Fetal circulation

Neonatal circulation
 Placenta and umbilical vessels

• Placenta functions as fetal

lungs and the oxygenated
blood passes into left
umbilical vein which
enters the liver.
• The umbilical
arteries(right and left)
carry deoxygenated blood
from the fetus to the
placenta
 Problems of fetal circulation
• The lungs do not function in fetal life.
• Hence the left heart and the systemic
circulation are maintained by number of by-
pass mechanisms namely;
• Foramen ovale
• Ductus arteriosus
• Ductus venosus
 The left umbilical vein
• Highly
oxygenated,nutrient
rich blood comes from
the left umbilical vein.
• Much of this blood is
diverted into ductus
venosus, which
connects the left
umbilical vein to IVC
in the liver
left umbilical vein
Sphincter mechanism in the liver
• This regulates the flow of remaining blood
from umbilical vein into IVC through
hepatic veins.
• It is generally agreed that a physiological
sphincter exists and prevents overloading of
heart when the venous flow in the
left.umb.vein is high(eg.during uterine
contractions)
 Foramen ovale
• After a short course in
IVC the blood enters
the right atrium and
much of it passes into
the left atrium through
foramen ovale(a gap in
the interatrial septum)
 Ductus arteriosus
• Low oxygenated blood
from SVC and some
amount of blood from IVC
pass into right ventricle
and thence into pulmonary
artery(trunk).
• 90% of this blood is by-
passed into the aorta by a
channel ductus arteriosus
 Ductus arteriosus
• Connects the left
branch of the
pulmonary trunk to
arch of aorta(beyond
the origin of left
subclavian artery)
• It protects the lungs
from circulatory
overloading.
 Pulmonary vascular resistance
• is high in fetal life and pulmonary blood
flow is low as the lungs do not need much
blood for their survival but developing brain
does.
 Umbilical arteries
• About 65%of blood in the descending aorta
• Passes into umbilical arteries(right and left)
• Which are direct branches of fetal internal
iliac arteries(hypo gastric arteries)
• Remaining 35% of blood supplies the lower
half of the body and viscera
 Postnatal changes
• Once the child takes the
first respiration,pulmonary
circulation begins and the
right and left hearts
become completely
independent of each other.
• All the by-pass channels
having served their
purpose,obliterate.
• Foramen ovale is closed
and becomes fossa ovalis
in the right atrium
 Ligamentum arteriosum
• The ductus arteriosus
becomes a fibrous band
called ligamentum
arteriosum(which has left
recurrent laryngeal nerve
hooking around)
• (By 96 hours after birth
100% closure occurs)
• Many factors contribute to
this process of obliteration
called involution(mainly
oxygen,and transforming
growth factor)
 Ligamentum venosum
• Ductus venosus
becomes a fibrous
band called
ligamentum venosum
which is seen in
continuation with
ligamentum
teres(obliterated left
umbilical vein)
Other changes and clinical aspects
• The umbilical arteries become umbilical ligaments
attached to the internal iliac arteries upto superior
vesical arteries.
• Any failure of all these closures lead to
• Patent foramen ovale,ASD,VSD,PDA and
coarctation of aorta.
• The left umbilical vein remains patent for
considerable time and can be used for exchanging
transfusions.