Fetal Circulation

The blood that flows through the fetus is actually more complicated than after the baby is
born (normal heart). This is because the mother (the placenta) is doing the work that the
babys lungs will do after birth.

The placenta accepts the bluest blood (blood without oxygen) from the fetus through blood
vessels that leave the fetus through the umbilical cord (umbilical arteries, there are two of
them). When blood goes through the placenta it picks up oxygen and becomes red. The red
blood then returns to the fetus via the third vessel in the umbilical cord (umbilical vein). The
red blood that enters the fetus passes through the fetal liver and enters the right side of the
heart.

The red blood goes through one of the two extra connections in the fetal heart that will close
after the baby is born.

The hole between the top two heart chambers (right and left atrium) is called a patent
foramen ovale (PFO). This hole allows the reddest blood to go from the right atrium to left
atrium and then to the left ventricle and out the aorta. As a result the blood with the most
oxygen gets to the brain.

Blood coming back from the fetuss body also enters the right atrium, but the fetus is able to
send this blue blood from the right atrium to the right ventricle (the chamber that normally
pumps blood to the lungs). Most of the blood that leaves the right ventricle in the fetus
bypasses the lungs through the second of the two extra fetal connections known as the ductus
arteriosus.

The ductus arteriosus sends the bluer blood to the organs in the lower half of the fetal body.
This also allows for the bluest blood to leave the fetus through the umbilical arteries and get
back to the placenta to pick up oxygen.

Since the patent foramen ovale and ductus arteriosus are normal findings in the fetus, it is
impossible to predict whether or not these connections will close normally after birth in a
normal fetal heart. These two bypass pathways in the fetal circulation make it possible for
most fetuses to survive pregnancy even when there are complex heart problems and not be
affected until after birth when these pathways begin to close.
Inside the fetal heart:
Blood enters the right atrium, the chamber on the upper right side of the heart.
When the blood enters the right atrium, most of it flows through the foramen ovale
into the left atrium.

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 heart muscle itself in addition to the
brain. After circulating there, the blood returns to the right atrium of the heart
through the superior vena cava.

About two thirds of the blood will pass through the foramen ovale as described
above, but the remaining one third will pass into the right ventricle, toward the
lungs.
 In the fetus, the placenta does the work of breathing instead of the lungs. As a
result, only a small amount of the blood continues on to the lungs. Most of this
blood is bypassed or shunted away from the lungs through the ductus arteriosus to
the aorta. Most of the circulation to the lower body is supplied by blood passing
through the ductus arteriosus.

This blood then enters the umbilical arteries and flows into the placenta. Carbon
dioxide and waste products are released into the mother's circulatory system, and
oxygen and nutrients from the mother's blood are released into the fetus' blood.

At birth, the umbilical cord is clamped and the baby no longer receives oxygen
and nutrients from the mother. With the first breaths of life, the lungs begin to
expand, the ductus arteriosis and the foramen ovale both close.