Fetal Circulation
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Study Tools For Fetal Circulation
Umbilical Cord Vasculature (Mnemonic)
Fetal Circulation (Cheatsheet)
Patent Ductus Arteriosus (Image)
Fetal Circulation (Image)
Fetal Circulation (Picmonic)
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Outline
Overview
- Closed circulatory system
- Blood flow from mother goes to the placenta and nutrients are absorbed and oxygen diffused through fetal circulation via the umbilical cord to the fetus
Nursing Points
General
- Blood is carried to and from the placenta via the umbilical cord
- While it appears as 1 big vessel, there are 2 arteries and 1 vein within the umbilical cord
- AVA= 2 arteries, 1 vein
- While it appears as 1 big vessel, there are 2 arteries and 1 vein within the umbilical cord
- Oxygen and nutrient exchange occurs in the placenta
- Lungs and liver not fully functional; bypasses necessary to ensure adequate oxygenation
- Gas exchange does not occur via alveoli like normal in fetal lungs, they are filled with fluid.
- Because of this, there is high pressure and therefore high resistance in lungs, which plays a role in these bypasses.
Assessment
Bypasses:
- Ductus arteriosus
- Connects pulmonary artery and aorta, bypasses lungs
- Blood moves from right ventricle to pulmonary artery then through ductus to aorta to bypass the lungs
- Foramen ovale
- Connects left and right atrium in the heart, bypasses lungs
- Blood shunts R → L
- Ductus venosus
- Shunts blood from the umbilical vein into the inferior vena cava → bypasses liver
- Critical for quickly shunting oxygenated blood to the fetal brain
Therapeutic Management
- Ensure umbilical veins have good blood flow by ultrasound visualization
- These bypasses and adaptations should close on their own after birth
- If they do not, the newborn could have difficulties with perfusion and oxygenation
- Refer to Congenital Heart Defects lesson
- Murmurs
- Newborn may require support
- Refer to Congenital Heart Defects lesson
Nursing Concepts
- Reproduction
- Perfusion
- Human Development
Patient Education
- Heart murmurs can be normal for the first 24 hours post delivery due to ducts closing
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Fetal Circulation
Transcript
In this lesson I will explain how fetal circulation works in utero and how this transition occurs once the baby is born.
So let’s understand some of the big picture before we break it down. It is a closed circulatory system. So this means the maternal blood doesn’t mix with the fetal blood. So how does this happen? The nutrients from the maternal blood supply at the uterus is absorbed. So the oxygen and nutrients will now diffuse through fetal circulation by the umbilical cord to the fetus. Ok so now this umbilical cord. Remember AVA. There are two arteries and one vein. Now if you ask me it seems a little backwards on their role so let’s look at that. The two small arteries are taking waste and deoxygenated blood away from the fetus and the veins are taking oxygen rich blood to the fetus. With fetal circulation there are little bypasses throughout because the fetus doesn’t need blood to go places like the lungs and liver. So the bypasses move the blood around and get oxygenated blood where it needs to go quickly. And the last big picture point is that gas exchange does not occur by the alveoli because they are filled with fluid. They don’t need to breathe to exchange oxygen and the fluid that is there creates a high pressure and therefore high resistance in lungs, which plays a role in these bypasses that we will discuss.
Ok so now onto these bypasses. The first is the ductus arteriosus. This one connects the pulmonary artery and aorta. Blood will move from the right ventricle to the pulmonary artery then through ductus to aorta and this will bypass the fetal lungs. In this image you can see here is the ductus and blood is moved from the pulmonary artery to the aorta to bypass the lungs.
The foramen ovale will connect the left and right atrium. So blood is shunted from the right to the left and this will also bypass the lungs. In this image you can see the foramen ovale is here so blood is shunted from the right atrium to left and bypass the pulmonary artery and lungs.
Our final bypass is the ductus venosus. Here blood is shunted from the umbilical vein up into the inferior vena cava so this will bypass the liver. Bypassing the liver is critical to get oxygenated blood to the fetal brain quickly. So in this image you see blood is coming through the umbilical vein to the inferior vena cava, which will bypass the liver taking oxygenated blood to the heart and quickly through the body.
For management of this patient we want to assess on ultrasound that proper circulation is occurring and that there is good blood flow through the umbilical veins. After birth we want to ensure that these bypasses and adaptations have closed on their own after birth. Usually by 24 hours they have. If they do not then the newborn could have difficulties with perfusion and oxygenation. Murmurs are normal so reassuring families that if a murmur is heard in the first 24 hours it is usually because these pathways are closing. For more information on when these pathways do not close refer to the Congenital Heart Defects lesson. Murmurs will really be the only education is on murmurs after delivery if they are present. Fetal circulation is a difficult topic for a nonmedical parent to understand so they do not need to be educated on so many details.
