the ductus venosus enters
to the inferior vena cava. Increase
levels of oxygenated blood flows
into the right atrium.
In adults, the increase
pressure of the right
atrium causes the
tricuspid valve to open
thus, draining the blood
into the right ventricle.
However, in fetal
circulation most of the
blood in the right atrium
is directed by the
foramen ovale (opening
between the two atria)
to the left atrium.
The portion of the blood that drained into
the right ventricle passes to the
pulmonary artery.
As blood enters the
pulmonary artery (carries
blood to the lungs), an
opening called ductus
arteriosus connects the
pulmonary artery and the
descending aorta. Hence,
most of the blood will
bypass the non-functioning
fetal lungs and will be
distributed to the different
parts of the body. A small
portion of the oxygenated
blood that enters the lungs
remains there for fetal lung
maturity .
F L O W C H A R T O F F E TA L
C I R C U L AT I O N
WH Y I S TH E P U L M O N A R Y
C I R C U L A TI O N R E D U C E D I N THE
HUMAN FETUS?
Pulmonary circulation is reduced in the
human fetus because the baby gets its
oxygen from its mother and does not breath
on its own.
P O S TN A TA L C H A N G E S
IN C I R C U L AT I O N
W HAT H A P P E N S AT B I RT H ?
The change from fetal to postnatal
circulation happens very quickly.
Changes are initiated by baby’s
first breath.
P O S T N ATA L C H A N G E S
Gas exchange function is transferred from placenta to the
lungs.
Separation of systemic and pulmonary circulations
Increased metabolism to maintain body temperature and
hence increased cardiac output.
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
N eonatal
circulation
CHANGES IN THE FETAL AFTE
CIRCULATION R
Shunt Functional BIRTH
Anatomical Remnant
closure closure
Ductus 10 – 96 hrs 2 – 3 wks Ligamentum
arteriosus after birth after birth arteriosum
Formame Within several One year Fossa ovalis
n ovale mins after after birth
birth
Ductus Within several 3 – 7 days Ligamentum
venosus mins after after birth venosum
birth
Umbilical arteries → Umbilical ligaments
Umbilical vein → Ligamentum teres
FETAL CIRCULATION VIII: Conversion to post-natal*
Closure of Foramen ovale
Forces venous blood (now all deoxygenated) into
the right ventricle for expulsion to the lungs
Closure of DUCTUS VENOSUS
Stops use of umbilical HEAR Pulmonary
veins
vessels, & converts
all vena cava blood to
Vena cava Right
ATRIUM
OLef t
T
LUNGS
deoxygenated ATRI
IVC U
Right
VENTRICLE
SYSTEMI Left Pulmonary
VENTRICLE arteries
CAPILLARIE
Closure of S
Umbilical
arteries
Stops use of Aorta Closure of
umbilical vessels Ductus arteriosus
means that blood expelled from the
right ventricle has to go to the lungs
Foramen ovale Closes shortly after
birth, fuses
completely in first
year.
Ductus arteriousus Closes soon after
birth, becomes
ligamentum
arteriousum in
about 3 months.
Ductus venosus Ligamentum venosum
Umbilical arteries Medial umbilical
ligaments
Umbilical vein Ligamentum teres
P R O B L E M WITH P E R S IS TE N C E
O F F E TA L C I R C U L AT I O N
Patent (open) ductus arteriosus and patent
foramen ovale each characterize about 8% of
congenital heart defects.
Both cause a mixing of oxygen-rich and oxygen-
poor blood; blood reaching tissues not fully
oxygenated. C a n cause cyanosis
Surgical correction now available, ideally
completed around age two.
Many of these defects go undetected until child
is at least school age.
A D U LT D E R I VAT I V E S O F F E TA L
VA S C U L A R S T R U C T U R E S
S .N o F E TA L S T R U C T U R E A D U LT S T R U C T U R E
1. F O R A M E N O VA L E F O S S A O VA L I S
2. UMBILICAL VEIN LIGAMENTUM TERES
3. DUCTUS VENOSUS LIGAMENTUM VENOSUM
4. D U C T U S A RT E R I O S U M L IG A M E N TU M
A RT E R I O S U M
5. U M B I L I C A L A RT E RY MEDIAL UMBILICAL
AND ABDOMINAL A RT E RY A N D S U P E R I O R
LIGAMENT V E S I C U L A R A RT E RY
FETAL VS INFANT
CIRCULATION
Fetal Infant
• Low pressure system •High pressure system
• Right to left shunting •Left to right blood
• Lungs non-functional •flow
Lungs functional
• Increased pulmonary •Decreased pulmonary
resistance resistance
• Decreased systemic •Increased
resistance systemic resistance
