{"id":"https://openalex.org/W7207758201","doi":"https://doi.org/10.5041/rmmj.10583","title":"Fetal Pain: Neurobiology, Clinical Practice, and Compassionate Care\u2014A Narrative Review","display_name":"Fetal Pain: Neurobiology, Clinical Practice, and Compassionate Care\u2014A Narrative Review","publication_year":2026,"publication_date":"2026-09-03","ids":{"openalex":"https://openalex.org/W7207758201","doi":"https://doi.org/10.5041/rmmj.10583","pmid":"https://pubmed.ncbi.nlm.nih.gov/42709688","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13719272"},"language":"en","primary_location":{"id":"doi:10.5041/rmmj.10583","doi":"https://doi.org/10.5041/rmmj.10583","is_oa":true,"landing_page_url":"https://doi.org/10.5041/rmmj.10583","pdf_url":"https://www.rmmj.org.il/userimages/4765/1/PublishFiles/4864OnlineFirst.pdf","source":{"id":"https://openalex.org/S144485983","display_name":"Rambam Maimonides Medical Journal","issn_l":"2076-9172","issn":["2076-9172"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","poland-20","russia-white-list-2"],"host_organization":"https://openalex.org/P4310319195","host_organization_name":"Rambam Health Care Campus","host_organization_lineage":["https://openalex.org/P4310319195"],"host_organization_lineage_names":["Rambam Health Care Campus"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rambam Maimonides Medical Journal","raw_type":"journal-article"},"volume":null,"type":"review","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.rmmj.org.il/userimages/4765/1/PublishFiles/4864OnlineFirst.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5077948181","display_name":"Omri Dominsky","orcid":"https://orcid.org/0009-0008-3096-4579","observed_orcids":["https://orcid.org/0009-0008-3096-4579"]},"institutions":[{"id":"https://openalex.org/I16391192","display_name":"Tel Aviv University","ror":"https://ror.org/04mhzgx49","country_code":"IL","type":"education","lineage":["https://openalex.org/I16391192"]},{"id":"https://openalex.org/I2799807261","display_name":"Tel Aviv Sourasky Medical Center","ror":"https://ror.org/04nd58p63","country_code":"IL","type":"healthcare","lineage":["https://openalex.org/I2799807261"]}],"countries":["IL"],"is_corresponding":false,"raw_author_name":"Omri Dominsky","raw_affiliation_strings":["Department of Obstetrics and Gynecology, Lis Hospital for Women\u2019s Health, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel (affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel)"],"raw_orcid":"https://orcid.org/0009-0008-3096-4579","affiliations":[{"raw_affiliation_string":"Department of Obstetrics and Gynecology, Lis Hospital for Women\u2019s Health, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel (affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel)","institution_ids":["https://openalex.org/I16391192","https://openalex.org/I2799807261"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5028188445","display_name":"Ido Solt","orcid":"https://orcid.org/0000-0002-6717-7631","observed_orcids":["https://orcid.org/0000-0002-6717-7631"]},"institutions":[{"id":"https://openalex.org/I174306211","display_name":"Technion \u2013 Israel Institute of Technology","ror":"https://ror.org/03qryx823","country_code":"IL","type":"education","lineage":["https://openalex.org/I174306211"]},{"id":"https://openalex.org/I2801301638","display_name":"Rambam Health Care Campus","ror":"https://ror.org/01fm87m50","country_code":"IL","type":"healthcare","lineage":["https://openalex.org/I2801301638"]}],"countries":["IL"],"is_corresponding":true,"raw_author_name":"Ido Solt","raw_affiliation_strings":["Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel and The Ruth and Bruce Rappaport Faculty of Medicine, Technion\u2013Israel Institute of Technology, Haifa, Israel"],"raw_orcid":"https://orcid.org/0000-0002-6717-7631","affiliations":[{"raw_affiliation_string":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel