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Fetal Circulation

• In the fetal circulatory system, the umbilical vein transports blood rich in O2 and
nutrients from the placenta to the fetal body.
o 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.
o The ductus venosus travels a short distance and joins the inferior vena
 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.
o In the adult heart, blood flows from the right atrium to the right ventricle
then through the pulmonary arteries to the lungs.
 In the fetus however, the lungs are nonfunctional and the blood
largely bypasses them.
o 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.
 A small valve, septum primum is located on the left side of the
atrial septum overlies the foramen ovale and helps prevent blood
from moving in the reverse direction.
o 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
 Only a small volume of blood enters the pulmonary circuit,
because the lungs are collapsed, and their blood vessels have a
high resistance to flow.
 Enough blood reaches the lung tissue to sustain them.
o 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.
 As a result of this connection, the blood with a relatively low O2
concentration which is returning to the heart through the superior
vena cava, bypasses the lungs.
 At the same time, the blood is prevented from entering the portion
of the aorta that provides branches leading to the brain.
o 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
 Some of it reaches the myocardium through the coronary
arteries and some reaches the brain through the carotid
o The blood carried by the descending aorta is partially oxygenated and
partially deoxygenated.
 Some of it is carries into the branches of the aorta that lead to
various 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.

During pregnancy, the fetal circulatory system works differently than after birth:

• The fetus is connected by the umbilical cord to the placenta, the organ
that develops and implants in the mother's uterus during pregnancy.
• Through the blood vessels in the umbilical cord, the fetus receives all
the necessary nutrition, oxygen, and life support from the mother
through the placenta.
• Waste products and carbon dioxide from the fetus are sent back
through the umbilical cord and placenta to the mother's circulation to
be eliminated.

Blood from the mother enters the placenta and comes in close proximity to
the fetal blood that has returned from the fetus to the placenta through the
umbilical arteries. Once the two circulations are in close proximity in the
placenta, the oxygen (O2) and nutrients, like sugar, protein and fat molecules
can move from maternal to fetal blood, and carbon dioxide (CO2) and waste
products can move from fetal to maternal blood. The maternal blood returns
from the placenta to the mother's veins for her systems to take care of the
waste. The new well nourished fetal blood returns to the baby through the
umbilical vein. The umbilical vein goes to the liver and splits in to three
branches, one of which connects to the inferior vena cava, a major vein
connected to the heart. In this way the well nourished blood reaches the fetal
heart to be sent to the rest of the body.

Inside the fetal heart:

• Blood enters the right atrium, the chamber on the upper right side of
the heart. Most of the blood flows to the left side through a special
fetal opening between the left and right atria, called the foramen
• Blood then passes into the left ventricle (lower chamber of the heart)
and then to the aorta, (the large artery coming from the heart).
• From the aorta, blood is sent to the head and upper extremities. After
circulating there, the blood returns to the right atrium of the heart
through the superior vena cava.
• About one-third of the blood entering the right atrium does not flow
through the foramen ovale, but, instead, stays in the right side of the
heart, eventually flowing into the pulmonary artery.

Because the placenta does the work of exchanging oxygen (O2) and carbon
dioxide (CO2) through the mother's circulation, the fetal lungs are not used
for breathing. Instead of blood flowing to the lungs to pick up oxygen and
then flowing to the rest of the body, the fetal circulation shunts (bypasses)
most of the blood away from the lungs. In the fetus, blood is shunted from
the pulmonary artery to the aorta through a connecting blood vessel called
the ductus arteriosus.

Blood circulation after birth:

With clamping of the cord, the detachment from the placenta and the first
breaths of air the baby takes at birth, the fetal circulation changes. By
removing the placenta reservoir, the baby's venous resistance/blood pressure
goes up. By filling the lungs with air, the blood pressure in the lung arteries
goes down. This eventually leads to the closing of the two areas for shunting,
the patent foramen ovale (PFO) and the patent ductus arteriosus (PDA).

• Because the ductus arteriosus (the normal connection between the

aorta and the pulmonary artery) is no longer needed, it begins to
constrict and close off.
• The circulation in the lungs increases and more blood flows into the
left atrium of the heart. This increased pressure causes the foramen
ovale to close and blood circulates normally.


Fetal circulation
1. Oxygenated blood enters the umbilical vein from the placenta
2. Enters ductus venosus
3. Passes through inferior venacava
4. Enters the right atrium
5. Enters the foramen ovale
6. Goes to the left atrium
7. Passes through left ventricle
8. Flows to ascending aorta to supply nourishment to the brain and upper
9. Enters superior vena cava
10. Goes to right atrium
11. Enters the right ventricle
12. Enters pulmonary artery with some blood going to the lungs to supply oxygen
and nourishment
13. Flows to ductus arteriosus
14. Enters descending aorta ( some blood going to the lower extremeties)
15. Enters hypogastric arteries
16. Goes back to the placenta

Special Structures in Fetal Circulation

Placenta – Where gas exchange takes place during fetal life

Umbilical Arteries – Carry unoxygenated blood from the fetus to placenta

Umbilical Vein – Brings oxygenated blood coming from the placenta to the fetus

Foramen Ovale – Connects the left and right atrium. It pushes blood from the right
atrium to the left atrium so that blood can be supplied to brain, heart and kidney

Ductus Venosus - Carry oxygenated blood from umbilical vein to inferior venacava,
bypassing fetal liver

Ductus Arteriosus - Carry oxygenated blood from pulmonary artery to aorta, bypassing
fetal lungs.


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