Placental compliance during fetal extracorporeal circulation

Department of Cardiovascular Surgery, The Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115 The fetus requires large amounts of volume when weaning from cardiac bypass. This suggests that placental vasculature can act as a large capacitor in the fetal circulation. To assess placental compliance of fetal lambs, seven isolated in situ lamb placentas were placed on extracorporeal circulation. Umbilical artery blood flow was varied from 0 to 350 ml · min 1 · kg fetal wt 1 . Because the extracorporeal circuit is a closed system, volume changes in the placenta induced by umbilical artery pressure changes were measured from reciprocal volume changes in the reservoir. There was a wide range of change in absolute volume of blood within the fetal placental compartment (216.4 ± 29.3 ml). Placental compliance was linear over the entire range of pressure changes exerted on the placental vasculature ( r 2 = 0.83, P = 0.0001). This indicates that the placenta is a unique and sensitive capacitor in the fetal circulation. This information is important clinically because it establishes that aggressive resuscitation of the fetus using volume may be necessary when weaning the fetus from cardiac bypass. fetal cardiac surgery; fetal cardiac bypass; regional blood flow; placental hemodynamics; placental compliance