Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-26T16:18:53.929Z Has data issue: false hasContentIssue false

5 - Gas Exchange across the Placenta

from Section 2 - The Basics: for the Non-Obstetrician

Published online by Cambridge University Press:  14 April 2020

By
Brahmdeep S. Saini ,
Janna L. Morrison  and
Mike Seed
Edited by
Stephen E. Lapinsky  and
Lauren A. Plante
Stephen E. Lapinsky
Affiliation:
Mount Sinai Hospital, Toronto
Lauren A. Plante
Affiliation:
Drexel University Hospital, Philadelphia
Get access

Summary

The placenta develops alongside the embryo and fetus and is responsible for fetal gas exchange and nutrition. The placenta also has important immune and endocrine functions and thus undertakes to fulfill the roles played by various somatic organs in the post-natal situation (Figure 5.1). The placental membrane, the chorion, prevents the fetal and maternal blood from mixing, while allowing transport of molecules. The human placenta is haemochorial, which means that maternal blood contacts the chorionic placental membrane (fetal epitheliem).

Type
Chapter
Information
Respiratory Disease in Pregnancy , pp. 34 - 56
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Soo, JY, Wiese, MD, Berry, MJ, Morrison, JL. Does poor fetal growth influence the extent of fetal exposure to maternal medications? Pharmacol Res. 2018 130:74–84.CrossRefGoogle ScholarPubMed
Jansson, T, Aye, ILMH, Goberdhan, DCI. The emerging role of mTORC1 signaling in placental nutrient-sensing. Placenta. 2012 33:e23–9.CrossRefGoogle ScholarPubMed
Poudel, R, McMillen, IC, Dunn, SL, Zhang, S, Morrison, JL. Impact of chronic hypoxemia on blood flow to the brain, heart, and adrenal gland in the late-gestation IUGR sheep fetus. Am J Physiol Regul Integr Comp Physiol. 2015 308:R151–62.Google Scholar
Tan, W, Riggs, KW, Thies, RL, Rurak, DW. Use of an automated fluorescent microsphere method to measure regional blood flow in the fetal lamb. Can J Physiol Pharmacol. 1997 75:959–68.Google Scholar
Morrison, JL, Carmichael, L, Homan, J, White, S, Richardson, BS. Cerebral blood flow during spontaneous and cholinergically induced behavioral states in the sheep fetus. Pediatr Res. 2005 57:667–73.Google Scholar
Hope, ID, Huikeshoven, FJ, Gilbert, RD, Power, GG, Longo, LD. Errors in microsphere determination of cardiac output: a computer simulation in fetal sheep. Am J Physiol Circ Physiol. 1989 256:H302–10.Google Scholar
Giussani, DA, Spencer, JA, Moore, PJ, Bennet, L, Hanson, MA. Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. J Physiol. 1993 461:431–49.Google Scholar
Bennet, L, Booth, LC, Ahmed-Nasef, N, et al. Male disadvantage? Fetal sex and cardiovascular responses to asphyxia in preterm fetal sheep. Am J Physiol Integr Comp Physiol. 2007 293:R1280–6.CrossRefGoogle ScholarPubMed
Morrison, JL, Chien, C, Riggs, KW, Gruber, N, Rurak, D. Effect of maternal fluoxetine administration on uterine blood flow, fetal blood gas status, and growth. Pediatr Res. 2002 51:433–42.CrossRefGoogle ScholarPubMed
Shalev, E, Dan, U, Weiner, E, et al. Prenatal diagnosis using sonographic guided cordocentesis. J Perinat Med. 1989;17:393–8.CrossRefGoogle ScholarPubMed
Mielke, G, Benda, N. Cardiac output and central distribution of blood flow in the human fetus. Circulation. 2001 103:1662–8.Google Scholar
Barbera, A, Galan, HL, Ferrazzi, E, et al. Relationship of umbilical vein blood flow to growth parameters in the human fetus. Am J Obstet Gynecol. 1999 181:174–9.CrossRefGoogle ScholarPubMed
Jansz, MS, Seed, M, van Amerom, JFP, et al. Metric optimized gating for fetal cardiac MRI. Magn Reson Med. 2010 64:1304–14.CrossRefGoogle ScholarPubMed
Seed, M, van Amerom, JFP, Yoo, S-J, et al. Feasibility of quantification of the distribution of blood flow in the normal human fetal circulation using CMR: a cross-sectional study. J Cardiovasc Magn Reson. 2012 14:79.Google Scholar