and The Ruth and Bruce Rappaport Faculty of Medicine, Technion\u2013Israel Institute of Technology, Haifa, Israel","institution_ids":["https://openalex.org/I174306211","https://openalex.org/I2801301638"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5028188445"],"corresponding_institution_ids":["https://openalex.org/I174306211","https://openalex.org/I2801301638"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.48058001,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"17","issue":"4","first_page":"e0025","last_page":"e0025"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11292","display_name":"Pediatric Pain Management Techniques","score":0.8335000276565552,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11292","display_name":"Pediatric Pain Management Techniques","score":0.8335000276565552,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10189","display_name":"Anesthesia and Pain Management","score":0.06809999793767929,"subfield":{"id":"https://openalex.org/subfields/2703","display_name":"Anesthesiology and Pain Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10196","display_name":"Pain Mechanisms and Treatments","score":0.017799999564886093,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/fetal-pain","display_name":"fetal pain","score":0.9089999794960022},{"id":"https://openalex.org/keywords/fetal-analgesia","display_name":"fetal analgesia","score":0.8790000081062317},{"id":"https://openalex.org/keywords/risk-benefit-assessment","display_name":"risk-benefit assessment","score":0.7850000262260437},{"id":"https://openalex.org/keywords/compassionate-care","display_name":"compassionate care","score":0.6990000009536743}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.670799970626831},{"id":"https://openalex.org/C172680121","wikidata":"https://www.wikidata.org/wiki/Q26513","display_name":"Fetus","level":3,"score":0.6654000282287598},{"id":"https://openalex.org/C25876315","wikidata":"https://www.wikidata.org/wiki/Q15197465","display_name":"Neurochemical","level":2,"score":0.6353999972343445},{"id":"https://openalex.org/C15490471","wikidata":"https://www.wikidata.org/wiki/Q2734305","display_name":"Nociception","level":3,"score":0.5299999713897705},{"id":"https://openalex.org/C169760540","wikidata":"https://www.wikidata.org/wiki/Q207011","display_name":"Neuroscience","level":1,"score":0.5022000074386597},{"id":"https://openalex.org/C2776814716","wikidata":"https://www.wikidata.org/wiki/Q574801","display_name":"Sedation","level":2,"score":0.4839000105857849},{"id":"https://openalex.org/C3020000205","wikidata":"https://www.wikidata.org/wiki/Q2412849","display_name":"Narrative review","level":2,"score":0.45890000462532043},{"id":"https://openalex.org/C104211972","wikidata":"https://www.wikidata.org/wiki/Q7067309","display_name":"Noxious stimulus","level":4,"score":0.4092000126838684},{"id":"https://openalex.org/C60644358","wikidata":"https://www.wikidata.org/wiki/Q128570","display_name":"Bioinformatics","level":1,"score":0.39329999685287476},{"id":"https://openalex.org/C36951298","wikidata":"https://www.wikidata.org/wiki/Q379784","display_name":"Arousal","level":2,"score":0.3813999891281128},{"id":"https://openalex.org/C2777122282","wikidata":"https://www.wikidata.org/wiki/Q1480305","display_name":"Fetal surgery","level":5,"score":0.3736000061035156},{"id":"https://openalex.org/C2779234561","wikidata":"https://www.wikidata.org/wiki/Q11995","display_name":"Pregnancy","level":2,"score":0.3555000126361847},{"id":"https://openalex.org/C2778013503","wikidata":"https://www.wikidata.org/wiki/Q152247","display_name":"Crying","level":2,"score":0.3531999886035919},{"id":"https://openalex.org/C26760741","wikidata":"https://www.wikidata.org/wiki/Q160402","display_name":"Perception","level":2,"score":0.34929999709129333},{"id":"https://openalex.org/C2779409897","wikidata":"https://www.wikidata.org/wiki/Q7631811","display_name":"Subplate","level":3,"score":0.3472000062465668},{"id":"https://openalex.org/C42219234","wikidata":"https://www.wikidata.org/wiki/Q131130","display_name":"Anesthesia","level":1,"score":0.33980000019073486},{"id":"https://openalex.org/C94487597","wikidata":"https://www.wikidata.org/wiki/Q11101","display_name":"Sensory