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TAS Perinatal Medicine ✅ > Transitional Changes After Birth ✅ > Flashcards

Transitional Changes After Birth ✅ Flashcards

1
Q

What happens to foetal circulation at birth?

A

Circulation through the placenta ceases

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2
Q

What happens to the lungs at birth?

A

They inflate

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3
Q

What happens to the foetal circulatory shunts at birth?

A

They are no longer necessary and cease to function

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4
Q

How long do changes occurring as a foetus transitions to independent life take?

A

Some occur with the first breath, some take place over hours or days

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5
Q

Are the changes that occur when a foetus transitions to independent life functional or structural?

A

Initially functional, followed by definitive anatomical changes

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6
Q

What effect does removal of the placenta have on foetal circulation?

A
  • Increases systemic vascular resistance

- Closure of the ductus venosus

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7
Q

Why does removal of the placenta lead to a closure in the ductus venosus?

A

Due to cessation of the blood flow in the umbilical veins

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8
Q

Where does blood pass through the liver once the ductus venosus has closed?

A

Through the hepatic sinusoids

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9
Q

What does the ductus venosus become?

A

The ligamentum venosum

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10
Q

Where does the ligamentum venosum pass?

A

Through the liver form the left branch of the portal vein to the IVC, to which it is attached

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11
Q

What does lung expansion and aeration cause?

A

An increase in alveolar oxygen tension

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12
Q

What does the increase in alveolar oxygen tension cause?

A

A rapid fall in pulmonary vascular resistance

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13
Q

Why does the increase in alveolar oxygen tension cause a rapid fall in the pulmonary vascular resistance?

A

Due to the vasodilatory effect of oxygen on the pulmonary vasculature

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14
Q

What happens to the pressure in the left atrium after birth?

A

It falls to below the left atrium

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15
Q

Why does the pressure in the right atrium fall after birth?

A
  • Increased pulmonary blood flow

- Removal of the placenta decreasing right atrial return and increasing systemic vascular resistance

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16
Q

What is the result of the left atrial pressure exceeding the right atrial after birth?

A

There is a functional closure of the foramen ovale

17
Q

When does anatomical closure of the foramen ovale occur?

A

By 3 months

18
Q

How is anatomical closure of the foramen ovale achieved?

A

The valve fuses with the septum premium and the intertribal septum becomes a complete partition between the atria

19
Q

What remains after anatomical closure of the foramen ovale?

A

The fossa ovale

20
Q

What is the fossa ovale?

A

An oval depression in the lower part of the interatrial septum

21
Q

What changes in the circulation occur 6-8 weeks after birth?

A

There is a second, slower fall in the pulmonary vascular resistance and pulmonary artery pressure

22
Q

What causes the fall in pulmonary vascular resistance and pulmonary arterial pressure 6-8 weeks after birth?

A

Thinning of the pulmonary arterioles

23
Q

What causes the closure of the ductus arteriosus?

A
  • Increase in prostaglandin E2 (PGE2) metabolism
  • Increase in arterial oxygen concentration
  • Increase in bradykinin and other vasoactive substances
24
Q

What causes the increase in bradykinin and other vasoactive substances in a newborn?

A

The increase in oxygen content of aortic blood

25
Q

What % of term neonates have functional closure of the ductus arteriosus within 24 hours?

A

50%

26
Q

What % of term neonates have functional closure of the ductus arteriosus within 48 hours?

A

75%

27
Q

What % of term neonates have functional closure of the ductus arteriosus within 96 hours?

A

Close to 100%

28
Q

When does anatomical closure of the ductus arteriosus occur?

A

By 3 months of age

29
Q

When might there be a delay in closure of the ductus arteriosus?

A

Preterm infants

30
Q

When might a delayed closure of the ductus arteriosus be induced?

A

In duct-dependent congenital heart disease

31
Q

How can closure of the ductus arteriosus be delayed?

A

By infusing prostaglandin E2

32
Q

When might the pulmonary vascular resistance not fall as usual with the infants first breaths?

A
  • Perinatal asphyxia
  • Neonatal hypothermia
  • Sepsis
  • Meconium aspiration
33
Q

What is it called when the pulmonary vascular resistance doesn’t fall with the infants first breaths?

A

Persistent pulmonary hypertension of the newborn (PPHN)

34
Q

What effect does PPHN have on shunts?

A

The fetal pattern of right to left shunting across the foramen ovale and ductus arteriosus persists

35
Q

What does the persistence of right to left shunting across the foramen ovale and ductus arteriosus in PPHN lead to?

A

Intrapulmonary shunting and further hypoxia and acidosis

TAS Perinatal Medicine ✅ (16 decks)

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