The transition from fetal to neonatal circulation is a complex process that has important clinical consequences if it does not occur correctly. Understanding the anatomy of fetal circulation and how this anatomy changes during the transitional period is important for understanding many neonatal and pediatric diagnoses.
In the fetal circulation, the right and left ventricles work in a parallel circuit. The ductus venosus, foramen ovale, and ductus arteriosus are three cardiovascular structures that are important for maintaining this circulation. The umbilical vein carries relatively well-oxygenated blood from the placenta to the IVC through the ductus venosus, where it partially mixes with poorly oxygenated IVC blood from the lower part of the fetal body. When it reaches the right atrium, oxygenated blood is preferentially shunted across the foramen ovale and then enters the left atrium, where it mixes with blood from the pulmonary veins before entering the left ventricle. From the LV, the ascending aorta sends fully oxygenated blood to the coronary arteries, the head, and the upper extremities. Only a small portion of the LV cardiac output streams through the aortic arch and supplies flow to the thoracic aorta.
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Blood from the superior vena cava, which is considerably less oxygenated, enters the RA where it is pumped across the tricuspid valve into the right ventricle, which is the predominant ventricle in the fetus.
Only about 10% of RV output enters the pulmonary arteries because the fetal lungs are still not expanded and ventilated, which causes pulmonary vascular resistance to be very high. Most RV output flows through the ductus arteriosus, bypassing the lungs, and into the descending aorta and the inferior part of the fetal body, after which it returns to the placenta via the two umbilical arteries. The placenta is a low-resistance vascular bed where oxygenation and metabolite exchange occur. The now oxygenated blood then re-enters the umbilical
vein. With the neonate’s first breath, changes in the cardiopulmonary system occur. As air begins to replace fluid in the lungs, there is a fall in pulmonary vascular resistance. As this occurs, there is a corresponding increase in systemic vascular resistance due to loss of the low-resistance placenta. These two changes result in a redistribution of blood flow to the pulmonary vascular bed. The consequent increase in pulmonary venous return results in the left atrial pressure being slightly higher than the right atrial pressure, which closes the foramen ovale, leaving behind the fossa ovale. This changed pattern results in decreased flow across the ductus arteriosus and the higher blood oxygen content stimulates the constriction and ultimately closure of the ductus arteriosus, leaving behind the ligamentum arteriosum. The umbilical vein and the ductus venosus close off within two to five days after birth, leaving behind the ligamentum teres and the ligamentum venosus of the liver. These cardiovascular system changes result in a transition from fetal to adult circulation pattern. Two common disease states that occur due to failure of the transition process are Primary Persistant Pulmonary Hypertension and Patent Ductus Arteriosus. Persistent pulmonary hypertension of the newborn (PPHN) is characterized by persistence of pulmonary hypertension which causes varying degrees of cyanosis depending on the amount of right-to-left shunting through the PDA or patent foramen ovale. In this situation, pulmonary vascular resistance exceeds the systemic vascular resistance, which can lead to reduced pulmonary perfusion and systemic hypoxemia. Initial treatment includes an immediate attempt to reverse hypoxemia, improving pulmonary and systemic perfusion. Respiratory support, correction of any metabolic disorder and hemodynamic support is also provided. The ductus arteriosus should close within 10 to 15 hours after birth. When this does not occur, it can lead to left ventricular volume overload, which in time may lead to a progressive rise in pulmonary artery pressures, which, in the uncorrected patient, may lead to irreversible pulmonary vascular changes. As pulmonary vascular resistance increases, flow reverses to a right-to-left shunt and, over time, these patients develop cyanotic heart disease (ie, Eisenmenger syndrome). When a clinically significant PDA is discovered, medical management through administration of indomethacin is initially attempted, which surgical ligation attempted later in life if this is unsuccessful.
Introduction: The purpose of this lab is to have a better understanding of the internal and external anatomy. The reasons for performing this lab is that pigs are similar to humans because they have skin, omnivores and as fetus they receive nutrients from an umbilical cord connected to the mother. As well as the similarities to human organ systems. The hypothesis of this lab is if the fetal pig has a similar organ system of a human and assuming those organs will be in the same locations as in a human then the organ systems should operate in the same fashion. Based on what I’ve learned from this lab and what I’ve learned during lecture I predict that the fetal pigs nervous and circulatory system would operate and look the same way as in a human.
Instead of focusing on what others were or were not doing, I decided to start focusing on me and goals I wanted to accomplish. One day, I was on the computer surfing the net and happened to get on social media. I happened to come by a post about The Birth Well doula training. A doula is a professional birth support person who assist women emotionally, physically, and with information during pregnancy, birth, and for a short while during postpartum. This sounded like a perfect opportunity to exercise my getting out and broadening my circle and meeting new people all the while fulfilling my birth worker goals from long ago. I decided to look into it, so on the day of the Q & A meeting I attended. I learned about the process, and I signed up for the classes. I was both super excited, and also super nervous at the same time because my family and I were experiencing financial hardships at the time, and I was about to be taking $400 dollars of our funds and investing into a career that was all up to me on whether or not it flourished.
Pam Jenkins is a 36 year-old woman that is 30 weeks into her third pregnancy. Since her pregnancy began, Pam has gained 20 pounds. Although Pam has reduced the amount that she smokes, she continues to smoke 5 cigarettes per day, which may cause some issues with her worry of another preterm birth. Another factor that could also cause complications is her delayed prenatal vitamin use. After logging her dietary intake within a 24 hour period into SuperTracker, I will be making recommendations on how she can alter her diet and lifestyle to ensure that Pam receives the nutrients she needs for herself and for her baby.