Prsa, M, Sun, L, van Amerom, J, et al. Reference ranges of blood flow in the major vessels of the normal human fetal circulation at term by phase contrast magnetic resonance imaging. Circ Cardiovasc Imaging. 2014 7:663–70.Google Scholar
Longo, L. Respiration in the fetal-placental unit. In: Cowett, R, ed. Principles of Perinatal-Neonatal Metabolism. New York: Springer-Verlag New York Inc. 1991:304–15.Google Scholar
Longo, L. Respiratory gas exchange in the placenta. In: Fishman, A, Farhi, L, Tenney, S, eds. Handbook of Physiology, Sec 3. The Respiratory System, Vol. IV. Gas Exchange. Washington, DC: American Physiological Society. 1987:351–401.Google Scholar
Soma-Pillay, P, Nelson-Piercy, C, Tolppanen, H, et al. Physiological changes in pregnancy. Cardiovasc J Afr. 2016 27:89–94.Google Scholar
Ouzounian, JG, Elkayam, U. Physiologic changes during normal pregnancy and delivery. Cardiol Clin. 2012 30:317–29.Google Scholar
Goplerud, JM, Delivoria-Papadopoulos, M. Physiology of the placenta – gas exchange. Ann Clin Lab Sci. 1985 15:270–8.Google Scholar
Fujikura, T, Yoshida, J. Blood gas analysis of placental and uterine blood during cesarean delivery. Obstet Gynecol. 1996 87:133–6.Google Scholar
Nye, GA, Ingram, E, Johnstone, ED, et al. Human placental oxygenation in late gestation: experimental and theoretical approaches. J Physiol. 2018 596:5523–34.Google Scholar
Siggaard-Andersen, O, Huch, R. The oxygen status of fetal blood. Acta Anaesthesiol Scand. 1995 39:129–35.Google Scholar
Soothill, PW, Nicolaides, KH, Rodeck, CH, Campbell, S. Effect of gestational age on fetal and intervillous blood gas and acid-base values in human pregnancy. Fetal Ther. 1986 1:168–75.Google Scholar
Lackman, F, Capewell, V, Gagnon, R, Richardson, B. Fetal umbilical cord oxygen values and birth to placental weight ratio in relation to size at birth. Am J Obstet Gynecol. 2001 185:674–82.CrossRefGoogle ScholarPubMed
Manomayangkul, K, Siriussawakul, A, Nimmannit, A, et al. Reference values for umbilical cord blood gases of newborns delivered by elective cesarean section. J Med Assoc Thai. 2016 99:611–17.Google Scholar
Link, G, Clark, KE, Lang, U. Umbilical blood flow during pregnancy: evidence for decreasing placental perfusion. Am J Obstet Gynecol. 2007 196:489.e1-7.Google Scholar
Acharya, G, Sitras, V. Oxygen uptake of the human fetus at term. Acta Obstet Gynecol. 2009 88:104–9.Google Scholar
Helwig, JT, Parer, JT, Kilpatrick, SJ, Laros, J. Umbilical cord blood acid-base state: what is normal? Am J Obstet Gynecol. 1996 174:1807–14.Google Scholar
Arikan, GM, Scholz, HS, Petru, E, et al. Cord blood oxygen saturation in vigorous infants at birth: what is normal? Br J Obstet Gynaecol. 2000 107:987–94.CrossRefGoogle Scholar
Sjostedt, S, Rooth, G, Caligara, F. The oxygen tension of the blood in the umbilical cord and the intervillous space. Arch Dis Child. 1960 35:529–33.CrossRefGoogle ScholarPubMed
Jopling, J, Henry, E, Wiedmeier, SE, Christensen, RD. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics. 2009 123:e333–7.Google Scholar
Longo, LD, Power, GG, Forster, RE. Respiratory function of the placenta as determined with carbon monoxide in sheep and dogs. J Clin Invest. 1967 46:812–28.Google Scholar
Longo, LD, Power, GG, Forster, RE. Placental diffusing capacity for carbon monoxide at varying partial pressures of oxygen. J Appl Physiol. 1969 26:360–70.Google Scholar
Bissonnette, JM, Wickham, WK. Placental diffusing capacity for carbon monoxide in unanesthetized guinea pigs. Respir Physiol. 1977 31:161–8.Google Scholar
Bacon, BJ, Gilbert, RD, Kaufmann, P, et al. Placental anatomy and diffusing capacity in guinea pigs following long-term maternal hypoxia. Placenta. 1984 5:475–87.Google Scholar
