Objectives This systematic review and meta‐analysis investigated the accuracy of prenatal fetal ultrasound (US) to detect cleft palate during the second and third trimester (12–36 weeks) of pregnancy in high‐risk fetuses. Methods Pubmed and Embase databases were searched for studies that performed prenatal fetal US (comparator) and postnatal examination (reference standard) in fetuses at high risk for orofacial clefts. Risk of bias among included studies was assessed using the QUADAS‐2. Area under the summary receiver operating characteristic (SROC) curve and pooled sensitivity and specificity were calculated. Results This meta‐analysis included 7 studies involving 663 high‐risk fetuses. The individual studies showed that prenatal fetal US accurately predicted the possibility of cleft palate in these fetuses. Pooled sensitivity was 87% (95% CI 71%–95%), pooled specificity was 98% (95%CI 90%–100%), and the area under the SROC curve was 0.98 (95% CI 0.97–0.99). Conclusion Second and third trimester fetal US has excellent sensitivity and specificity for the detection of cleft palate in high‐risk pregnancies.

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