In most hospital delivery rooms, the doctors will routinely clamp and sever the umbilical cord with in fifteen to thirty seconds of the mother giving birth. When clamping the cord, the doctors will clamp the cord in two places, one close to the infant and then again in the middle of the cord another clamp. By delaying the clamping, fetal blood in the placental transfusion can provide the infant with an additional thirty percent more blood volume and up to sixty percent more blood cells (McDonald, S., & Middleton, P., 2009). This reduces the risk of the hemorrhaging that could occur after birth. But with new ongoing studies, it is said that by delaying the clamping of the cor...
According to Batshaw, Roizen, and Lotrecchiano (2013), patent ductus arteriosus (PDA) is “the persistence of a fetal passage permitting blood to bypass the lungs” (p. 745). This is an inherited heart condition in which the ductus, a small pathway between the pulmonary and the aortic, valves remain open. This cardiovascular problem usually occurs in low birth weight infants. The blood vessels usually naturally closes after birth (Batshaw et al., 2013, p. 96). It becomes atypical if it remains open after the neonatal period. The structure usually closes in typical developing newborns around the initial 24 hours, and anatomical closure is supposed to follow several weeks later (Stanford Children’s Health, 2015). At the point when the ductus arteriosus stays open, the blood from the oxygen-rich aorta blends with the oxygen-poor pulmonary artery causing the higher chance of blood pressure in the lung pathways (U. S. Department of Health and Human Services, 2011). Certain children who have patent ductus arteriosus may be given medication, relying upon the circumstance to standardize the blood and oxygen levels until surgery is performed. Doctor can treat this condition by providing pharmaceutical medicine, catheter-based procedures, and surgery (U. S. Department of Health and Human Services, 2011).
Association of Placenta Preparation Arts board member Nikole Keller says, “the placenta is often referred to as a filter; this isn’t an ideal term for the placenta considering its function in the body… A more suitable way of looking at it would be as a gate keeper between the mother and the fetus. The placenta’s job is to keep the maternal and fetal blood separate, at the same time allowing nutrients to pass to the fetus, gas exchange to occur, and allowing waste from the fetus to pass through the mother, . The placenta does prevent some toxins from passing through to the fetus but they are not stored in the placenta. Toxins in the body and waste from the fetus are processed by the mother’s liver and kidneys for elimination”
The history in a family can influence many generations. Certain families have stereotypes about them based on family history. This is a real world situation; the movie The Pregnancy Project, stereotypes about teen pregnancy where shown, and how they affect people. In the Pregnancy Project, the use of Gabi’s background influenced people’s reactions because her family has a history of teen pregnancy.
The typical defect that takes place with a human affected is heart problems. In early infancy surgery needs to be taken place to avoid serious issues in the future. Atypica...
The pattern of blood flow starts in the left atrium to right atrium, then into the left ventricle and right ventricle. During its course, blood flows through the mitral and tricuspid valves. Simultaneously, the right atrium is granted blood from the veins through the superior and inferior vena cava. The job of the superior vena cava is to transport de-oxygenated blood to the right atrium. When your heart beats, the first beat represents the AV valves closing to prevent the backflow of blood into the atrium.
Technology has had a very prominent influence on electronic fetal monitoring since its appearance in the 1960’s and 1970’s. For many years, fetal monitoring was simply done by listening to a fetal heartbeat through a stethoscope. Dramatic changes in the heartbeat, such as a long period or a drop in the rate or intensity, could be detected,. Now, not only is the electronic fetal monitor used on the outside of the womb by strapping electrodes to the mother’s abdomen but electrodes can also be inserted during the first stage of labor and placed directly on the baby’s head. With advanced technologies such as this the acidity of the infant’s blood as well as the heart rate can be measured.
Serving as the first stage of life, the prenatal and natal phase is the most critical period in relation to ensuring a healthy, lifelong development in a child. During pregnancy, the placenta works to transfer oxygen and nutrients from
"Fetal Development: MedlinePlus Medical Encyclopedia." National Library of Medicine - National Institutes of Health. Web. 06 Mar. 2011. .
The process of human development is very complex. It is a continual process, providing gradual development for the fetus. Some of the most important factors to fetal development such as blood flow, heart beats, muscle development, and brain activity can all be determined within the first seven weeks of pregnancy (Baby Developme...
The pregnant trauma patient presents a unique challenge because care must be provided for two patients, the mother and the fetus. It is vital that the nurse know and understand the anatomical and physiological changes that occur during pregnancy. She must be aware of these changes, and how they can mask or mimic injury, and very importantly that fetal distress or loss can occur even when the mother has incurred no abdominal injuries.
An obstetrician is one thing, and a gynecologist is another. The job is combined together, but the two branches can be worked separately. An obstetrician is a physician who focuses and is trained in the management of pregnancy, labor, and pueperium (the period following childbirth). A physician who has specialized and trained in the health of the female reproductive system is a gynecologist. The reason the jobs are combined is because they’re both all about women. Obstetricians and Gynecologists are physicians who provide general medical care to women. They equip medical care associated with pregnancy or childbirth, and they diagnose, treat, and help prevent diseases, especially those affecting the female