Bissonnette, JM, Longo, LD, Novy, MJ, Murata, Y, Martin, CB. Placental diffusing capacity and its relation to fetal growth. J Dev Physiol. 1979 1:351–9.Google Scholar
Mayhew, TMM, Joy, CF, Haas, JD. Structure-function correlation in the human placenta: the morphometric diffusing capacity for oxygen at full term. J Anat. 1984 139:691–708.Google Scholar
Longo, LD, Ching, KS. Placental diffusing capacity for carbon monoxide and oxygen in unanesthetized sheep. J Appl Physiol. 1977 43:885–93.Google Scholar
Rocco, E, Bennett, T, Power, G. Placental diffusing capacity in unanesthetized rabbits. Am J Physiol Content. 1975 228:465–9.Google Scholar
Aherne, W, Dunnill, MS. Quantitative aspects of placental structure. J Pathol Bacteriol. 1966 91:123–39.Google Scholar
Boyd, JD, Hamilton, WJ. Development and structure of the human placenta from the end of the 3rd month of gestation. Br J Obstet Gynaecol. 1967 74:161–226.Google Scholar
McNanley, T, Woods, J. Placental Physiology [Internet]. In: von Dadelszen, P, ed. The Global Library of Women’s Medicine. Paula and David Bloomer. 2008. Available from: www.glowm.com/section_view/heading/PlacentalPhysiology/item/195 (accessed November 2019.)Google Scholar
Jackson, MR, Mayhew, TM, Boyd, PA. Quantitative description of the elaboration and maturation of villi from 10 weeks of gestation to term. Placenta. 1992 13:357–70.Google Scholar
Mayhew, TM, Jackson, MR, Boyd, PA. Changes in oxygen diffusive conductances of human placentae during gestation (10–41 weeks) are commensurate with the gain in fetal weight. Placenta. 1993 14:51–61.Google Scholar
Wilkening, RB, Meschia, G. Current topic: comparative physiology of placental oxygen transport. Placenta. 1992 13:1–15.Google Scholar
Power, GG, Longo, LD, Wagner, N, Kuhl, DE, Forster, RE. Uneven distribution of maternal and fetal placental blood flow, as demonstrated using macroaggregates, and its response to hypoxia. J Clin Invest. 1967 46:2053–63.Google Scholar
Power, GG, Dale, PS, Nelson, PS. Distribution of maternal and fetal blood flow within cotyledons of the sheep placenta. Am J Physiol. 1981 241:H486-96.Google Scholar
Nelson, PS, Gilbert, RD, Longo, LD. Fetal growth and placental diffusing capacity in guinea pigs following long-term maternal exercise. J Dev Physiol. 1983 5:1–10.Google Scholar
Meng, Q, Shao, L, Luo, X, et al. Ultrastructure of placenta of gravidas with gestational diabetes mellitus. Obstet Gynecol Int. 2015 2015:283124.Google Scholar
Genç, M, Ledger, WJ. Syphilis in pregnancy. Sex Transm Inf. 2000 76:73–9.Google Scholar
Burton, GJ, Jauniaux, E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol. 2018 218:S745–61.Google Scholar
Mayhew, TM, Manwani, R, Ohadike, C, Wijesekara, J, Baker, PN. The placenta in pre-eclampsia and intrauterine growth restriction: studies on exchange surface areas, diffusion distances and villous membrane diffusive conductances. Placenta. 2007 28:233–8.Google Scholar
Power, GG, Jenkins, F. Factors affecting O2 transfer in sheep and rabbit placenta perfused in situ. Am J Physiol. 1975 229:1147–53.Google Scholar
Young, DC, Popat, R, Luther, ER, Scott, KE, Writer, WDR. Influence of maternal oxygen administration on the term fetus before labor. Am J Obstet Gynecol. 1980 136:321–4.Google Scholar
Longo, LD, Dale, PS, Gilbert, RD. Uteroplacental O2 uptake: continuous measurements during uterine quiescence and contractions. Am J Physiol Integr Comp Physiol. 1986 250:R1099–107.Google Scholar
Battaglia, C, Artini, PG, D’Ambrogio, G, et al. Maternal hyperoxygenation in the treatment of intrauterine growth retardation. Am J Obstet Gynecol. 1992 167:430–5.Google Scholar
