Post-natal circulation
⟶ Circulation in the grown-ups
⟶ The boundary is at birth
Fetal Circulation
⟶ Circulation in the fetus
⟶ Pulmonary circulation is not functioning in the fetus
⟶ Amniotic fluid as the environment of the baby allows it to
receive oxygen and carbon dioxide from the mother through
the placenta
 Placenta
 Exchange mechanism
 Allows the exchange between the mother and the fetus
without the two systems coming in contact with each
other
 There is no contact between maternal blood and fetal
blood
 The wastes go to the mother, the nutrients go to the baby
through the structure called the umbilical cord
 Umbilical cord
 Umbilical vein
⟶ Carries oxygenated blood towards the fetus
⟶ Enters the umbilicus of the fetus
⟶ Enters the area under the liver and brings the
oxygenated blood to flow directly to your inferior
vena cava through your ductus venous shunt
⟶ It then goes into the right atrium, then from there,
most of the blood will go to the left atrium through
another shunt called foramen ovale
⟶ Some blood goes into the right ventricle to your
pulmonary artery
⟶ Because the lungs are still immature, the capillaries in
the alveoli are still vasoconstricted which causes the
difficulty of the blood to flow for there is higher
resistance, from here, blood just goes back to the left
atrium
⟶ Blood is directed to the aorta by the shunt called
ductus arteriosus which connects the pulmonary
artery to the aorta
⟶ The oxygenated blood in the left atrium goes into the
left ventricle, then goes to the aorta supplying the
systemic circulation to the rest of the bodies
 Umbilical artery
⟶ After the systemic circulation, wastes products are
carried by the umbilical artery and goes out of the
fetus by way of the umbilicus
⟶ It is continuous to the umbilical artery of the umbilical
cord
⟶ The umbilical cord brings the wastes out of the
placenta and out of the fetal circulation to be
absorbed by the maternal circulation
⟶ From the uterus, the wastes from the fetal circulation
enters the veins in the mother which continues into
the inferior vena cava then goes up into the right
atrium and right ventricle
⟶ The wastes are removed by the pulmonary circulation
and are replaced by oxygen.
⟶ Oxygen goes back to the left atrium, left ventricle, to
the aorta, to the placenta to the umbilical vein,
ductus venosus, inferior vena cava, right atrium to
foramen ovale to left atrium, the rest of the blood
goes in to the right ventricle, to the pulmonary artery,
to ductus arteriosus to aorta.
⟶ Repeat the whole cycle
 Shunt
⟶ Temporary vascular connection
Fetal Circulation to Post-natal Circulation
 Parturian / Parturient
⟶ The mother that is giving birth
⟶ When giving birth, does the Valsalva maneuver
⟶ The Valsalva maneuver should be silent in order to
increase the pressure in the abdomen
 As soon as the nose, head, and mouth are outside, they
begin to breathe as a reflex
 As soon as they breathe, the alveoli in the lungs are filled
with air, which is theoretically painful and is the very
reason why the newborn cries.
 The blood vessels in the pulmonary circulation becomes
vasodilated, having a low resistance
 The change in pressure in the pulmonary and systemic
circulation will cause the shunts to close:
⟶ Ductus venosus: Ligamentum venosum
⟶ Foramen ovale: Fossa ovalis
⟶ Ductus arteriosus: Ligamentum arteriosum
 When the shunts close, the circulation through the heart is
now going to be post-natal circulation
What is the newborn is not crying?
 One reason why the newborn is not crying is that there are
still fluids in the passages
 Another reason is that the newborn is still sleeping
 In pathologic conditions, even after stimulation, the babies
are still not breathing and starts turning blue. For this
reason, a CPR is initiated. If the newborn is still not being
revived, tubes are inserted to revive the baby
Pathologic Conditions
 Congenital heart disease
⟶ Failure of the shunts to close
⟶ There is no forward flow
⟶ Overworking of the heart
 Atrial Septal Defect
⟶ The condition when the foramen ovale remained open
and did not close.
⟶ The blood on the left keeps on going back to the right
atrium, which leads to the overworking of the right side
of the heart.
⟶ The direction is from left to right because the left has
thicker walls than the right. Therefore, the left is always
stronger than the right.
  Ventricular Septal Defect
⟶ A hole is formed in the interventricular septum
⟶ “May butas sa puso”
 Patent Ductus Arteriosus
⟶ The ductus arteriosus remained open
⟶ The murmur is said to be machinery-like for it is heard
in both systole and diastole with a soft blowing sound.
 Stenosis
⟶ Narrow pulmonary trunk
 Tetralogy of Falot
⟶ Aorta opens both on the right and left ventricle which
cause oxygenated and deoxygenated blood both flow
through it
⟶ Pulmonary stenosis, large ventricular septal defect,
overriding aorta, cyanosis
⟶ a congenital heart condition involving four
abnormalities occurring together, including a defective
septum between the ventricles and narrowing of the
pulmonary artery, and accompanied by cyanosis
⟶ patients with TOF are cyanotic which becomes worse as
they get older
o Squatting
⟶ Causes a kink in the iliac, creating a
backpressure towards the pulmonary artery,
which causes it to open up, causing more
blood to go to the lungs leading to the
increase of oxygen.
⟶ This causes the cyanosis to go away.

 Auscultation
⟶ The action of listening to sounds from the heart, lungs, or
other organs, typically with a stethoscope, as a part of
medical diagnosis.
⟶ When you auscultate, patients with CHD usually presents
with additional sounds called murmurs.

 Murmurs
⟶ Result of abnormal blood flow
⟶ Lack of forward flow
⟶ Also present in valvular defects
 If the valve is characterized by stenosis, the murmur is
usually soft and blowing.
 If there is valvular stenosis, it is not a problem in systole but
a problem in the diastole. This leads to the overworking of
the right atrium which then creates a sound during diastole
(Swishhh)
 If the valve manifests with regurgitation or valvular
insufficiency (valve that does not close), the murmur
created is harsh and rough
 If there is regurgitation, it is not a problem in diastole but a
problem in systole. The valve does not closes therefore
blood rushes into the atrium, causing the valves to vibrate
with a harsh and rough sound during systole.