Fetal Pain: Do We Know Enough to Do the Right Thing?

Derbyshire, Stuart

doi:10.1016/s0968-8080(08)31370-6

Cited by 22 publications

(18 citation statements)

References 50 publications

(60 reference statements)

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“…Fetal cutaneous nociceptors would likely receive minimal stimulation during pregnancies that progress without traumatic, therapeutic, or pathological injury to the skin. Yet, these nociceptors clearly develop functionally in utero because invasive skin manipulations elicit physiological stress and other responses when conducted both before birth (e.g., fetal lambs and fetal human infants [20,46,108,109]) and soon after birth (e.g., lambs [110]; piglets [111]; lambs, calves, piglets [112]; human infants [46,66,108]). Of course, variable levels of fetal nociceptor stimulation are likely to occur as a result of labour-induced compression and/or injuries sustained during normal and, especially, difficult births (e.g., [17,19,21,113]).…”

Section: The Intrauterine Sensory Environment Of the Embryo/fetusmentioning

confidence: 99%

Preparing for Life After Birth: Introducing the Concepts of Intrauterine and Extrauterine Sensory Entrainment in Mammalian Young

Mellor

2019

Animals

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Simple SummaryA key event in the life of a mammalian fetus is its birth, especially in view of the exceptional change in its environment that occurs at birth. An area of great interest is the extent to which factors within the uterus prepare the fetus for birth and postnatal life. These and other factors are evaluated here for mammalian young that exhibit mature, moderately immature, and exceptionally immature neurological development at birth. A striking finding is the basic uniformity of various preparatory processes despite the diversity of birth-related circumstances among different terrestrial mammals. Numerous scientific disciplines have contributed to understanding in this area. Accordingly, the major purpose of this review is to construct from these diverse sources an integrated account of important facets of our current understanding. The primary focus is on how a progressive improvement in the functional effectiveness of the sensory systems for touch, temperature, taste, smell, balance/movement, hearing, and sight equips young mammals to cope successfully with the considerable challenge of being expelled from the uterus into the outside world. It is shown that the sensory environment in the uterus interacts with the genetically preprogrammed development of the apparatus for each sensory modality. It is also shown that the way this occurs can embed stimulus-response capabilities that can be accessed and beneficially utilised after birth. This phenomenon is called “trans-natal sensory continuity”. This embedding of sensory capabilities has previously been described as “learning” and the subsequent accessing of these embedded capabilities as “memory”. However, it is noted that such “learning” and “memory” processes are sometimes mistakenly thought to require the fetus to be conscious, a view which does not accord with established understanding of learning processes, nor with compelling contrary evidence from direct studies of fetal brain states. The solution proposed is to describe trans-natal sensory continuity in terms of the neurophysiological mechanisms involved and not as learning and memory outcomes. Introduced here, therefore, is the concept of “intrauterine sensory entrainment”. Its specific mechanistic basis is the well-established way nervous systems respond to sensory stimuli by reorganising their neural structures, functions, and connections. Known as neuroplasticity, this is recognised as integral to both prenatal and postnatal brain development and as the basis of postnatal learning and memory. Thus, intrauterine sensory entrainment is the mechanism by which trans-natal sensory continuity is achieved. It begins with the prenatal embedding of responsiveness to particular sensory inputs which are generated by the stimulation of specific receptors once the neurological apparatus for that sensory modality has begun to develop. Thereafter, this process continues until birth, and this makes all such entrained sensory capabilities available to operate after birth. Nevertheless, all sensory systems th...

