Effects of cord compression on fetal blood flow distribution and O2 delivery.

We used the radionuclide microsphere technique in nine fetal lambs to examine the effect of partial cord compression on distribution of cardiac output and O2 delivery to fetal organs and venous flow patterns. With a 50% reduction in umbilical blood flow the fraction of fetal cardiac output distributed to the brain, heart, carcass, kidneys, and gastrointestinal tract increased. Pulmonary blood flow fell. O2 delivery to the brain and myocardium was maintained but was reduced to peripheral, renal, and gastrointestinal circulations. Hepatic blood flow decreased and O2 delivery fell by 75%. The proportion of umbilical venous blood passing through the ductus venosus increased from 43.9 to 71.8%. The preferential distribution of ductus venosus blood flow through the foramen ovale was enhanced (29.4 vs. 47.2%) and the proportion of O2 delivery to upper body organs derived from the ductus venosus increased (33.2 vs. 49.4%). Abdominal inferior vena caval blood flow increased, and it was also preferentially distributed through the foramen ovale (21.9 vs. 44.2%) and constituted the major fraction of the arterial blood supply to the upper body organs (16.5 vs. 36.4%). Thus cord compression modified the distribution of cardiac output and the patterns of venous returns in the fetus. This pattern of circulatory response differs from that observed with other causes of reduced O2 delivery.