Fetal Circulation

Fetal Circulation
This particular diagram shows the flow of blood in a fetus in the later stages of
pregnancy. This particular representation is very useful because it actually shows
the flow of blood. Oxygenated blood can be seen coming from the placenta, the
umbilical cord, then the umbilical vein and flowing into the liver and then the
vena cava to begin its circulatory process. Other important information one needs
to remember about fetal circulation is that the blood takes three 'shortcuts' during

its

journey.

First and foremost, half the blood coming from the placenta goes to the liver, and
the other half is diverted along the ductus venosus which "skips" the liver. Then
there's a connection through which blood can flow directly between the right and
left atria called the foramen ovale. The foramen ovale has a small valve called
the septum primum which is located on the left side of the atrial septum that
prevents the blood from flowing from the left atrium to the right. After birth this
valve is sealed by the increased left and decreased right atrial pressure. The last
'shortcut' is the ductus arteriosus, which allows blood to flow from the
pulmonary trunk to the descending portion of the aorta to keep blood out of the
lungs and from damaging lung capillaries. The ductus arteriosus connects to the
lower portion of the aortic arch so the blood traveling to the brain is largely
oxygenated.

Differences between the Fetal Circulatory system and the Adult Circulatory
system:
The fetal blood has bout a 50% higher concentration of hemoglobin than the
maternal blood, and is chemically slightly different. Under the right
circumstances, the fetal blood can carry 20-30% more oxygen then the maternal
blood.
Changes

in

Newborns

Circulatory

system:

The foramen ovale is sealed shut by the change in atrial pressure, and becomes the
fossa ovalis. Both the ductus arteriosis and the ductus venosum are closed by
sphincter muscles and get turned into ligaments.

Because of certain changes in the cardiovascular system at birth, certain vessels

and structures are no longer required.
Over a period of months these fetal vessels form nonfunctional ligaments, and
fetal structures such as the foramen ovale persist as anatomic vestiges of the
prenatal circulatory system.

 Fetal Structure
Foramen Ovale
Umbilical Vein
(intra-abdominal part)
Ductus Venosus
Umbilical Arteries and abdominal
ligaments
Ductus Arteriosum

Adult Structure
Fossa Ovalis
Ligamentum teres
Ligamentum venosum
medial umbilical ligaments,
superior vesicular artery (supplies
bladder)
Ligamentum arteriosum

Two common defects:

1. patent ductus arteriosus

common in females 2-3 times more than males, unknown reason why
If instead of functional closure after birth there is patent structure then aortic
blood is shunted into the pulmonary artery.
Most common congenital anomaly associated with maternal rubella infection
during early pregnancy (mode of action by virus unclear)
Premature infants usually have a PDA due to hypoxia and immaturity.
Surgical closure of PDA is achieved by ligation and division of the DA.

2. Patent foramen ovale

most common form of an Atrial Septal Defects (ASDs)
a small isolated patent foramen ovale is of no hemodynamic significance; but if
other defects present (e.g. pulmonary stenosis or atresia), blood is shunted through
the foramen ovale into the left ventricle, producing cyanosis, a dark bluish
coloration of the skin and mucous membranes resulting from deficient oxygenation
of the blood.
A probe patent foramen ovale is present in up to 25% of people. A probe can be
passed from one atrium to the other through the superior part of the floor of the
fossa ovalis. Though not clinically significant (usually small) but may be forced
open because of other cardiac defects and contribute to functional pathology of the
heart. Results from incomplete adhesion between the original flap of the valve of
the foramen ovale and the septum secundum after birth.