Letter to “Cold therapy for pain relief during and after amniocentesis procedure: A randomized controlled trial”

Abstract

Dear Editor, I have read the article titled “Cold therapy for pain relief during and after amniocentesis procedure: A randomized controlled trial” by Benchahong et al. The authors have very well studied the effect of the cold application on amniocentesis pain, but only from the maternal aspect. They have not mentioned any response of the fetus to the cold therapy. While the prevention of pain is very important in all medical and surgical interventions, prenatal diagnostic procedures are a different category, since the influence on the fetus has to be taken into account in such studies. Kimura et al. concluded that cold stimulus induces the constriction of the uterine artery, leading to a decrease of placental blood flow, and their study was only immersing the maternal hand into cold water. Here, the cold is applied directly to the maternal abdomen. Benchahong et al. also referenced a similar study by Hanprasertpong et al. who also did not mention about any possible fetal effects of cold application onto the pregnant uterus. Recently, a study by Lian et al. indicated that prenatal cold stress affected the maternal neuroendocrine system, as well as the immune system, lipid and amino acid metabolism; thus, supporting the effect of prenatal cold stress on the mother and offspring. It would have been nice to know whether the authors have done any evaluation of fetal heart rates, fetal movements, or uterine/placental blood flow through uterine or umbilical arteries using a Doppler ultrasound. I strongly believe that further studies to decrease maternal pain on prenatal diagnostic procedures should also include fetal parameters.