Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Gynecology and Obstetrics Department, University of Sao Paulo, São Paulo, Brazil; Gynecology and obstetrics, SEPACO Maternity Hospital, São Paulo, Brazil; Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark.
Pain Center, Department of Neurology, University of Sao Paulo, São Paulo, Brazil.
J Pain. 2024 Sep;25(9):104527. doi: 10.1016/j.jpain.2024.104527. Epub 2024 Apr 8.
Improvements in fetal ultrasound have allowed for the diagnosis and treatment of fetal diseases in the uterus, often through surgery. However, little attention has been drawn to the assessment of fetal pain. To address this gap, a fetal pain scoring system, known as the Fetal-7 scale, was developed. The present study is a full validation of the Fetal-7 scale. The validation involved 2 steps: 1) 4 fetuses with the indication of surgery were evaluated in 3 conditions perioperatively: acute pain, rest, and under loud sound stimulation. Facial expressions were assessed by 30 raters using screenshots from 4D high-definition ultrasound films; 2) assessment of sensitivity and specificity of the Fetal-7 scale in 54 healthy fetuses and 2 fetuses undergoing acute pain after preoperative anesthetic intramuscular injection. There was high internal consistency with Cronbach's alpha (α) of .99. Intrarater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient was .95, and inter-rater reliability was .99. The scale accurately differentiated between healthy fetuses at rest and those experiencing acute pain (sensitivity of 100% and specificity of 94.4%). The Fetal-7 scale is a valid tool for assessing acute pain-related behavior in third-trimester fetuses and may be of value in guiding analgesic procedures efficacy in these patients. Further research is warranted to explore the presence of postoperative pain in fetuses and its effects after birth. PERSPECTIVE: Recordings with 3-dimensional ultrasound of human fetuses undergoing preoperative anesthetic injections revealed complex facial expressions during acute pain, similar to those collected in newborns. This study presented the validation process and cut-off value of the Fetal-7 scale, paving the way for the study of pain before birth in humans.
胎儿超声技术的进步使得在子宫内对胎儿疾病进行诊断和治疗成为可能，通常通过手术实现。然而，对于胎儿疼痛的评估却很少受到关注。为了解决这一空白，人们开发了一种胎儿疼痛评分系统，称为 Fetal-7 量表。本研究是对 Fetal-7 量表的全面验证。验证分为 2 个步骤：1）对 4 例有手术指征的胎儿在围手术期的 3 种情况下进行评估：急性疼痛、休息和大声声音刺激。通过 30 名评分者使用 4D 高清超声电影的截图来评估面部表情；2）评估 Fetal-7 量表在 54 例健康胎儿和 2 例术前肌内麻醉注射后出现急性疼痛的胎儿中的敏感性和特异性。Cronbach's alpha（α）值为.99，具有较高的内部一致性。通过组内相关系数计算的 Fetal-7 量表的组内可靠性为.95，组间可靠性为.99。该量表准确地区分了休息时的健康胎儿和经历急性疼痛的胎儿（敏感性为 100%，特异性为 94.4%）。Fetal-7 量表是一种评估第三孕期胎儿与急性疼痛相关行为的有效工具，可能有助于指导这些患者的镇痛程序疗效。需要进一步的研究来探索胎儿术后疼痛的存在及其对出生后的影响。观点：对接受术前麻醉注射的人类胎儿进行三维超声记录显示，在急性疼痛期间出现了复杂的面部表情，与在新生儿中收集到的表情相似。本研究介绍了 Fetal-7 量表的验证过程和截断值，为人类出生前疼痛的研究铺平了道路。