Khatib, N, Thaler, I, Beloosesky, R, et al. The effect of maternal hyperoxygenation on fetal circulatory system in normal growth and IUGR fetuses: what we can learn from this impact. J Matern Neonatal Med. 2018 31:914–18.Google Scholar
Porayette, P, Madathil, S, Sun, L, et al. MRI reveals hemodynamic changes with acute maternal hyperoxygenation in human fetuses with and without congenital heart disease. Prenat Diagn. 2016 36:274–81.CrossRefGoogle ScholarPubMed
Presbitero, P, Somerville, J, Stone, S, et al. Pregnancy in cyanotic congenital heart disease: outcome of mother and fetus. Circulation. 1994 89:2673–6.Google Scholar
Hutter, D, Kingdom, J, Jaeggi, E. Causes and mechanisms of intrauterine hypoxia and its impact on the fetal cardiovascular system: a review. Int J Pediatr. 2010 2010: 401323.CrossRefGoogle ScholarPubMed
Gelson, E, Johnson, M. Effect of maternal heart disease on pregnancy outcomes. Expert Rev Obstet Gynecol. 2010 5:605–17.Google Scholar
McGillick, EV, Orgeig, S, Allison, BJ, et al. Maternal chronic hypoxia increases expression of genes regulating lung liquid movement and surfactant maturation in male fetuses in late gestation. J Physiol. 2017 595:4329–50.Google Scholar
Brain, KL, Allison, BJ, Niu, Y, et al. Induction of controlled hypoxic pregnancy in large mammalian species. Physiol Rep. 2015 3:1–13.CrossRefGoogle ScholarPubMed
Allison, BJ, Brain, KL, Niu, Y, et al. Fetal in vivo continuous cardiovascular function during chronic hypoxia. J Physiol. 2016 594:1247–64.Google Scholar
Oh, C, Dong, Y, Harman, C, et al. Chronic hypoxia differentially increases glutathione content and γ-glutamyl cysteine synthetase expression in fetal guinea pig organs. Early Hum Dev. 2008 84:121–7.Google Scholar
Botting, KJ, Loke, XY, Zhang, S, et al. IUGR decreases cardiomyocyte endowment and alters cardiac metabolism in a sex- and cause-of-IUGR-specific manner. Am J Physiol Integr Comp Physiol. 2018 315:R48–67.Google Scholar
Delivoria-Papadopoulos, M, McGowan, JE. Oxygen transport and delivery. In: Polin, RA, Fox, WW, Abman, SH, eds. Fetal and Neonatal Physiology. Philadelphia, PA: WB Saunders Company. 2004:880–9.Google Scholar
Wood, WG. Haemoglobin synthesis during human fetal development. Br Med Bull. 1976 32:282–7.CrossRefGoogle ScholarPubMed
Hill, E, Power, G, Longo, L. A mathematical model of carbon dioxide transfer in the placenta and its interaction with oxygen. Am J Physiol Content. 1973 224:283–99.Google Scholar
Karamermer, Y, Roos-Hesselink, JW. Pregnancy and adult congenital heart disease. Expert Rev Cardiovasc Ther. 2007 5:859–69.Google Scholar
Longo, LD. Maternal blood volume and cardiac output during pregnancy: a hypothesis of endocrinologic control. Am J Physiol Integr Comp Physiol. 1983 245:R720–9.Google Scholar
Longo, LD, Hill, EP, Power, GG. Theoretical analysis of factors affecting placental O2 transfer. Am J Physiol. 1972 222:730–9.Google Scholar
Wilkening, RB, Meschia, G. Fetal oxygen uptake, oxygenation, and acid-base balance as a function of uterine blood flow. Am J Physiol. 1983 244:H749-55.Google Scholar
Dawes, GS, Mott, JC. Changes in O2 distribution and consumption in foetal lambs with variations in umbilical blood flow. J Physiol. 1964 170:524–40.CrossRefGoogle ScholarPubMed
Clapp, JF. The relationship between blood flow and oxygen uptake in the uterine and umbilical circulations. Am J Obstet Gynecol. 1978 132:410–13.Google Scholar
Browne, VA, Toledo-Jaldin, L, Davila, RD, et al. High-end arteriolar resistance limits uterine artery blood flow and restricts fetal growth in preeclampsia and gestational hypertension at high altitude. Am J Physiol Regul Integr Comp Physiol . 2011 300:R1221–9.Google Scholar
Metcalfe, J, Romney, SL, Ramsey, LH, Reid, DE, Burwell, CS. Estimation of uterine blood flow in normal human pregnancy at term. J Clin Invest. 1955 34:1632–8.Google Scholar
