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Fetal and Neonatal Circulation - MBBS, Gandhi medical College Hyderabad

Physiology chapter presentation Reference - Guyton and Hall By Swetha Rani Savala, MBBS 1st year (2017), Gandhi medical College, Hyderabad.

1 of 16
Fetal and Neonatal
circulation
- Swetha Rani
Basics to remember
Development of the heart -
between 20-44 days after
fertilization
The Heart starts beating during
the 4th week - Rate of 65
beats/min
Just before birth - 140 beats/min
Adult : The lungs oxygenate venous blood
and the liver handles the products of
digestion from portal vein to pass the
nutritional blood to the heart.
Fetus : The placenta handles both these
functions and so the lungs and liver need
less blood (almost non functional). Lungs
are compressed and filled with fluid here.
Shunts are present anatomically which
bypass instead of direct blood flow through
the liver and lungs. They have Valves.
PATHWAY TO THE UPPER
EXTREMITIES
Placenta → Umbilical vein →
Ductus venosus (shunt bypasses
liver) → Right atrium → Foramen
ovale → Left atrium → Ascending
Aorta
Blood flows to the arteries of
head and forelimbs
OXYGENATION OF THE
BLOOD
Head and forelimbs → Superior
vena cava → Right atrium→ Right
ventricle → Pulmonary artery →
Ductus Arteriosus (Shunt
bypasses lungs) → Descending
aorta → Umbilical arteries →
Placenta
Changes after Birth
Placental connection is lost: The
Umbilical cord is cut and clamped to the baby,
This constricts the umbilical vessels and the
Vascular resistance for the blood to return
from the descending aorta to the right atrium
INCREASES
Systemic Resistance ↑ (x2)
Aortic pressure ↑
Left Atrial and Ventricular pressure ↑
Onset of Breathing: The CNS reacts to the sudden
change in temperature and new environment. This
triggers it to take the first breath, within about 10
seconds after delivery. The Hypoxic baby this
eliminates lung fluid and expands the lungs.
Vasodilation of the compressed blood vessels takes
place and hypoxia is eliminated
Resistance to blood flow through lungs ↓
DECREASES (x5)
Pulmonary arterial pressure ↓
Right atrial and ventricular pressure ↓

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Fetal and Neonatal Circulation - MBBS, Gandhi medical College Hyderabad

  • 2. Basics to remember Development of the heart - between 20-44 days after fertilization The Heart starts beating during the 4th week - Rate of 65 beats/min Just before birth - 140 beats/min
  • 3. Adult : The lungs oxygenate venous blood and the liver handles the products of digestion from portal vein to pass the nutritional blood to the heart. Fetus : The placenta handles both these functions and so the lungs and liver need less blood (almost non functional). Lungs are compressed and filled with fluid here. Shunts are present anatomically which bypass instead of direct blood flow through the liver and lungs. They have Valves.
  • 4. PATHWAY TO THE UPPER EXTREMITIES Placenta → Umbilical vein → Ductus venosus (shunt bypasses liver) → Right atrium → Foramen ovale → Left atrium → Ascending Aorta Blood flows to the arteries of head and forelimbs OXYGENATION OF THE BLOOD Head and forelimbs → Superior vena cava → Right atrium→ Right ventricle → Pulmonary artery → Ductus Arteriosus (Shunt bypasses lungs) → Descending aorta → Umbilical arteries → Placenta
  • 5. Changes after Birth Placental connection is lost: The Umbilical cord is cut and clamped to the baby, This constricts the umbilical vessels and the Vascular resistance for the blood to return from the descending aorta to the right atrium INCREASES Systemic Resistance ↑ (x2) Aortic pressure ↑ Left Atrial and Ventricular pressure ↑
  • 6. Onset of Breathing: The CNS reacts to the sudden change in temperature and new environment. This triggers it to take the first breath, within about 10 seconds after delivery. The Hypoxic baby this eliminates lung fluid and expands the lungs. Vasodilation of the compressed blood vessels takes place and hypoxia is eliminated Resistance to blood flow through lungs ↓ DECREASES (x5) Pulmonary arterial pressure ↓ Right atrial and ventricular pressure ↓
  • 7. Right atrium and ventricle - Low Pressure Left atrium and ventricle - High Pressure Blood travels from Left to Right side of the heart now. The direction of blood flows reverses over Ductus Arteriosus and foramen ovale. Closure of Foramen Ovale : A small valve present on the left side of atrial septum closes over the opening of the foramen to prevent blood flow through it. The valve becomes adherent over the foramen within a few months. Fossa Ovalis -Remnant
  • 8. Patent Foramen Ovale : When permanent closure does not occur. The Left atrial pressure is 2-3 mm of Hg > Right atrial pressure through out life. This keeps the valve closed and prevents mixing of blood. Closure of Ductus Venosus : Most of the blood still flows through Ductus Venosus even after the placental connection is lost immediately after birth, however within 3 Hours the muscle of Ductus Venosus contracts strongly and closes the blood flow through it. Patent Ductus Venosus is rare. The Pressure increases in the portal vein to about 6- 10mm of Hg and forces blood to finally open into the liver sinuses.
  • 9. Closure of Ductus Arteriosus : Aortic pressure ↑ Pulmonary arterial pressure↓ Backflow of blood from aorta to pulmonary artery The muscle wall constricts within 8 days after birth due to the loss of PGE2 Prostaglandin E2 - Vasodilator Increased oxygenation through ductus is also a factor for closure Po2 increases from 20mmHg immediately after birth to 100 mmHg within a few hours Patent Ductus Arteriosus : Failure to flow hrough systemic circulation (bypasses)
  • 10. Recirculation Through the lungs Pulmonary Congestion and Pulmonary Edema Patent Ductus Arteriosus/ Left to right shunt Atrium Ventricle Early death due to heart disease between 20 to 40 years
  • 11. Machinery Murmur : Abnormal Heart sound Not found when Immediately born Age 1-3 years : Harsh Blowing Continous Murmur Aortic pressure High - Systole - Intense murmur Aortic pressure Low - Diastole - Less intense
  • 12. Congenital Heart defects These cause abnormal circulatory effects. The 3 Major congenital anomalies 1. Stenosis of a major blood vessel 2. Left to right Shunt (Patent Ductus Arteriosus) 3. Right to Left Shunt (Tetrology of Fallot)
  • 13. Tetrology of Fallot /Right to left Shunt Most Common cause of Blue baby syndrome • Ventricular Septal Hole/Defect • Pulmonary Artery stenosis • Overriding Aorta • Right Ventricle Hypertrophy Four main abnormalities * VPOR*
  • 14. Diagnosis of a Blue baby Boot shaped Heart Abnormal Angiogram
  • 15. Is this the future?!
  • 16. Thank you! Not all Superheroes wear Capes Moms!