FETAL CIRCULATION
The circulation in the fetus is essentially the same as in the adult except for the following:
Fetal circulation involves three shunts: the ductus venosus, the ductus arteriosus, and the
foramen ovale.
1. The source of oxygenated blood is not the lung but the placenta. Highly oxygenated
and nutrient-enriched blood returns to the fetus from the placenta via the left umbilical
vein. (Note: Highly oxygenated blood is carried by the left umbilical vein, not by an artery.)
2. Oxygenated blood from the placenta comes to the fetus through the umbilical vein, which
joins the left branch of the portal vein. A small portion of this blood passes through the
substance of the liver to the inferior vena cava, but the greater part passes directly to the
inferior vena cava through the ductus venosus. A sphincter mechanism in the ductus venosus
controls blood flow.
3. The oxygen-rich blood reaching the right atrium through the inferior vena cava is directed
by the valve of the inferior vena cava towards the foramen ovale. Here it is divided into two
portions by the lower edge of the septum secundum {crista dividens):
(a} Most of it passes through the foramen ovale into the left atrium.
(b) The rest of it gets mixed up with the blood returning to the right atrium through the
superior vena cava, and passes into the right ventricle.
4. From the right ventricle, the blood (mostly deoxygenated) enters the pulmonary trunk.
Only a small portion of this blood reaches the lungs and passes through it to the left atrium.
The greater part is short-circuited by the ductus arteriosus into the aorta.
5. Hence the left atrium receives:
(a} oxygenated blood from the right atrium, and
(b) a small amount of deoxygenated blood from the lungs.
The blood in this chamber is, therefore, fairly rich in oxygen. This blood passes into the left
ventricle and then into the aorta.
Some of this oxygen-rich blood passes into the carotid and subclavian arteries to supply the
brain, the head and neck and the upper extremities. The rest of it gets mixed up with poorly
oxygenated blood from the ductus arteriosus. The parts of the body that are supplied by
branches of the aorta arising distal to its junction with the ductus arteriosus, therefore,
receive blood with only moderate oxygen content.
6. Much of the blood of the aorta is carried by the umbilical arteries to the placenta where it
is again oxygenated and returned to the heart.
N/B: Fetal lungs receive only a minimal amount of blood for growth and
development. The blood is returned to the left ventricle via pulmonary veins. Fetal
lungs are not capable of respiratory function because they are functionally immature
and the fetus is underwater (amniotic fluid). The placenta provides respiratory
function for the fetus.
CHANGES IN THE CIRCULATION AT BIRTH
Soon after birth, several changes take place in the fetal blood vessels. These lead to the
establishment of the adult type of circulation. The changes are as follows:
1. The muscle in the wall of the umbilical arteries contracts immediately after birth, and
occludes their lumen. This prevents loss of fetal blood into the placenta.
2. The lumen of the umbilical veins and the ductus venosus is also occluded, but this takes
place a few minutes after birth, so that all fetal blood that is in the placenta has time to drain
back to the fetus.
3. The ductus arteriosus is occluded, so that all blood from the right ventricle now goes to
the lungs, where it is oxygenated. Initial closure of the ductus arteriosus is caused by
contraction of muscle in the vessel wall. Later intima proliferation obliterates the lumen.
4. The pulmonary vessels increase in size and, consequently, a much larger volume of blood
reaches the left atrium from the lungs. As a result, the pressure inside the left atrium is
greatly increased. Simultaneously, the pressure in the right atrium is diminished because
blood from the placenta no longer reaches it. The net result of these pressure changes is that
the pressure in the left atrium now exceeds that in the right atrium causing the valve of the
foramen ovale to close.
The vessels that are occluded soon after birth are, in due course, replaced by fibrous tissue,
and form the following ligaments:
Vessels Remnant
(a) Umblical arteries Medial umbilical ligaments
(b) Left umbilical vein Ligamentum teres of the liver
(c) Ductus venosus Ligamentum venosus
(d) Ductus arteriosus Ligamentum arteriosum
CLINICALS
1. When the foramen ovale stays open after birth, it's called a patent foramen ovale (PFO). A
PFO usually causes no problems. If a newborn has congenital heart defects, the
foramen ovale is more likely to stay open. Most people don't have symptoms. Rarely,
though, patent foramen ovale symptoms manifest as migraines, shortness of breath
when getting up and standing, and a higher risk for certain kinds of strokes.
2. Patent ductus arteriosus (PDA) is a persistent opening between the two major blood
vessels leading from the heart. The heart problem is present from birth. That means it is a
congenital heart defect. An opening called the ductus arteriosus is part of a baby's blood
flow system in the womb. It usually closes shortly after birth. If it remains open, it's called a
patent ductus arteriosus. A small patent ductus arteriosus often doesn't cause problems
and might never need treatment. However, a large, untreated patent ductus arteriosus can
let oxygen-poor blood move the wrong way. This can weaken the heart muscle, causing
heart failure and other complications. A large PDA found during infancy or childhood might
cause:
Poor eating, which leads to poor growth.
Sweating with crying or eating.
Persistent fast breathing or breathlessness.
Easy tiring.
Rapid heart rate.