Assali, NS, Rauramo, L, Peltonen, T. Measurement of uterine blood flow and uterine metabolism. Am J Obstet Gynecol. 1960 79:86–98.Google Scholar
Konje, JC, Kaufmann, P, Bell, SC, Taylor, DJ. A longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies. Am J Obstet Gynecol. 2001 185:608–13.Google Scholar
Konje, JC, Howarth, ES, Kaufmann, P, Taylor, DJ. Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction. Br J Obstet Gynaecol. 2003 110:301–5.CrossRefGoogle ScholarPubMed
Maini, CL, Rosati, P, Galli, G, et al. Non-invasive radioisotopic evaluation of placental blood flow. Gynecol Obstet Invest. 1985 19:196–206.Google Scholar
Thaler, I, Manor, D, Itskovitz, J, et al. Changes in uterine blood flow during human pregnancy. Am J Obstet Gynecol. 1990 162:121–5.Google Scholar
Ziegler, WF, Bernstein, I, Badger, G, Leavitt, T, Cerrero, ML. Regional hemodynamic adaptation during the menstrual cycle. Obstet Gynecol. 1999 94:695–9.Google ScholarPubMed
Beltrame, RT, Covre, C, Littig, LB, et al. Transrectal Doppler sonography of uterine blood flow in ewes during pregnancy. Theriogenology. 2017 91:55–61.Google Scholar
Elmetwally, M, Rohn, K, Meinecke-Tillmann, S. Noninvasive color Doppler sonography of uterine blood flow throughout pregnancy in sheep and goats. Theriogenology. 2016 85:1070–9.Google Scholar
Elmetwally, M, Bollwein, H. Uterine blood flow in sheep and goats during the peri-parturient period assessed by transrectal Doppler sonography. Anim Reprod Sci. 2017 176:32–9.Google Scholar
Ducas, RA, Elliott, JE, Melnyk, SF, et al. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson. 2014 16:1.Google Scholar
Silver, M, Barnes, RJ, Comline, RS, Burton, GJ. Placental blood flow: some fetal and maternal cardiovascular adjustments during gestation. J Reprod Fertil Suppl. 1982 31:139–60.Google Scholar
Lotz, J, Meier, C, Leppert, A, Galanski, M. Cardiovascular flow measurement with phase-contrast MR imaging: basic facts and implementation. Radiographics. 2002 22:651–71.Google Scholar
Saini, BS, Zhu, M, Portnoy, S, et al. OP29.07: Non‐invasive in utero measurements of placental oxygen transport using MRI. Ultrasound Obstet Gynecol. 2016 48:148.Google Scholar
Rudolph, AM, Heymann, MA. Circulatory changes during growth in the fetal lamb. Circ Res. 1970 26:289–99.Google Scholar
Chung, M, Teng, C, Timmerman, M, Meschia, G, Battaglia, FC. Production and utilization of amino acids by ovine placenta in vivo. Am J Physiol. 1998 274:E13-22.Google Scholar
Rudolph, A. Congenital Diseases of the Heart: Clinical-Physiological Considerations. 3rd edn. Hoboken, NJ: Wiley-Blackwell. 2009.Google Scholar
Kiserud, T, Ebbing, C, Kessler, J, Rasmussen, S. Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound Obstet Gynecol. 2006 28:126–36.Google Scholar
Sun, L, Macgowan, CK, Sled, JG, et al. Reduced fetal cerebral oxygen consumption is associated with smaller brain size in fetuses with congenital heart disease. Circulation. 2015 131:1313–23.Google Scholar
Zhu, MY, Milligan, N, Keating, S, et al. The hemodynamics of late-onset intrauterine growth restriction by MRI. Am J Obstet Gynecol. 2016 214(3):367.e1-e17.Google Scholar
Figueras, F, Fernández, S, Hernández-Andrade, E, Gratacós, E. Umbilical venous blood flow measurement: accuracy and reproducibility. Ultrasound Obstet Gynecol. 2008 32:587–91.Google Scholar
Edelstone, DI, Rudolph, AM, Heymann, MA. Liver and ductus venosus blood flows in fetal lambs in utero. Circ Res. 1978 42:426–33.Google Scholar
Meschia, G, Cotter, JR, Breathnach, CS, Barron, DH. The hemoglobin, oxygen, carbon dioxide and hydrogen ion concentrations in the umbilical bloods of sheep and goats as sampled via indwelling plastic catheters. Am J Obstet Gynecol. 1965 50:185–95.Google ScholarPubMed
