FETAL PHYSIOLOGICAL

DEVELOPMENT
CARDIOVASCULAR SYSTEM
Fetal Circulation
Nutrients for growth and development are
delivered from the umbilical vein in the
umbilical cord placenta fetal heart




Fetal Circulation
Oxygenated blood from mother
(via umbilical vein)
Liver

Portal sinus Ductus venosus

Inferior vena cava (mixes with
deoxygenated blood)

Right atrium
Right atrium
(through Foramen ovale)
Left atrium

Left ventricle
(through Aorta)
Heart and Brain
Deoxygenated blood
from lower half of
fetal body

Inferior vena cava

Right atrium

Right ventricle
Deoxygenated blood
flowing through
Superior vena cava
Right ventricle

Pulmonary artery
(through Ductus arteriosus)
Descending aorta

Hypogastric arteries

Umbilical arteries

Placenta
Fetal
Circulation
Source: http://images.google.com.ph
Differences in Fetal and Adult
Circulation
1
st
difference:
Presence of shunts which allow oxygenated
blood to bypass the right ventricle and
pulmonary circulation, flow directly to the left
ventricle, and for the aorta to supply the
heart and brain
3 shunts:
- Ductus venosus
- Foramen ovale
- Ductus arteriosus
Differences in Fetal and Adult
Circulation
2
nd
difference:
Ventricles of the fetal heart work in parallel
compared to the adult heart which works
in sequence.
Differences in Fetal and Adult
Circulation
Fetal cardiac output per unit weight is 3
times higher than that of an adult at rest.
This compensated for low O
2
content of
fetal blood.
Is accomplished by heart rate and
peripheral resistance
Changes After Birth
Clamped cord + fetal lung expansion =
constricting and collapsing of umbilical
vessels, ductus arteriosus, foramen ovale,
ductus venosus
Fetal circulation changes to that of an
adult
Changes After Birth: Closing of Shunts
Shunt Functional
closure
Anatomical
closure
Remnant
Ductus
arteriosus
10 96 hrs after
birth
2 3 wks after
birth
Ligamentum
arteriosum
Formamen
ovale
Within several
mins after birth
One year after
birth
Fossa ovalis
Ductus
venosus
Within several
mins after birth

3 7 days
after birth
Ligamentum
venosum
Umbilical arteries Umbilical ligaments
Umbilical vein Ligamentum teres
Changes After Birth
Maintenance of ductus arteriosus depends
on:
- difference in blood pressure bet.
Pulmonary artery and aorta
- difference in O
2
tension of blood passing
through ductus. p O
2
= stops flow.
Mediated through prostaglandins.

Fetal Blood
Hematopoiesis
First seen in the yolk sac during embryonic
period (mesoblastic period)
Liver takes over up to bear term (hepatic
period)
Bone marrow: starts hematopoietic
function at around 4 months fetal age;
major site of blood formation in adults
(myeloid period)
Fetal Blood
Hematopoiesis
Erythrocytes progress from nulceated to
non-nucleated
Blood vol. and Hgb concentration increase
progressively
Midpregnancy: Hgb 15 gms/dl
Term: 18 gms/dl
Fetal Blood
Hematopoiesis
Fetal erythrocytes: 2/3 that of adults (due to
large volume and more easily deformable)
During states of fetal anemia: fetal liver
synthesizes erythropoietin and excretes it
into the amniotic fluid. (for erythropoiesis in
utero)
Fetal Blood
Fetal Blood Volume
Average volume of 80 ml/kg body wt. right
after cord clamping in normal term infants
Placenta contains 45 ml/kg body weight
Fetoplacental blood volume at term is
approx. 125 ml/kg of fetus
Fetal Blood
Type Description Chains
Hemoglobin F Fetal Hgb or alkaline-
resistant Hgb
2 alpha chains,
2 gamma chains

Hemoglobin A Adult Hgb. Formed starting
at 32-34 wks gestation and
results from methylation of
gamma globin chains
2 alpha chains,
2 beta chains
Hemoglobin
A
2
Present in mature fetus in
small amounts that
increase after birth
2 alpha chains,
2 delta chains
Fetal Hemoglobin
Fetal Blood
Fetal Hemoglobin
Fetal erythrocytes that contain mostly Hgb F
bind more O
2
than Hgb A erythrocytes
Hgb A binds more 2-3 BPG more tightly than
Hgb F (this lowers affinity of Hgb for O
2
)
Increased O
2
affinity of fetal erythrocytes
results from lower concentartion of 2-3 BPG
in the fetus
Affinity of fetal blood for O
2
decreases at
higher temp. (maternal hyperthermia)
Oxygen dissociation curve of fetal and maternal blood
Source: http://www.colorado.edu/intphys/Class/IPHY3430-200/image/18-12.jpg
Fetal Blood
Fetal Coagulation Factors
Contains lowers levels of coagulation factors II, VI,
IX, X, XI, XII, XIII and fibrinogen (vit. K dependent
factors)
Routine prophylaxis of vit. K injections to prevent
hemorrhagic disease of the newborn
Platelet count is normal
Thrombin time prolonged
Factor XIII (fibrin stabilizing factor) & plasminogen
lower than adult
Low level of factor VIII hemophilia in male infants


