Elsevier

The Lancet

Volume 344, Issue 8915, 9 July 1994, Pages 77-81
The Lancet

Articles
Fetal plasma cortisol and β-endorphin response to intrauterine needling

https://doi.org/10.1016/S0140-6736(94)91279-3Get rights and content

Abstract

Summary

The purpose of this study was to investigate whether the fetus mounts a hormonal stress response to a potentially painful procedure, intrauterine needling.

Cortisol and β-endorphin concentrations in fetal plasma obtained during uncomplicated fetal blood sampling or intrauterine transfusions by needling the fetal intra-abdominal portion of the umbilical vein (intrahepatic vein) were compared to hormone concentrations in fetal plasma obtained by the conventional technique of needling the placental cord insertion, which is not innervated. Cortisol and β-endorphin concentrations did not increase within 10 minutes of fetal abdominal needling (n=15). However, more prolonged needling during transfusion at the intrahepatic vein was associated with an increase in fetal plasma cortisol (median increase 48 nmol/L; 95% Cl, 23-86) and β-endorphin (207 pg/mL; 113-307) concentrations compared to transfusion at the placental cord insertion (p<0 005 for both hormones). The magnitude of rise in hormone increased linearly with the duration of needling (cortisol, r= 0 80; β-endorphin, r= 0 88; p<0·05 for both).

These data suggest that the fetus mounts a hormonal stress response to invasive procedures. They raise the possibility that the human fetus feels pain in utero, and may benefit from anaesthesia or analgesia for invasive procedures.

References (31)

  • Mc Rogers

    Do the right thing: pain relief in infants and children

    N Engl J Med

    (1992)
  • F. Daffos et al.

    Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases

    Am J Obstet Gynecol

    (1986)
  • N. Zosmer et al.

    Fetal blood sampling from the intrahepatic vein versus cord insertion: effect on pH and blood gases

    Obstet Gynecol

    (1993)
  • U. Nicolini et al.

    The fetal intrahepatic vein as an alternative to cord needling for prenatal diagnosis and therapy

    Prenat Diagn

    (1988)
  • U. Nicolini et al.

    Fetal blood sampling from the intrahepatic portion of the umbilical vein: experience with 210 cases

    Obstet Gynecol

    (1990)
  • Cited by (268)

    • Endocrine consequences of circadian rhythm disruption in early life

      2020, Current Opinion in Endocrine and Metabolic Research
    • Fetal Intervention and the EXIT Procedure

      2019, A Practice of Anesthesia for Infants and Children
    • Fetal Intervention and the EXIT Procedure

      2018, A Practice of Anesthesia for Infants and Children
    View all citing articles on Scopus
    View full text