A Multiscale Mathematical Model for Fetal Gas Transport and Regulatory Systems During Second Half of Pregnancy.

Fetal asphyxia, a condition resulting from the combined effects of hypoxia and hypercapnia, leads to approximately 900,000 annual deaths worldwide. One cause is umbilical cord compression during labor-induced uterine contractions, disrupting the transport of metabolites to and from the placenta, and resulting in asphyxia. Current fetal well-being assessment relies on monitoring fetal heart rate and uterine contractions as indicators of oxygen delivery to the brain. To enhance our understanding of this complex relationship, this study aims to develop a modular mathematical model including fetal blood gas dynamics, the autonomic nervous system, and cerebral blood flow regulation. The novelty of this study lies in the capability of the model to simulate fetal growth. These submodels are part of a larger multiscale mathematical model describing fetal circulation in the second half of pregnancy. The blood gas model realistically replicates partial oxygen and carbon dioxide pressures in umbilical arteries and veins during healthy fetal development reported in the literature. An in silico experiment is conducted to simulate umbilical cord occlusion and is compared with lamb experiments to verify the realism of the regulation models during fetal growth. Our findings suggest that premature infants are more susceptible to umbilical cord occlusion, exhibiting elevated cerebral perfusion pressure and flow. This modular mathematical model may serve as a valuable tool for testing hypotheses related to the fetal regulatory system.