Our nursing concepts are reproduction, perfusion because it is cardiac and human development because all of this is part of development.
Ok so I don’t know about you but I think the heart is fascinating but also confusing and especially in fetal circulation so let’s review. The umbilical cord has 2 arteries and 1 vein. Remember AVA. The arteries carry the deoxygenated, nutrient depleted blood from the fetus to the mother for waste removal. The 1 vein brings the oxygenated nutrient rich blood to the fetus. For the ductus arteriosus blood moves from right ventricle to pulmonary artery then through ductus to aorta to bypass the lungs. With the foramen ovale the blood is shunted right to left between the atriums and bypasses the lungs. With the ductus venosus there is shunting from the umbilical vein into the inferior vena cava and this bypasses liver. And last the lungs. It is important to remember that they do not do the gas exchange. This is done at the placenta.
Make sure you check out the resources attached to this lesson and review all these pathways. Sometimes drawing it out with arrows pointing to the direction of the blood flow can help commit it to memory. Now, go out and be your best selves today. And, as always, happy nursing.
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Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
12 Points to Answering Pharmacology Questions
ABGs Nursing Normal Lab Values
Care of the Pediatric Patient
Glaucoma
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Alcoholism – Outcomes Nursing Mnemonic (BAD)
Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)
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Alzheimer – Diagnosis Nursing Mnemonic (The 5 A’s)
Nursing Care and Pathophysiology for Anemia
Anion Gap Acidosis 1 Nursing Mnemonic (KULT)
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Anorexia – Signs and Symptoms Nursing Mnemonic (ANOREXIA)
Anticholinergics – Side Effects Nursing Mnemonic (4 Can’ts)
Aortic Aneurysm – Management Nursing Mnemonic (CRAM)
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Aortic Stenosis Symptoms Nursing Mnemonic (SAD)
Appendicitis – Assessment Nursing Mnemonic (PAINS)
ARDS causes Nursing Mnemonic (GUT PASS)
Arterial Blood Gases Nursing Mnemonic (ROME)
Assessment for Myasthenic Crisis Nursing Mnemonic (BRISH)
Assessment of a Burn Nursing Mnemonic (SCALD)
Assessment of Guillain-Barre Syndrome Nursing Mnemonic (GBS=PAID)
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At Risk for Gout Nursing Mnemonic (MALE)
AVPU Mnemonic (The AVPU Scale)
Bacterial Endocarditis – Symptoms Nursing Mnemonic (Be Joan Of Arc)
Benzodiazepines Nursing Mnemonic (Donuts and TLC)
Beta 1 and Beta 2 Nursing Mnemonic (1 Heart, 2 Lungs)
Bleeding Complications (Minor) Nursing Mnemonic (BEEP)
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Blood Type O Nursing Mnemonic (Universally Odd)
BPH Symptoms Nursing Mnemonic (FUN WISE)
Bulimia – Signs and Symptoms 1 Nursing Mnemonic (BULIMIA)
Bulimia – Signs and Symptoms 2 Nursing Mnemonic (WASHED)
Cancer – Early Warning Signs Nursing Mnemonic (CAUTION UP)
Cancer – Nursing Priorities Nursing Mnemonic (CANCER)
Canes Nursing Mnemonic (COAL)
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Caring Licensed Practical Nurse Nursing Mnemonic (CLPN)
Causes of Anaphylaxis Nursing Mnemonic (Many Boys Love Food)
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Dyspnea Nursing Mnemonic (The 6 P’s)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
Causes of Poor Gas Exchange Nursing Mnemonic (All People Can Value Lungs)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Causes of Renal Calculi Nursing Mnemonic (Patients Complain of Pain and Difficulty Urinating)
Chest Tube Assessment Nursing Mnemonic (Two AA’s)
CHF Treatment Nursing Mnemonic (UNLOAD FAST)
Child Abuse/Neglect – Warning Signs Nursing Mnemonic (CHILD ABUSE)
CHO, CHO, CHON Nursing Mnemonic (CHO, CHO, CHON)
Cholinergic Crisis – Signs and Symptoms Nursing Mnemonic (SLUDGE)
Circulatory Checks (5 P’s) Nursing Mnemonic (The 5 P’s)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Cleft Lip Repair – Post Op Care Nursing Mnemonic (CLEFT LIP)
Common Pathogens for UTI Nursing Mnemonic (KEEPS)
Common Signs of Parkinson’s Nursing Mnemonic (SMART)
Community Health Tool Nursing Mnemonic (MAP-IT)
Complications of Spinal Cord Injuries Nursing Mnemonic (ABCDEFG)
Complications of Thoracentesis Nursing Mnemonic (Patients Sometimes Bleed Internally)
Nursing Care and Pathophysiology for Heart Failure (CHF)
COPD management Nursing Mnemonic (COPD)
Cor Pulmonale – Signs & Symptoms Nursing Mnemonic (Please Read His Text)
Coronary Arteries – Location Nursing Mnemonic (I have a RIGHT to CAMP if you LEFT off the AC)
Cranial Nerve Mnemonic 01 Nursing Mnemonic (Olympic Opium Occupies Troubled Triathletes After Finishing Vegas Gambling Vacations Still High)
Cranial Nerve Mnemonic 02 Nursing Mnemonic (Oh Oh Oh To Touch And Feel Very Good Velvet AH!)
