Fetoplacental
circulation
Presenter:-[Link]
Moderator:-[Link]
INTRODUCTION
Circulatory system of fetus with entire fetoplacental circulation including umbilical
cord and blood vessels within the placenta.
Characteristics
● Placenta - source of oxygen for fetus
● No gas exchange in lungs
● Right atrium receives the highest concentration of oxygenated blood
● CVS designed in such a way that most highly oxygenated blood is delivered to
myocardium and brain
These circulatory adaptation are achieved by preferential streaming of oxygenated blood
and the presence of intra cardiac and extracardiac shunts.
Fetal circulation can be defined as shunt dependent circulation.
UNIQUE STRUCTURE
● Umbilical cord- 2 umbilical artery carrying deoxygenated blood and waste
to placenta
● umbilical vein carrying oxygenated blood and nutrients from placenta.
● Placenta facilitates gas and nutrients exchange between maternal and
fetal blood.
● Ductus arteriosus- connection between pulmonary artery and aorta .
● Ductus venousus- connection between umblicus and IVC.
● Foramen ovale- connection between right and left atrium.
FETAL CIRCULATION
COMBINED VENTRICULAR OUTPUT
● Cardiac output in fetus is defined in terms of combined ventricular output of other
right and left ventricles - 450ml/kg/min
● As a result of intra cardiac and extracardiac shunting,the stroke volume of fetal LV is
not equal to RV.
● The RV receives 65% of the venous return and the LV about 35%.
● About 45% of the combined ventricular output is directed to placental circulation
with only 8% of CVO entering pulmonary circulation.
OXYGEN DELIVERY IN FETUS
● Fetus has high hemoglobin concentration about 16-18 mg/dl at term
● Fetus has high % of HbF
● HbF has low affinity to 2,3 DPG
● ODC of fetus is shifted to left favouring oxygen uptake in placenta.
● P50 of adult 26.5 mmHg and fetus 19.1 mmHg
CHANGES AT BIRTH
● Cessation of umbilical blood flow
Clamping of umbilical cord obliterates umbilical [Link] flow in ductus venousus
leading sudden hypoxia and hypercapnia which stimulates respiratory centre and the
respiration starts.
● Intake of first breath
Lung inflation causing fall in PVR and opening of pulmonary vessels, the blood flow from
pulmonary artery to lungs increases.
Increase in pulmonary blood flow leads to large rise in pulmonary venous return to left
atrium. This increases left atrial pressure more than right atrium causing closure of
foramen ovale by apposition of left and right atrial flaps bordering the opening.
Constriction of ductus arteriosus occurs due to high partial pressure of oxygen.
In neonatal life,since the systemic arterial pressure is more than pulmonary
pressure, reversal of blood flow occurs in ductus arteriosus,. This reversed flow in
ductus arteriosus is heard as continuous murmur in infants.
Ductus arteriosus closure is mainly by high pao2 .High pao2 causes
● direct effects- inhibition of oxygen sensitive k+channel and activation of
voltage sensitive Ca2+channel
● Indirect effect- decrease of PGE2 and prostacyclin secretion
Increase in bradykinin and decrease in Nitric oxide
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