system","level":2,"score":0.33559998869895935},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.32339999079704285},{"id":"https://openalex.org/C2781118164","wikidata":"https://www.wikidata.org/wiki/Q1088113","display_name":"Chronic pain","level":2,"score":0.31150001287460327},{"id":"https://openalex.org/C186720457","wikidata":"https://www.wikidata.org/wiki/Q7087","display_name":"Consciousness","level":2,"score":0.30320000648498535},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.29910001158714294},{"id":"https://openalex.org/C2991880133","wikidata":"https://www.wikidata.org/wiki/Q2734305","display_name":"Pain perception","level":2,"score":0.29499998688697815},{"id":"https://openalex.org/C2991701371","wikidata":"https://www.wikidata.org/wiki/Q34581","display_name":"Labor pain","level":3,"score":0.27619999647140503},{"id":"https://openalex.org/C2779703513","wikidata":"https://www.wikidata.org/wiki/Q34581","display_name":"Childbirth","level":3,"score":0.26570001244544983},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.2621999979019165},{"id":"https://openalex.org/C2993247534","wikidata":"https://www.wikidata.org/wiki/Q621261","display_name":"Pain relief","level":2,"score":0.2513999938964844},{"id":"https://openalex.org/C2778376644","wikidata":"https://www.wikidata.org/wiki/Q2253111","display_name":"Gestational age","level":3,"score":0.25040000677108765}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.5041/rmmj.10583","doi":"https://doi.org/10.5041/rmmj.10583","is_oa":true,"landing_page_url":"https://doi.org/10.5041/rmmj.10583","pdf_url":"https://www.rmmj.org.il/userimages/4765/1/PublishFiles/4864OnlineFirst.pdf","source":{"id":"https://openalex.org/S144485983","display_name":"Rambam Maimonides Medical Journal","issn_l":"2076-9172","issn":["2076-9172"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","poland-20","russia-white-list-2"],"host_organization":"https://openalex.org/P4310319195","host_organization_name":"Rambam Health Care Campus","host_organization_lineage":["https://openalex.org/P4310319195"],"host_organization_lineage_names":["Rambam Health Care Campus"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rambam Maimonides Medical Journal","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13719272","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13719272/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13719272/pdf/rmmj-17-4-e0025.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rambam Maimonides Med J","raw_type":"Text"},{"id":"pmid:42709688","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42709688","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rambam Maimonides medical journal","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:4b8e1edf5b074c3d85ebc201c90050dc","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/4b8e1edf5b074c3d85ebc201c90050dc","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Rambam Maimonides Medical Journal, Vol 17, Iss 4, p e0025 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.5041/rmmj.10583","doi":"https://doi.org/10.5041/rmmj.10583","is_oa":true,"landing_page_url":"https://doi.org/10.5041/rmmj.10583","pdf_url":"https://www.rmmj.org.il/userimages/4765/1/PublishFiles/4864OnlineFirst.pdf","source":{"id":"https://openalex.org/S144485983","display_name":"Rambam Maimonides Medical Journal","issn_l":"2076-9172","issn":["2076-9172"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","poland-20","russia-white-list-2"],"host_organization":"https://openalex.org/P4310319195","host_organization_name":"Rambam