2021
DOI: 10.1097/pr9.0000000000000882
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Sorting pain out of salience: assessment of pain facial expressions in the human fetus

Abstract: Introduction:The question of whether the human fetus experiences pain has received substantial attention in recent times. With the advent of high-definition 4-dimensional ultrasound (4D-US), it is possible to record fetal body and facial expressions. Objective: To determine whether human fetuses demonstrate discriminative acute behavioral responses to nociceptive input. Methods: This cross-sectional study included 5 fetuses with diaphragmatic hernia with indication of intrauterine surgery (fetoscopic endolumin… Show more

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Cited by 13 publications
(12 citation statements)
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“…Issues such as the use of anesthesia during medical termination of pregnancy, efficacy of anesthesia during invasive intrauterine procedures and presence of postprocedural fetal pain have major clinical implications. Recently, a tool for evaluating facial expressions related to acute pain was described in an experimental study and was used to assess pain in late third‐trimester human fetuses 2 . In order to investigate the presence of fetal pain during the second trimester, we evaluated fetal pain score in a 23‐week fetus undergoing cardiac surgery.…”
Section: Figurementioning
confidence: 99%
“…Issues such as the use of anesthesia during medical termination of pregnancy, efficacy of anesthesia during invasive intrauterine procedures and presence of postprocedural fetal pain have major clinical implications. Recently, a tool for evaluating facial expressions related to acute pain was described in an experimental study and was used to assess pain in late third‐trimester human fetuses 2 . In order to investigate the presence of fetal pain during the second trimester, we evaluated fetal pain score in a 23‐week fetus undergoing cardiac surgery.…”
Section: Figurementioning
confidence: 99%
“…Fetal blood pressure monitoring is not yet feasible [139] Slowing of the fetal heart can be a sign of fetal hypoxaemia and acidosis, but can also be related to a decrease in temperature, maternal respiratory acidosis, or to the administration of drugs [140]. Some authors have tried to create a fetal pain assessment tool, to be used during prenatal surgery [141]. The current fetal monitoring during prenatal surgery is based on echocardiographic monitoring of fetal heart rate and contractility.…”
Section: Extraction Indexmentioning
confidence: 99%
“…As noted by researchers in 2019, "It is now recognised that the developing motor and sensory systems are able to function long before they have completed their neural maturation" (Borsani et al 2019, 225). This has raised growing concern that the necessity of the cortex for pain perception may have been overstated, and that fetal pain perception is possible even with an immature cortex (Bellieni 2020;Bernardes et al 2021a;Derbyshire and Bockmann 2020;Merker 2007).…”
Section: Hypothesis 1: Cortical Necessity (>24 Weeks)mentioning
confidence: 99%
“…These indices reflect the earlier development of the upper facial muscles compared Thill to the lower facial muscles. Fetal pain assessments have also been conducted using the NFCS during painful intramuscular injections prior to fetal surgery (Bernardes et al 2021a(Bernardes et al , 2021b(Bernardes et al , 2018. Facial expressions (horizontal mouth stretch, open lips, vertical mouth stretch, and brow lowering) were elevated in those fetuses receiving injections compared to controls.…”
Section: Behavioral Evidencementioning
confidence: 99%
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