Maternal & Newborn
Health Nursing
Fetal Circulation
Dr.Doaa Elkersh
Lecturer of Maternal & Newborn
Health Nursing
2021
Aim:
By the end of the lecture, students
will have knowledge,
understanding, and intellectual
skills regarding fetal circulation.
Intended learning outcomes
A-Knowledge and Understanding:
A1-Discuss direction of blood flow from and to
placenta
A2-Explain development of cardiovascular
system
A3- Define foramen ovale, ducts arteriosus, and
ducts venosus
C-Intellectual skills
C1-Detect shunts of fetal circulation
C2-Differentiate between fetal and maternal
blood
C3-Compare between blood in umbilical
arteries and blood in umbilical vein
D-Professional skills
None
Outline
▪ Introduction
▪ The development of the cardiovascular
system
▪ shunts in the fetal circulation
▪ Adaptation of fetal blood and vascular
system
▪ Direction of blood flow in the four chambers
of the fetal heart.
▪ Direction of blood flow in relation to the fetus
and placenta.
Introduction
Fetal circulation is the circulation of the blood in fetal
cardiovascular system during the fetal period
Throughout the fetal stage of development, the
maternal blood supplies the fetus with O2 and
nutrients and carries away its wastes. These substances
diffuse between the maternal and fetal blood through
the placental membrane. They are carried to and from
the fetal body by the umbilical blood vessels.
The development of the cardiovascular system
▪ Begins to develop toward the end of the
third week.
▪ Heart starts to beat at the beginning of the
fourth week.
▪ The critical period of heart development is
from 20 day To day 50 after fertilization.
▪ The human heart is one of the first organs to
form and function during embryogenesis. By
the end of gestational week 3, passive oxygen
diffusion becomes insufficient to support
metabolism of the developing embryo, and
thus the fetal heart becomes vital for oxygen
and nutrient distribution. The initiation of the
first heart beat via the primitive heart tube
begins at gestational day 22, followed by
active fetal blood circulation by the end of
week 4
Three shunts in the fetal circulation
1- Ducts arteriosus
▪ Fetal blood vessel connecting pulmonary
trunk/ artery and descending aorta
▪ protects lung against circulatory overload.
▪ carries mostly mid oxygenated blood.
2- Ductus venosus
▪ fetal blood vessel connecting the umbilical
vein to the IVC inferior vena cava.
▪ carries mostly high oxygenated blood.
3- formen ovale
▪ shunts highly oxygenated blood from right
atrium to left atrium.
Adaptations of fetal blood and
vascular system
▪ The concentration of hemoglobin in fetal
blood is about 50 % greater than in maternal
blood.
▪ Fetal hemoglobin is slightly different
chemically and has a greater affinity for O2
than maternal hemoglobin (fetal hemoglobin
can carry 20-30% more O2 than maternal
hemoglobin).
▪ In the fetal circulatory system, the umbilical vein
transports blood rich in O2 and nutrients from the
placenta to the fetal body.
▪ The umbilical vein enters the body through the
umbilical ring and travels along the anterior
abdominal wall to the liver. About 1/2 the blood it
carries passes into the liver. The other 1/2 of the
blood enters a vessel called the ductus venosus
which bypasses the liver.
▪ The ductus venosus travels a short distance and
joins the inferior vena cava (IVC). There, the
oxygenated blood from the placenta is mixed with
the deoxygenated blood from the lower parts of
the body. This mixture continues through the vena
cava to the right atrium.
▪ As the blood from the inferior vena cava enters the
right atrium, a large proportion of it is shunted
directly into the left atrium through an opening called
the foramen ovale.
N.B-In the adult heart, blood flows from the
right atrium to the right ventricle then through
the pulmonary arteries to the lungs.
N.B-A small valve, is located on the left side of
the atrial septum overlies the foramen ovale and
helps prevent blood from moving in the reverse
direction.
The more highly oxygenated blood that enters
the left atrium through the foramen ovale is
mixed with a small amount of deoxygenated
blood returning from the pulmonary veins.
This mixture moves into the left ventricle and is
pumped into the aorta. Some of it reaches the
myocardium through the coronary arteries and
some reaches the brain through the carotid
arteries.
▪ The rest of the fetal blood entering the right
atrium, including a large proportion of the
deoxygenated blood entering from the superior
vena cava passes into the right ventricle and out
through the pulmonary trunk.
▪ Only a small volume of blood enters the
pulmonary circuit, because the lungs are
collapsed, and non functional and their blood
vessels have a high resistance to flow.
▪ Enough blood reaches the lung tissue to sustain
them.
Most of the blood in the pulmonary trunk bypasses
the lungs by entering a fetal vessel called the
ductus arteriosus which connects the pulmonary
trunk to the descending portion of the aortic arch.
The blood carried by the descending aorta is
partially oxygenated and partially deoxygenated.
▪ This blood is carried to parts of the lower
regions of the body. The rest passes into the
umbilical arteries, which branch from the
internal iliac arteries and lead to the placenta.
There the blood is reoxygenated.
Conclusion
References
▪ Haseeb, F. (2007): Basic obstetrics,
Puerperium, 262-265, 8th ed.,
▪ Adel, M. (2018): Obstetrics & Gynecology,
Obstetrics, 2nd ed., 129-131.
▪ https://www.who.int/ar