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Section: The Intrauterine Sensory Environment Of the Embryo/fetusmentioning

confidence: 99%

Preparing for Life After Birth: Introducing the Concepts of Intrauterine and Extrauterine Sensory Entrainment in Mammalian Young

Mellor

2019

Animals

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“…24 Importantly, no new revelatory scientific insights have been published since 2005 to challenge the authors' findings at the time. 25 Thus, while it may be accurate for Nebraska to find that some of the anatomic structures within the developing nervous system are present in a normally developed fetus at 20 weeks postfertilization gestation, it is misleading to suggest this physical reality is sufficient for a fetus to "experience" pain. It is further misleading to suggest that observable neuroendocrine, metabolic, and reflexive responses to stimuli are equivalent to meaningful pain perception.…”

Section: The State's New Interest In Preventing Fetal Painmentioning

confidence: 99%

Fetal Pain, Abortion, Viability, and the Constitution

Cohen¹,

Sayeed²

2011

J. Law. Med. Ethics

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In early 2010, the Nebraska state legislature passed a new abortion restricting law asserting a new, compelling state interest in preventing fetal pain. In this article, we review existing constitutional abortion doctrine and note difficulties presented by persistent legal attention to a socially derived viability construct. We then offer a substantive biological, ethical, and legal critique of the new fetal pain rationale.

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“…The majority of current standpoints about fetal pain follow this concept 5–8. The perception of pain among adults encompasses the subject’s consciousness and active cortex cerebri, which enables learning and activates memory and emotions in the process of pain processing 9.…”

Section: Introductionmentioning

confidence: 99%

“…The perception of pain among adults encompasses the subject’s consciousness and active cortex cerebri, which enables learning and activates memory and emotions in the process of pain processing 9. If the definition including the learning process and understating the cause–effect relationship is applied, it would mean that the infant would become aware of pain between the second and fourth week of postnatal life 5. Mellor et al completely dismiss the notion that the fetus feels pain during pregnancy 3.…”

Section: Introductionmentioning

confidence: 99%

“…Derbyshire concludes, based on the necessity of cortex cerebri activity in processing pain perception, that the earliest period when the fetus can feel pain is the 23rd gestation week. That is the week when thalamic projections, which can transmit information about nociception to the cortical plate, are formed 5. The maturity of the thalamus and associated subcortical structures with proper thalamocortical connections at the 20th gestation week accompanied by a coordinating electroencephalogram rhythm, provide the possibility for the fetus to experience something approximating “pain” 6.…”

Section: Introductionmentioning

confidence: 99%

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Appearance of fetal pain could be associated with maturation of the mesodiencephalic structures

Sekulić¹,

Gebauer-Bukurov²,

Cvijanović³

et al. 2016

JPR

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Fetal pain remains a controversial subject both in terms of recognizing its existence and the time-frame within which it appears. This article investigates the hypothesis that pain perception during development is not related to any determined structures of the central nervous system (CNS), on the contrary, the process of perception could be made with any structure satisfying conditions that the perception of pain is the organization, identification, and interpretation of sensory information in order to represent and understand the environment. According to this definition, chronic decerebrate and decorticate experimental animals, anencephalic, and hydranencephalic patients demonstrate that the basic, most general, appropriate interaction with the environment can be achieved with a functional mesodiencephalon (brain stem, and diencephalon) as the hierarchically highest structure of the CNS during development. In intact fetuses, this structure shows signs of sufficient maturation starting from the 15th week of gestation. Bearing in mind the dominant role of the reticular formation of the brain stem, which is marked by a wide divergence of afferent information, a sense of pain transmitted through it is diffuse and can dominate the overall perception of the fetus. The threshold for tactile stimuli is lower at earlier stages of gestation. The pain inhibition mechanisms are not sufficiently developed during intrauterine development, which is another factor that leads to increased intensity of pain in the fetus. As a conclusion it could be proposed that the fetus is exposed to rudimentary painful stimuli starting from the 15th gestation week and that it is extremely sensitive to painful stimuli.

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Fetal Pain: Do We Know Enough to Do the Right Thing?

Cited by 22 publications

References 50 publications

Preparing for Life After Birth: Introducing the Concepts of Intrauterine and Extrauterine Sensory Entrainment in Mammalian Young

Preparing for Life After Birth: Introducing the Concepts of Intrauterine and Extrauterine Sensory Entrainment in Mammalian Young

Fetal Pain, Abortion, Viability, and the Constitution

Appearance of fetal pain could be associated with maturation of the mesodiencephalic structures

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