VP21.11: Assessment of postoperative pain in the fetus

The existence of pain during intrauterine life is still poorly explored. There is lack of models to study pain in fetuses and the existing studies have shown to be inconsistent. Although evidence has suggested that fetuses are capable to experience acute pain, there are no reports investigating fetal pain after invasive intrauterine procedures. The aim of this study was to assess postoperative fetal pain by the use of a facial expression-based method with 4D-US. A 37-year-old pregnant woman was referred to our service for fetal hydrops at 31 weeks. The ultrasound evaluation detected fetal hydrops due to bilateral pleural effusion, and congestive heart failure. Thoraco-amniotic shunt was performed. At 33 weeks the drains were well positioned, pleural effusion was no longer observed, edema had regressed and heart function became normal. In order to assess intrauterine pain-related behaviour in the postoperative period we monitored the fetal facial expressions of the subsequent 3 days after the shunt using the ultrasound WS80, Samsung. A 4D film was recorded and images were anonymised for blinded assessment and they were presented to 3 coders: a neurologist and 2 fetal medicine specialists. Facial expressions evaluated were brow lowering, eyes squeezed shut, deepening of the nasolabial furrow, open lips, vertical and horizontal mouth stretch and neck extension. The cut-off value for identifying acute pain in the 7-item pain scale is 5. The results obtained from the video did not evidence pain-related facial expression after the procedure and neither indicated persistent postoperative pain. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.