Fetal Circulation

Burhan Iskandar
Pediatric Cardiology Division
Pediatric Department,Medical Faculty
Hasanuddin University Makassar

SIRKULASI JANIN
Tanda-tanda :

Sirkulasi sistemik dan sirkulasi paru paralel

Tekanan ventrikel kanan = ventrikel kiri

Foramen ovale dan ductus Botalli, ductus venosus

terbuka

Atrium kanan lebar, sirkulasi didalammnya menyilang

Jantung, kepala & anggota gerak atas disuplai darah

kaya oksigen

Sirkulasi paru minim sekali (paru-paru belum berfungsi)

Plasenta : pertukaran gas (respirasi), nutrisi, ekskresi

2

SIRKULASI JANIN / BAYI

Bayi lahir : - Paru berfungsi

- Sirkulasi plasenta berhenti

Sirkulasi sistemik dan sirkulasi paru seri

Tekanan ventrikel kiri > ventrikel kanan

Fungsi vaskularisasi paru mulai berlangsung tahanan

sirkulasi paru-paru berkurang

Kadar oksigen meninggi suplai oksigen pd seluruh tubuh

Tidak ada sirkulasi silang di atrium kanan

Foramen ovale, ductus Botalli & ductus Venosus menutup

3

Fetal circulation
Fetal circulation

Infant and children

Gases exchange

Placenta

Lung

In fetal circulation, there 4 shunts :

Placenta
Ductus venosus
Foramen ovale
Ductus arteriosus

Fetal cardiac output

Cardiac output in adult, if heart rate

decreased stroke volume
In fetal cardiac output, if heart rate
decreased stroke volume is unable
to increase so is easy develop fetal
distress

Changes in circulation after birth

Removal placenta

SVR

Ductus venosus closure

Lung expansion
PVR

Foramen ovale closure

PDA closure

SO2

LA pressure
PBF

Venous return to LA

RA pressure

Closure of the ductus

Fungsional closure
Anatomic closure

10-15 h
2-3 wk

Oxygen, Protaglandin E2, Maturity

Bradykinin
Acethylchloline

Oxygen ~ the ductus

SO2 systemic circulation is the
strongest stimulus for ductal closure
Premature infant less responsiveness
to oxygen than full-term infant
Decreased responsiveness of
immature ductus may also due to
persistently high level of PGE2

PGE2 ~ the ductus

PGE2 level aft birth ductal constriction
Removal of the placenta
Removal PGE2 from circulating due to PBF

Constricting effect of Indomethacine and

dilator effect of PGE2 are greater in
immatur fetus than term fetus

Prolonged patency of PDA

Synthetic
1/ iv
Synthetic PGE
PGE1/iv

Closed sinificant PDA

Indomethacine

Premature Newborn
The ductus arteriosus is more likely to remain
open after birth due to :
Ductal smooth muscle doesnt have fully
developed contrictor response to oxygen
Persistent high level of PGE2
PVR more rapid fall in premature infant and
this is lead to early L R shunt and CHF

Premature Newborn
The ductus arteriosus is more likely to remain
open after birth due to :
Ductal smooth muscle doesnt have fully
developed contrictor response to oxygen
Persistent high level of PGE2
PVR more rapid fall in premature infant

Respone PA and DA to
various stimuli
Hypoxia and acidosis
Symphatetic stimulation

DA DA

relaxes

constricts

PA

Oxygen

DA

constricts

relaxes

PA

Vagal stimulation
-adrenergic block
Bradykinin

Dilated PA