Bessette, NW, Rurak, DW. Chronic fetal and maternal instrumentation in pregnant sheep: effect on gestation length and birthweight. Reprod Fertil Dev. 2010 22:459–67.Google Scholar
Comline, RS, Silver, M. Daily changes in foetal and maternal blood of conscious pregnant ewes, with catheters in umbilical and uterine vessels. J Physiol. 1970 209:567–86.Google Scholar
Morrison, JL, Botting, KJ, Dyer, JL, et al. Restriction of placental function alters heart development in the sheep fetus. Am J Physiol Regul Integr Comp Physiol. 2007 293:R306–13.Google Scholar
Berman, W, Goodlin, RC, Heymann, MA, Rudolph, AM. Relationships between pressure and flow in the umbilical and uterine circulations of the sheep. Circ Res. 1976 38:262–6.Google Scholar
Rurak, D, Bessette, NW. Changes in fetal lamb arterial blood gas and acid-base status with advancing gestation. Am J Physiol Regul Integr Comp Physiol. 2013 304:R908-16.Google Scholar
Quintó, L, Aponte, JJ, Menéndez, C, et al. Relationship between haemoglobin and haematocrit in the definition of anaemia. Trop Med Int Heal. 2006 11:1295–302.Google Scholar
Carneiro, IA, Drakeley, CJ, Owusu-Agyei, S, Mmbando, B, Chandramohan, D. Haemoglobin and haematocrit: is the threefold conversion valid for assessing anaemia in malaria-endemic settings? Malar J. 2007 6:67.Google Scholar
Rossi, A, Cornette, J, Johnson, MR, et al. Quantitative cardiovascular magnetic resonance in pregnant women: cross-sectional analysis of physiological parameters throughout pregnancy and the impact of the supine position. J Cardiovasc Magn Reson. 2011 13:31.Google Scholar
Humphries, A, Mirjalili, SA, Tarr, GP, Thompson, JMD, Stone, P. The effect of supine positioning on maternal hemodynamics during late pregnancy. J Matern Neonatal Med. 2018 32(23):3923–30.Google Scholar
Power, G, Longo, L. Sluice flow in placenta: maternal vascular pressure effects on fetal circulation. Am J Physiol Content. 1973 225:1490–6.Google Scholar
Warland, J, Dorrian, J, Kember, AJ, et al. Modifying maternal sleep position in late pregnancy through positional therapy: a feasibility study. J Clin Sleep Med. 2018 14:1387–97.Google Scholar
Warland, J, Dorrian, J, Morrison, JL, O’Brien, LM. Maternal sleep during pregnancy and poor fetal outcomes: a scoping review of the literature with meta-analysis. Sleep Med Rev. 2018 41:197–219.Google Scholar
Macara, L, Kingdom, JC, Kaufmann, P, et al. Structural analysis of placental terminal villi from growth-restricted pregnancies with abnormal umbilical artery Doppler waveforms. Placenta. 1996 17:37–48.Google Scholar
Todros, T, Sciarrone, A, Piccoli, E, et al. Umbilical Doppler waveforms and placental villous angiogenesis in pregnancies complicated by fetal growth restriction. Obstet Gynecol. 1999 93:499–503.Google Scholar
Gu, W, Jones, CT, Parer, JT. Metabolic and cardiovascular effects on fetal sheep of sustained reduction of uterine blood flow. J Physiol. 1985 368:109–29.Google Scholar
Owens, JA, Falconer, J, Robinson, JS. Effect of restriction of placental growth on umbilical and uterine blood flows. Am J Physiol. 1986 250:R427–34.Google Scholar
Carter, AM. Placental oxygen consumption. Part I: in vivo studies – a review. Placenta. 2000 21:S31–7.Google Scholar
Morrison, JL. Sheep models of intrauterine growth restriction: fetal adaptations and consequences. Clin Exp Pharmacol Physiol. 2008 35:730–43.Google Scholar
Zhang, S, Regnault, TRH, Barker, PL, et al. Placental adaptations in growth restriction. Nutrients. 2015 7:360–89.Google Scholar
Zhang, S, Barker, P, Botting, KJ, et al. Early restriction of placental growth results in placental structural and gene expression changes in late gestation independent of fetal hypoxemia. Physiol Rep. 2016 4:1–19.Google Scholar
Drenthen, W, Pieper, PG, Roos-Hesselink, JW, et al. Pregnancy and delivery in women after Fontan palliation. Heart. 2006 92:1290–4.Google Scholar
