What cardiovascular and respiratory changes must occur at birth for a baby to survive the transition?

During pregnancy, the fetal circulatory system works differently than after birth:

• The fetus is connected by the umbilical cord to the placenta, the organ that develops and implants in the mother's uterus during pregnancy.

• Through the blood vessels in the umbilical cord, the fetus receives all the necessary nutrition, oxygen, and life support from the mother through the placenta.

• Waste products and carbon dioxide from the fetus are sent back through the umbilical cord and placenta to the mother's circulation to be eliminated.

The fetal circulatory system uses two right to left shunts, which are small passages that direct blood that needs to be oxygenated. The purpose of these shunts is to bypass certain body parts? in particular, the lungs and liver ? that are not fully developed while the fetus is still in the womb. The shunts that bypass the lungs are called the foramen ovale, which moves blood from the right atrium of the heart to the left atrium, and the ductus arteriosus, which moves blood from the pulmonary artery to the aorta.

Oxygen and nutrients from the mother's blood are transferred across the placenta to the fetus. The enriched blood flows through the umbilical cord to the liver and splits into three branches. The blood then reaches the inferior vena cava, a major vein connected to the heart. Most of this blood is sent through the ductus venosus, also a shunt that passes highly oxygenated blood through the liver to the inferior vena cava and then to the right atrium of the heart. A small amount of this blood goes directly to the liver to give it the oxygen and nutrients it needs.

Waste products from the fetal blood are transferred back across the placenta to the mother's blood.

Inside the fetal heart:

• Blood enters the right atrium, the chamber on the upper right side of the heart. When the blood enters the right atrium, most of it flows through the foramen ovale into the left atrium.

• Blood then passes into the left ventricle (lower chamber of the heart) and then to the aorta, (the large artery coming from the heart).

• From the aorta, blood is sent to the heart muscle itself in addition to the brain. After circulating there, the blood returns to the right atrium of the heart through the superior vena cava. About two thirds of the blood will pass through the foramen ovale as described above, but the remaining one third will pass into the right ventricle, toward the lungs.

• In the fetus, the placenta does the work of breathing instead of the lungs. As a result, only a small amount of the blood continues on to the lungs. Most of this blood is bypassed or shunted away from the lungs through the ductus arteriosus to the aorta. Most of the circulation to the lower body is supplied by blood passing through the ductus arteriosus.

• This blood then enters the umbilical arteries and flows into the placenta. In the placenta, carbon dioxide and waste products are released into the mother's circulatory system, and oxygen and nutrients from the mother's blood are released into the fetus' blood.

At birth, the umbilical cord is clamped and the baby no longer receives oxygen and nutrients from the mother. With the first breaths of life, the lungs begin to expand. As the lungs expand, the alveoli in the lungs are cleared of fluid. An increase in the baby's blood pressure and a significant reduction in the pulmonary pressures reduces the need for the ductus arteriosus to shunt blood. These changes promote the closure of the shunt. These changes increase the pressure in the left atrium of the heart, which decrease the pressure in the right atrium. The shift in pressure stimulates the foramen ovale to close.

The closure of the ductus arteriosus and foramen ovale completes the transition of fetal circulation to newborn circulation.