Health Care Campus","host_organization_lineage":["https://openalex.org/P4310319195"],"host_organization_lineage_names":["Rambam Health Care Campus"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rambam Maimonides Medical Journal","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9537000060081482}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7207758201.pdf","grobid_xml":"https://content.openalex.org/works/W7207758201.grobid-xml"},"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2103270251","https://openalex.org/W2145284884","https://openalex.org/W4206316125","https://openalex.org/W4312915290","https://openalex.org/W4402117760","https://openalex.org/W4200248133","https://openalex.org/W4398246312","https://openalex.org/W7100480795","https://openalex.org/W2926380900","https://openalex.org/W3209278243"],"abstract_inverted_index":{"BACKGROUND:":[0],"Whether":[1],"a":[2,47,209,217],"fetus":[3],"can":[4,87],"experience":[5],"pain":[6,32,167],"remains":[7],"scientifically":[8],"and":[9,28,34,60,74,86,95,143,199],"clinically":[10],"contested,":[11],"particularly":[12],"as":[13],"invasive":[14,42],"fetal":[15,23,39,91,127,137,155,176],"procedures":[16],"become":[17],"more":[18],"common.":[19],"OBJECTIVES:":[20],"To":[21],"review":[22],"nociceptive":[24,73],"development,":[25],"the":[26,35,55,83,100,136,162,182],"evidence":[27],"uncertainties":[29],"relevant":[30],"to":[31,77,119],"perception,":[33],"clinical":[36,173],"rationale":[37],"for":[38,108,122,175],"analgesia":[40,177],"during":[41],"procedures.":[43],"METHODS:":[44],"We":[45],"performed":[46],"targeted":[48],"narrative":[49],"search":[50],"of":[51,185],"PubMed/MEDLINE,":[52],"Google":[53],"Scholar,":[54],"Cochrane":[56],"Library,":[57],"reference":[58],"lists,":[59],"professional":[61],"society":[62],"websites.":[63],"The":[64,172],"final":[65],"synthesis":[66],"comprised":[67],"34":[68],"core":[69],"sources.":[70],"RESULTS:":[71],"Functional":[72],"neuroendocrine":[75],"responses":[76],"noxious":[78],"stimuli":[79],"are":[80],"documented":[81,195],"from":[82,181],"mid-second":[84],"trimester":[85],"be":[88,120,179,206],"attenuated":[89],"by":[90,132],"opioids.":[92],"Early":[93],"thalamic":[94],"subplate":[96],"circuitry":[97,114],"may":[98,140,151],"challenge":[99],"claim":[101],"that":[102],"mature":[103],"cortical":[104],"architecture":[105],"is":[106,129],"required":[107],"all":[109],"pain-related":[110],"processing,":[111],"but":[112],"this":[113],"has":[115],"not":[116,130,152],"been":[117],"shown":[118],"sufficient":[121],"conscious":[123,186],"pain.":[124,187],"Continuous":[125],"endogenous":[126],"sedation":[128],"supported":[131],"behavioral":[133],"evidence,":[134],"although":[135],"neurochemical":[138],"environment":[139],"modulate":[141],"arousal":[142],"sensory":[144],"processing.":[145],"Maternal":[146],"anesthesia,":[147,150],"especially":[148],"regional":[149],"provide":[153],"reliable":[154],"analgesic":[156],"exposure.":[157],"Professional":[158],"guidance":[159],"differs":[160],"on":[161,208],"gestational":[163],"age":[164],"at":[165],"which":[166],"perception":[168],"becomes":[169],"possible.":[170],"CONCLUSIONS:":[171],"case":[174],"should":[178,204],"separated":[180],"unresolved":[183],"question":[184],"Potential":[188],"rationales":[189],"include":[190],"preventing":[191],"possible":[192],"suffering,":[193],"attenuating":[194],"physiological":[196],"stress":[197],"responses,":[198],"facilitating":[200],"procedural":[201],"stability.":[202],"Decisions":[203],"therefore":[205],"based":[207],"proportionate,":[210],"procedure-specific":[211],"maternal-fetal":[212],"risk-benefit":[213],"assessment":[214],"rather":[215],"than":[216],"universal":[218],"precautionary":[219],"default.":[220]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-09-04T00:00:00"}