Fetal Pain in the First Trimester

Thill, Bridget

doi:10.1177/00243639211059245

Cited by 13 publications

(11 citation statements)

References 102 publications

(223 reference statements)

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“…During the 17th week, the development of the cerebral cortex takes place, which continues even after birth. In addition, data obtained from studies on the behavior of the fetus, prove that most of the time the fetus “sleeps” inside the uterus, however during painful stimuli fetuses were stimulated [ 35 ]. It is important to note that fetuses show stress-like hormonal responses to pain during intrauterine surgeries performed at 16 weeks of gestation, suggesting that a pain perception pathway has been formed at that time [ 35 ].…”

Section: Pain and Fetal Lifementioning

confidence: 99%

“…In addition, data obtained from studies on the behavior of the fetus, prove that most of the time the fetus “sleeps” inside the uterus, however during painful stimuli fetuses were stimulated [ 35 ]. It is important to note that fetuses show stress-like hormonal responses to pain during intrauterine surgeries performed at 16 weeks of gestation, suggesting that a pain perception pathway has been formed at that time [ 35 ]. Therefore, it becomes important to limit painful procedures for fetuses in order to prevent a potential impact of pain and stress both on survival and on its long-term neurodevelopmental course [ 36 ].…”

Section: Pain and Fetal Lifementioning

confidence: 99%

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Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

et al. 2022

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Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.

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Section: Pain and Fetal Lifementioning

confidence: 99%

Section: Pain and Fetal Lifementioning

confidence: 99%

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

et al. 2022

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“…Animals/foetuses need both sentience and consciousness to be able to perceive pain. All through the gestational periods, foetuses are kept in a sleep-like or comatose state via the activities of neuroinhibitors [ 54 ]. Reports that consciousness and responsiveness only begin postnatal [ 55 ] suggest that during the unforeseen death of the dam, the foetus simply passes from the sleep-like mode to death with minute or no distress at all.…”

Section: Discussionmentioning

confidence: 99%

Indiscriminate slaughter of pregnant goats for meat in Enugu, Nigeria: Causes, prevalence, implications and ways-out

UGWU

Njoga

et al. 2023

PLoS ONE

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Background The indiscriminate slaughter of pregnant goats (SPGs) undermines meat production and food security especially in developing countries. It also connotes animal cruelty, depletion of goat population and may enhance the spread of zoonotic pathogens inhabiting the female reproductive tract during carcass processing. Consequently, this study determined the causes and prevalence of slaughtering pregnant goats for meat in Enugu, Nigeria. The study also estimated the economic losses associated with SPGs, discussed the negative public health consequences and suggested the ways-out. Methods Structured, validated and pilot-tested questionnaire was used to ascertain the reasons for SPGs for meat among 78 willing and randomly selected respondents. The questionnaire survey was conducted in the form of interview. Pregnancy statuses of the goats slaughtered were ascertained by visual inspection and palpation of the eviscerated and longitudinally incised uteri and the horns for macroscopic evidence of pregnancy. Ages of the dams were estimated by dentition method. Estimation of the gestational age was performed by crown-rump length method. The study lasted for six months, comprised of three months (December to March) during the dry/hot season and another three months (May to August) during the wet/rainy season. Economic loss estimation was based on the current monetary values of a matured (30 kilogram) goat and one kilogram of chevon in Enugu, Nigeria; which was determined through market survey. Pearson’s Chi-square test was used to determine whether there were significant (P<0.05) statistical associations between SPGs and age and season. Results Major reasons adduced for SPGs were: economic hardship (41%), ignorance of the goat’s pregnancy status (21%), increased demand for chevon (13%) and feed scarcity during drought (11%). Of the 1,658 does examined during the six months study, 589 (35.5%) were pregnant. The majority (876/1658, 52.8%) of the female goats slaughtered were in their active reproductive age of ≤ 4 years, while 782 (47.2%) were aged > 4 years. Similarly, majority (1007/1658, 60.7%) of the does/nannies were slaughtered during the dry/hot season. A total of 907 foetuses at first (n = 332, 36.6%), second (n = 486, 53.6%) and third (n = 89, 9.8%) trimesters of gestation were recovered from the 589 PGs. Singleton, twin and triplet pregnancies were observed in 312 (53%), 236 (40%) and 41 (7%) PGs, respectively. About ₦34.44 million ($83,390) would have been earned if the foetuses were born alive and raised to maturity. Additionally, 19,136 kg of chevon, valued at ₦47,841, 000 ($115,838), which would have accrued from the wasted foetuses was also lost. Conclusion Considering the economic, zoonotic and livestock production implications of this work, frantic efforts to reduce SPGs in Enugu, Nigeria is imperative. This could be achieved through advocacy, goat farmers’ enlightenment, ante-mortem pregnancy diagnosis, provision of subsidized feed materials during the dry season and strict enforcement of the Nigerian Meat Edict law, which proscribes unapproved slaughter of gravid animals. These measures may improve food safety and security, improve goat reproduction and production, reduce protein malnutrition, limit dissemination of zoonotic pathogens during carcass processing and hence protect public health in Nigeria.

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“…In the 2020s, researchers suggest that the necessity of the cortex in pain perception may have been overestimated ( 4 , 16 , 35 , 46 ). Recent evidence indicates that thalamic projections to the subplate at 12 weeks gestation may be functionally equivalent to thalamocortical connections that develop at 24 weeks gestation ( 4 ), signifying that fetal pain mediated by the subplate and subcortical structures may be possible as early as the first trimester (<14 weeks) ( Figure 4 ) ( 4 , 35 , 36 , 47 ). Fetal responses to noxious stimuli during clinically-indicated procedures are listed in Table 1 .…”

Section: An Evolving Understanding Of Painmentioning

confidence: 99%

The fetal pain paradox

Thill

2023

Front. Pain Res.

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Controversy exists as to when conscious pain perception in the fetus may begin. According to the hypothesis of cortical necessity, thalamocortical connections, which do not form until after 24–28 weeks gestation, are necessary for conscious pain perception. However, anesthesiologists and neonatologists treat age-matched neonates as both conscious and pain-capable due to observable and measurable behavioral, hormonal, and physiologic indicators of pain. In preterm infants, these multimodal indicators of pain are uncontroversial, and their presence, despite occurring prior to functional thalamocortical connections, has guided the use of analgesics in neonatology and fetal surgery for decades. However, some medical groups state that below 24 weeks gestation, there is no pain capacity. Thus, a paradox exists in the disparate acknowledgment of pain capability in overlapping patient populations. Brain networks vary by age. During the first and second trimesters, the cortical subplate, a unique structure that is present only during fetal and early neonatal development, forms the first cortical network. In the third trimester, the cortical plate assumes this function. According to the subplate modulation hypothesis, a network of connections to the subplate and subcortical structures is sufficient to facilitate conscious pain perception in the fetus and the preterm neonate prior to 24 weeks gestation. Therefore, similar to other fetal and neonatal systems that have a transitional phase (i.e., circulatory system), there is now strong evidence for transitional developmental phases of fetal and neonatal pain circuitry.

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Fetal Pain in the First Trimester

Cited by 13 publications

References 102 publications

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

Indiscriminate slaughter of pregnant goats for meat in Enugu, Nigeria: Causes, prevalence, implications and ways-out

The fetal pain paradox

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