Dor fetal: motivo para preocupação?

Abstract

IntroductionWith the evolution of Fetal Medicine and the increasing use of invasive techniques, it is mandatory to investigate if fetal pain is really an issue. MethodsA bibliographic search on scientific knowledge of fetal pain, its neuroanatomical and neurophysiological bases, consequences and clinical implications was conducted in Pubmed. ResultsDue to practical and ethical restrictions in using the human fetus in research, most of the evidence in this area is indirectly inferred from animal studies and through observations made in preterm human newborns. Pain perception is assumed from the integrity of neuroanatomic structures and its functionality, as well as from the endocrinal, hemodynamic and behavioral changes associated with pain. This perception is not likely to exist before 29-30 weeks of gestational age. The exposure to noxious stimulus in the perinatal period seems likely to cause to neurological development and behavioral changes, thereby fetal analgesia/anesthesia can mitigate the reaction to stress and thus avoid these deleterious long-term effects. ConclusionsGiven that pain is a subjective experience, its neurobiological understanding is far more complex than the basic knowledge of the anatomical and physiological ways of nociception. Available data derived from main studies in this area do not take into account the intrauterine environment idiossincracies and so can not prove the existence of fetal pain awareness. On the other hand, further investigation is needed to clarify the impact of fetal nociception in postnatal neurodevelopment, as well as the need for fetal analgesia/anesthesia.