Fetal Physiology By Abdul Qahar
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Transcript of Fetal Physiology By Abdul Qahar
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Fetal CirculationNutrients for growth and development are delivered from the umbilical vein in the umbilical cord → placenta → fetal heart
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Oxygenated blood from mother
↓ (via umbilical vein) Liver
Portal sinus Ductus venosus↓
Inferior vena cava (mixes with deoxygenated blood)
↓Right atrium
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Right atrium ↓ (through Foramen
ovale)Left atrium
↓Left ventricle
↓ (through Aorta)Heart and Brain
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Deoxygenated blood
from lower half of fetal body ↓Inferior vena cava
Right atrium ↓
Right ventricle
Deoxygenated blood flowing through
Superior vena cava
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Right ventricle
↓Pulmonary artery
↓ (through Ductus arteriosus)
Descending aorta↓
Hypogastric arteries ↓
Umbilical arteries↓
Placenta
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1st 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.
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3 shunts: - Ductus venosus- Foramen ovale - Ductus arteriosus
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2nd difference:Ventricles of the fetal heart work in
parallel compared to the adult heart which works in sequence.
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Fetal cardiac output per unit weight is 3 times higher than that of an adult at rest.
This compensated for low O2 content of fetal blood.
Is accomplished by ↑ heart rate and ↓ peripheral resistance
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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
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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
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Maintenance of ductus arteriosus depends on: - difference in blood pressure bet. Pulmonary artery and aorta- difference in O2 tension of blood passing through ductus. ↑ p O2 = stops flow. Mediated through prostaglandins.
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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)
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Hematopoiesis
Erythrocytes progress from nulceated to non-nucleated
Blood vol. and Hgb concentration increase progressively
Midpregnancy: Hgb 15 gms/dlTerm: 18 gms/dl
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Hematopoiesis
Fetal erythrocytes: 2/3 that of adult’s (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)
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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
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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 A2
Present in mature fetus in small amounts that increase after birth
2 alpha chains,
2 delta chains
Fetal Hemoglobin
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Fetal Hemoglobin
Fetal erythrocytes that contain mostly Hgb F bind more O2 than Hgb A erythrocytes
Hgb A binds more 2-3 BPG more tightly than Hgb F (this lowers affinity of Hgb for O2)
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Increased O2 affinity of fetal erythrocytes results from lower concentartion of 2-3 BPG in the fetus
Affinity of fetal blood for O2 decreases at higher temp. (maternal hyperthermia)
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Sufficient development of synaptic functions are signified by flexion of fetal neck & trunk
If fetus is removed from the uterus during the 10th wk, spontaneous movements may be
observed although movements in utero aren’t felt by the mother until 18-20 wks
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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
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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
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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.
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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)
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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
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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
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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.
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Insulin levels: ↑ in newborns of diabetic mothers and LGAs (large for gestational age); ↓in infants who are SGA (small for gestational age)
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