Pain in the fetus

In utero care: The definition of pain proposed by the international Associa tion for the Study of Pain is not adapted to the newborn or to the fetus be cause it assumes recognition and verbal expression of an unpleasant experie nce. Neonatologists have however demonstrated that full term and highly pre mature infants experience pain. In addition, the health of these infants i mproves 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 ques tion of conscious perception of pain by the fetus, we use experimental or c linical arguments favoring sensitivity to pain to assess pain during fetal life. We have also investigated the deleterious consequences of antenatal p ain and how to evaluate them clinically in order to propose therapeutic car e, it can be accepted that the fetus is able to perceive pain as early as 2 6 weeks gestation, possibly from 20 weeks. In the short-term, fetal pain ca uses 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 fetu s are available, prevention becomes primordial in all at risk situations (p regnancy termination beyond 24 weeks gestation, in utero interventions). Mo rphine derivatives (sufentanyl) would be the analgesic of choice for antena tal pain.