FETAL CIRCULATION IN THE WOMB

Because the fetus does not breathe or metabolize substances in the liver, several alterations of the
post birth circulatory route are needed. Three shunts ductus venosus, foramen ovale, And ductus
arterioles divert most of circulating blood away from the lungs and liver.
Oxygenated blood from the placenta enters the fetal body through the umbilical vein. About half
of the oxygenated venous blood goes through the liver during early pregnancy and the rest bypasses the
liver and enters the inferior vena cave through the first shunt, the ductus venosus. The blood then enters
the right atrium. Most of the blood passes directly into the left atrium through the second shunt, the
foramen ovale, where it mixes with the small amount of blood returning from the lungs. Blood is pumped
from the left ventricle into the aorta to nourish the body. A small amount of blood from the right ventricle
is circulated to the lungs to nourish the lung tissue. The rest of the blood from the right ventricle joins
oxygenated blood in the aorta through the third shut, ductus arteriosus.

CHANGES IN BLOOD CIRCULATION AFTER BIRTH

Fetal circulatory shunts are not needed after birth because the infant oxygenates blood in the
lungs, metabolizes substances in the liver, and stops circulating blood to the placenta. As the infant
breathes, blood flow to the lung increases, pressure in the right heart falls, and the foramen ovale closes.
Pressure in the aorta rises as pressure in the pulmonary artery falls, causing the direction of blood flow
through the ductus arteriosus to reverse, from the aorta into the pulmonary artery. The ductus arteriosus
constricts as the arterial oxygen levels rises. The ductus venosus constricts when blood flow from the
umbilical cord stops. The foramen ovale and ductus venosus permanently close as tissue proliferates in
these structures. The ductus venosus and ductus arteriosus become ligaments, as do the umbilical veins
and arteries.

DUCTUS ARTERIOSUS
Functional closure- 10-15 hours after
birth
(reversible
in
hypoxemia
and
hypovolemia)
Permanent closure 2-3 weeks
Remnant ligamentum arteriosum

FORAMEN OVALE
Increased pulmonary blood flow &
left atrial distention cause closure
Functional closure- at birth ,
anatomical closure by 1 year
maneuvers increase PVR increases
RA & RV pressure
Right to left atrial shunt may occur
in newborns & young infants