Gelson, E, Curry, R, Gatzoulis, MA, et al. Effect of maternal heart disease on fetal growth. Obstet Gynecol. 2011 117:886–91.Google Scholar
Parer, JT, De Lannoy, CW, Hoversland, AS, Metcalfe, J. Effect of decreased uterine blood flow on uterine oxygen consumption in pregnant macaques. Am J Obstet Gynecol. 1968 100:813–20.Google Scholar
Chen, JZJ, Sheehan, PM, Brennecke, SP, Keogh, RJ. Vessel remodelling, pregnancy hormones and extravillous trophoblast function. Mol Cell Endocrinol. 2012 349:138–44.Google Scholar
Harris, L. Review: trophoblast-vascular cell interactions in early pregnancy. How to remodel a vessel. Placenta. 2010 31:S93-8.Google Scholar
Burton, G, Woods, A, Jauniaux, E, Kingdom, J. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta. 2009 30:473–82.Google Scholar
Naeye, RL. Pregnancy hypertension, placental evidences of low uteroplacental blood flow, and spontaneous premature delivery. Hum Pathol. 1989 20:441–4.Google Scholar
Stott, D, Papastefanou, I, Paraschiv, D, Clark, K, Kametas, NA. Longitudinal maternal hemodynamics in pregnancies affected by fetal growth restriction. Ultrasound Obstet Gynecol. 2017 49:761–8.Google Scholar
Guy, GP, Ling, HZ, Machuca, M, Poon, LC, Nicolaides, KH. Maternal cardiac function at 35–37 weeks’ gestation: relationship with birth weight. Ultrasound Obstet Gynecol. 2017 49:67–72.Google Scholar
Melchiorre, K, Sutherland, GR, Liberati, M, Thilaganathan, B. Maternal cardiovascular impairment in pregnancies complicated by severe fetal growth restriction. Hypertension. 2012 60:437–43.Google Scholar
Jouppila, P, Kirkinen, P. Umbilical vein blood flow in the human fetus in cases of maternal and fetal anemia and uterine bleeding. Ultrasound Med Biol. 1984 10:365–70.Google Scholar
Cohn, HE, Sacks, EJ, Heymann, MA, Rudolph, AM. Cardiovascular responses to hypoxemia and acidemia in fetal lambs. Am J Obstet Gynecol. 1974 120:817–24.Google Scholar
Adamsons, K, Beard, RW, Myers, RE. Comparison of the composition of arterial, venous, and capillary blood of the fetal monkey during labor. Am J Obstet Gynecol. 1970 107:435–40.Google Scholar
Browne, VA, Stiffel, VM, Pearce, WJ, Longo, LD, Gilbert, RD. Cardiac beta-adrenergic receptor function in fetal sheep exposed to long-term high-altitude hypoxemia. Am J Physiol. 1997 273:R2022-31.Google Scholar
Ferrazzi, E, Rigano, S, Bozzo, M, et al. Umbilical vein blood flow in growth-restricted fetuses. Ultrasound Obstet Gynecol. 2000 16:432–8.Google Scholar
Rigano, S, Bozzo, M, Padoan, A, et al. Small size-specific umbilical vein diameter in severe growth restricted fetuses that die in utero. Prenat Diagn. 2008 28:908–13.Google Scholar
Grocott, MPW, Martin, DS, Levett, DZH, et al. Arterial blood gases and oxygen content in climbers on Mount Everest. N Engl J Med. 2009 360:140–9.Google Scholar
Moore, LG, Charles, SM, Julian, CG. Humans at high altitude: hypoxia and fetal growth. Respir Physiol Neurobiol. 2011 178:181–90.Google Scholar
Julian, CG, Galan, HL, Wilson, MJ, et al. Lower uterine artery blood flow and higher endothelin relative to nitric oxide metabolite levels are associated with reductions in birth weight at high altitude. Am J Physiol Integr Comp Physiol. 2008 295:R906–15.Google Scholar
Moore, LG, Zamudio, S, Zhuang, J, Sun, S, Droma, T. Oxygen transport in Tibetan women during pregnancy at 3,658 m. Am J Phys Anthropol. 2001 114:42–53.Google Scholar
Wilson, MJ, Lopez, M, Vargas, M, et al. Greater uterine artery blood flow during pregnancy in multigenerational (Andean) than shorter-term (European) high-altitude residents. Am J Physiol Regul Integr Comp Physiol. 2007 293:R1313–24.Google Scholar
