[Fetal pain].
IN UTERO CARE: The definition of pain proposed by the International Association for the Study of Pain is not adapted to the newborn or to the fetus because it assumes recognition and verbal expression of an unpleasant experience. Neonatologists have however demonstrated that full term and highly premature infants experience pain. In addition, the health of these infants improves with proper management. Such an approach is indispensable, not only from an obvious humane point of view, but also because treatment of pain in utero could have a beneficial effect for the fetus. PRENATAL PAIN AND ITS CONSEQUENCES: As it is impossible to resolve the question of conscious perception of pain by the fetus, we use experimental or clinical arguments favoring sensitivity to pain to assess pain during fetal life. We have also investigated the deleterious consequences of antenatal pain and how to evaluate them clinically in order to propose therapeutic care. It can be accepted that the fetus is able to perceive pain as early as 26 weeks gestation, possibly from 20 weeks. In the short-term, fetal pain causes changes in behavior, hemodynamics and hormonal functions but the long-term consequences remain unknown. ANTENATAL ANALGESIA: As no validated data on assessment of pain in the fetus are available, prevention becomes primordial in all at risk situations (pregnancy termination beyond 24 weeks gestation, in utero interventions). Morphine derivatives (sufentanil) would be the analgesic of choice for antenatal pain.
Mahieu-Caputo
D
D
Hôpital Necker-enfants-malades, Paris. dominique.mahieu@nck.ap-hop-paris.fr
Dommergues
M
M
Muller
F
F
Dumez
Y
Y
D000818:Animals; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D010146:Pain / Q000175:diagnosis*; D059408:Pain Management; D010147:Pain Measurement; D011247:Pregnancy; D011296:Prenatal Diagnosis