Cranial Nerve Mnemonic 03 Nursing Mnemonic (On Old Obando Tower Top A Filipino Army Guards Villages And Huts)
Crohn’s Morphology and Symptoms Nursing Mnemonic (CHRISTMAS)
Cushings Assessment Nursing Mnemonic (STRESSED)
Cyanotic Defects Nursing Mnemonic (The 4 T’s)
Decrease ICP Nursing Mnemonic (Craniums Excite Me)
Dementia Nursing Mnemonic (DEMENTIA)
Depression Assessment Nursing Mnemonic (SIGNS)
Diabetes Insipidus Nursing Mnemonic (DDD)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
Diarrhea – Treatment Nursing Mnemonic (BRAT)
Dissociative Disorders
Diverticulitis Complications Nursing Mnemonic (Please Fix His Abscess SOon)
DKA Treatment Nursing Mnemonic (KING UFC)
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Drugs for Bradycardia & Low Blood Pressure Nursing Mnemonic (IDEA)
Drugs that Cause SJS Nursing Mnemonic (I C NASA)
Eczema
Electrolytes – Location in Body Nursing Mnemonic (PISO)
Emergency Drugs Nursing Mnemonic (LEAN)
Environmental Health Assessment Nursing Mnemonic (I PREPARE)
Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Evaluation of Irregular Moles Nursing Mnemonic (ABCDE)
Exercise Guidelines Nursing Mnemonic (FIT)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Fetal Distress Interventions Nursing Mnemonic (Stop MOAN)
Fetal Wellbeing Assessment Tests Nursing Mnemonic (ALONE)
Fire Safety 1 Nursing Mnemonic (PASS)
Fire Safety 2 Nursing Mnemonic (RACE)
Flu Symptoms Nursing Mnemonic (FACTS)
Fractures
GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
Global Symptoms for Brain Tumors Nursing Mnemonic (HAS)
Gluten Free Diet Nursing Mnemonic (BROW)
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hemodynamics
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Hiatal Hernia Symptoms Nursing Mnemonic (Her Belly Really Hurts Following Dinner)
High Pressure Vent Alarms Nursing Mnemonic (Kings Eat Big Cakes)
High Risk Behavior Nursing Mnemonic (HEADSS)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
IADLS (Instrumental Activities of Daily Living) Nursing Mnemonic (SCUM)
Increase MAP Nursing Mnemonic (VAK)
Inflammation- Signs and Symptoms Nursing Mnemonic (HIPER)
Insulin Mnemonic (Ready, Set, Inject, Love)
Interventions for Aphasia Nursing Mnemonic (PROP)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Mnemonic for Organ Systems (MR DICE RUNS)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction Nursing Mnemonic (MONATAS)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OLD CARTS Mnemonic (OLD CARTS)
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Nursing Care and Pathophysiology for Parkinsons
Asthma
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pharmacokinetics Nursing Mnemonic (ADME)
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Hemorrhage (PPH)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Prostate Nursing Mnemonic (FUN)
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Safety Check Nursing Mnemonic (MADLE)
SBAR Communication Nursing Mnemonic (SBAR)
Schizophrenia
Scleroderma Symptoms Nursing Mnemonic (CREST)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Documentation Nursing Mnemonic (TDOC)
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Stages of Hepatitis Nursing Mnemonic (PIP)
Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Steps in the Nursing Process 2 Nursing Mnemonic (AAPIE)
Steps In The Nursing Process 3 Nursing Mnemonic (SOAPIE)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoke Assessments Nursing Mnemonic (FAST)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
TB Drugs Nursing Mnemonic (RIPE)
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Triage Nursing Mnemonic (START)
Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasospasm Therapy Nursing Mnemonic (Triple H Therapy)
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Vitamins – Fat Soluble Nursing Mnemonic (All Dogs Eat Kibble)
Vitamins – Water Soluble Nursing Mnemonic (Birth Control)
Walkers Nursing Mnemonic (Wandering Wilma Always Late)
Who Needs Dialysis Nursing Mnemonic (AEIOU)