Chen, D, Zhou, X, Zhu, Y, Zhu, T, Wang, J. Comparison study on uterine and umbilical artery blood flow during pregnancy at high altitude and at low altitude. Zhonghua Fu Chan Ke Za Zhi. 2002 37:69–71.Google Scholar
Julian, CG, Wilson, MJ, Lopez, M, et al. Augmented uterine artery blood flow and oxygen delivery protect Andeans from altitude-associated reductions in fetal growth. Am J Physiol Regul Integr Comp Physiol . 2009 296:R1564–75.Google Scholar
Postigo, L, Heredia, G, Illsley, NP, et al. Where the O2 goes to: preservation of human fetal oxygen delivery and consumption at high altitude. J Physiol. 2009 587:693–708.Google Scholar
Bulas, D, Egloff, A. Benefits and risks of MRI in pregnancy. Semin Perinatol. 2013 37:301–4.Google Scholar
Powell, A, Maier, S, Chung, T, Geva, T. Phase-velocity cine magnetic resonance imaging measurement of pulsatile blood flow in children and young adults: in vitro and in vivo validation. Pediatr Cardiol. 2000 21:104–10.Google Scholar
Sun, L, Macgowan, CK, Portnoy, S, et al. New advances in fetal cardiovascular magnetic resonance imaging for quantifying the distribution of blood flow and oxygen transport: potential applications in fetal cardiovascular disease diagnosis and therapy. Echocardiography. 2017 34:1799–803.Google Scholar
Portnoy, S, Osmond, M, Zhu, MY, et al. Relaxation properties of human umbilical cord blood at 1.5 Tesla. Magn Reson Med. 2017 77:1678–90.Google Scholar
Portnoy, S, Milligan, N, Seed, M, Sled, JG, Macgowan, CK. Human umbilical cord blood relaxation times and susceptibility at 3 T. Magn Reson Med. 2018 79:3194–206.Google Scholar
Portnoy, S, Seed, M, Sled, JG, Macgowan, CK. Non-invasive evaluation of blood oxygen saturation and hematocrit from T1 and T2 relaxation times: in-vitro validation in fetal blood. Magn Reson Med. 2017 78:2352–9.Google Scholar
Seed, M. Advanced fetal cardiac MR Imaging. In: Kline-Fath, BM, Bulas, DI, Bahado-Singh, R, eds. Fundamental and Advanced Fetal Imaging: Ultrasound and MRI. Wolters Kluwer Health. 2015:228–34.Google Scholar
Jones, HN, Olbrych, SK, Smith, KL, et al. Hypoplastic left heart syndrome is associated with structural and vascular placental abnormalities and leptin dysregulation. Placenta. 2015 36:1078–86.Google Scholar
Matthiesen, NB, Henriksen, TB, Agergaard, P, et al. Congenital heart defects and indices of placental and fetal growth in a nationwide study of 924 422 liveborn infants. Circulation. 2016 134:1546–56.Google Scholar
Hodgkinson, CP. Physiology of the ovarian veins during pregnancy. Obstet Gynecol. 1953 1:26–37.Google Scholar
Bonds, DR, Crosby, LO, Cheek, TG, et al. Estimation of human fetal-placental unit metabolic rate by application of the Bohr principle. J Dev Physiol. 1986 8:49–54.Google Scholar
Meschia, G, Battaglia, FC, Hay, WW, Sparks, JW. Utilization of substrates by the ovine placenta in vivo. Fed Proc. 1980 39:245–9.Google Scholar
Owens, J, Falconer, J, Robinson, J. Effect of restriction of placental growth on oxygen delivery to and consumption by the pregnant uterus and fetus. J Dev Physiol. 1987 9:137–50.Google Scholar
Campbell, GM, Dawes, GS, Fishman, AP, Hyman, AI, James, GB. The oxygen consumption of the placenta and foetal membranes in the sheep. J Physiol. 1966 182:439–64.CrossRefGoogle ScholarPubMed
Koos, BJ. Central stimulation of breathing movements in fetal lambs by prostaglandin synthetase inhibitors. J Physiol. 1985 362:455–66.Google Scholar
Dawes, GS, Fox, HE, Leduc, BM, Liggins, GC, Richards, RT. Respiratory movements and rapid eye movement sleep in the foetal lamb. J Physiol. 1972 220:119–43.Google Scholar
te Pas, AB, Davis, PG, Hooper, SB, Morley, CJ. From liquid to air: breathing after birth. J Pediatr. 2008 152:607–11.Google Scholar
Donnelly, L, Campling, G. Functions of the placenta. Anaesth Intensive Care Med. 2014 15:136–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×