Fetal Blood
Fetal Plasma Proteins and Blood Viscosity
Mean total plasma protein, Plasma
albumin concentration, and Blood
viscosity: similar in maternal & fetal blood
Increased viscosity in fetal blood: due to
higher Hct. Is offset by lower levels of
fibrinogen and IgM, and by more
deformable erythrocytes
Fetal Blood
Immunocompetence of Fetus
IgG from mother begins at around 16 wks and is
most pronounce during last 4 wks or pregnancy
Newborns produce IgG and adult values are reached
at 3 years old
IgM produced by fetus in response to congenital
infections (Rubella, CMV, Toxoplasmosis)
Adult levels of IgM attained by 9 mos old
Fetal Blood
B lymphocytes appear in liver by 9 wks
gestation, and seen in the blood and spleen
by 12 wks gestation
T lymphocytes produced by thymus at 14
wks
Monocytes of newborns able to process and
present antigen when tested w/ maternal
antigen-specific T-cells
Fetal Blood
Ontogeny of the Immune Response
Hemolytic disease of the newborn: maternal
antibodies to fetal erythrocyte antigen cross
the placenta to destroy fetal erythrocytes
Fetus is immunologically competent at 13
wks AOG
Synthesis of complement in late 1
st
trimester.
At term, complement levels are of adults
Fetal Blood
Ontogeny of the Immune Response
Newborn responds poorly to immunization
(due to deficient response of newborn B cells
or lack of T cells)
Only IgA from colostrum may protect against
enteric infections
IgM predominantly produced in response to
antigenic stimulation. Identification may help
diagnose intrauterine infections

NERVOUS SYSTEM and
SENSORY ORGANS
Sufficient development of synaptic
functions are signified by flexion of fetal
neck & trunk
If fetus is removed from the uterus during
the 10
th
wk, spontaneous movements may
be observed although movements in utero
arent felt by the mother until 18-20 wks
NERVOUS SYSTEM and SENSORY ORGANS
Gestational
age
Fetal development
10 wks Squinting, opening of mouth, incomplete finger
closure, plantar flexion of toes, swallowing and
respiration
12 wks Taste buds evident histologically
16 wks Complete finger closure
24 26
wks
Ability to suck, hears some sounds
28 wks Eyes sensitive to light, responsive to variations
in taste of ingested substances
DIGESTIVE SYSTEM
11 wks gestation peristalsis in small
intestine, transporting glucose actively
16 wks gestation able to swallow
amniotic fluid, absorb much water from it,
and propel unabsorbed matter to lowe
colon
Hydrochloric acid & other digestive
enzymes present in very small amounts
DIGESTIVE SYSTEM
Term fetuses can swallow 450 ml amniotic fluid in 24
hours
This regulates amniotic fluid volume:
- inhibition of swallowing (esophageal atresia) =
Polyhydramnios
Amniotic fluid contributes little to caloric requirements
of fetus, but contributes essential nutrients: 0.8 gms
of soluble protein is ingested daily by the fetus from
amniotic fluids. Half is alubumin.
DIGESTIVE SYSTEM
Meconium passed after birth
Dark greenish black color of meconium caused
by bile pigments (esp. biliverdin)
Meconium passage during labor due to hypoxia
(stimulates smooth muscle of colon to contract)
Small bowel obstruction may lead to vomiting in
utero
Fetuses with congenital chloride diarrhea may
have diarrhea in utero. Vomiting and diarrhea in
utero may lead to polyhydramnios and preterm
delivery
DIGESTIVE SYSTEM
Liver and Pancreas
Fetal liver enzymes reduced in amount compared
to adult
Fetal liver has limited capacity to convert free
bilirubin to conjugated bilirubin
Fetus produces more bilirubin due to shorter life
span of fetal erythrocytes. Small fraction is
conjugated and excreted and oxidized to biliverdin
Much bilirubin is transferred to the placenta and to
the maternal liver for conjugation and excretion


DIGESTIVE SYSTEM
Fetal pancreas responds to hyperglycemia
by insulin
Insulin containing granules identified in
fetal pancreas at 9-10 wks. Insulin in fetal
plasma detectable at 12 wks.
Insulin levels: in newborns of diabetic
mothers and LGAs (large for gestational
age); in infants who are SGA (small for
gestational age)