EP10.09: Assessing human fetuses undergoing acute pain: validation of the fetal‐7 scale

To validate the Fetal-7 scale, a fetal pain scoring system that was created to evaluate and quantify fetal pain, and which can be used to evaluate fetuses that were submitted to fetal surgery and fetal treatment. The validation process involved two steps. Step 1 focused on internal consistency, inter- and intrarater reliability. US images from four fetuses were recorded under different conditions: acute pain (AP), control at rest (Co-Re), and control with acoustic startle (Co-AS). Twenty images per fetus were evaluated by 30 raters blinded to fetal groups. Raters underwent training and assessed facial movements using the Fetal-7 scale twice with a 30-day interval for intrarater reliability. Step 2 involved sensitivity and specificity analysis, comparing healthy fetuses at rest (Co-Re) to those experiencing acute pain (AP) during surgery to calculate the scale's performance. There was high internal consistency with Cronbach's alpha (α) of 0.99. Intrarater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient (ICC) was 0.95, and interrater reliability was 0.99. 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 behaviour in third trimester fetuses and may be of value in guiding analgesic procedures efficacy in fetuses after fetal surgery. Further research are warranted to explore the presence of postoperative pain in fetuses and its effects after birth.