Prenatal Counseling for Cleft Lip and Palate

Abstract

Prenatal diagnoses of cleft lip and palate can occur during both routine screening obstetrical ultrasound and high resolution obstetrical ultrasound done for other reasons. The affected family or obstetrician may request prenatal consultation with the plastic surgeon. To define this population, a survey was done of all families who were referred to our cleft program with a prenatal diagnosis of cleft between 1990 and 1994. Of 80 newborn referrals, 13 had a prenatal diagnosis of cleft. These children had a higher incidence of bilateral cleft than our average population (53.8 percent versus 28.7 percent, p < 0.03, chi square test). No isolated cleft palates were identified. Nine families were available for follow-up. Only one-third of the families felt that they had been given adequate information about clefts from their obstetrician or ultrasonographer. All who had prenatal contact with the cleft team felt it was valuable. A review of prenatal diagnosis of cleft is given including limitations. Specific counseling information is discussed.

Initial counselling for cleft lip and palate: Parents’ evaluation, needs and expectations

“…This also applies for the low rate of prenatally diagnosed clefts (16%) in the study population compared with the literature, where an average sensitivity of 25% is found, which can be raised to over 90% using intravaginal ultrasound 4,5,7,10,16,24,26 . Today, up to 89% of parents with cleft children support the use of prenatal diagnostics 7,17,18,23 . In the present population only 58% of those parents who were informed about the cleft prenatally rated this as positive and only 43% of the parents who did not know the diagnosis would have preferred to have been informed before birth, which is in contrast to the data of DAVALBHAKTA & HALL 7 .…”

Impact parental de l’échographie 3D/4D des fentes labiopalatines

“…L'apport du diagnostic anténatal des fentes labiopalatines a été particulièrement étudié [14][15][16][17][18] et son bénéfice est incontestable en permettant : la préparation psychologique des parents et leur éducation à la gestion pratique de leur enfant à la naissance [19,20] ; la planification des soins néonatals et une meilleure connaissance des mesures à mettre en oeuvre pour l'alimentation (réduction de la mortalité périnatale) [21][22][23] ; le dépistage d'autres malformations associées ; la réalisation anténatale d'un caryotype [24,25] ; la possibilité de demander une interruption de grossesse en cas d'anomalies graves associées à la fente [23,26].…”

Prenatal Detection of Facial Clefts

“…In one series of over 8,000 2nd-trimester anomaly scans, 2 out of 9 cleft lips and/or cleft palates were identified prenatally [19]. In another study [3], only 13 out of the 80 cases referred to a surgical cleft program were diagnosed prenatally. However, this would have included cases from several different centres with different policies for routine anomaly scan, whereas the data on detection rate in this study are from a single unit in which examination of the face was a routine part of the anomaly scan and the patient was recalled if adequate views of the face were not obtained.…”

“…Facial clefting is, therefore, an important indication for referral to a fetal medicine unit, so that the couple can have a complete detailed scan, receive appropriate counselling, and be offered invasive testing. Referral to the cleft team is also advisable, so that parents can have as much information as possible to assist in preparation for the condition [3].…”

“…However, it is important to consider parents' views about prenatal diagnosis of the condition. In a study of nine families who had prenatal diagnosis of a cleft lip, all felt that it made adjustment easier [3]. Seven of the families had consultations which included a review of cleft treatment and viewing of average pre-operative and postoperative photographs of both unilateral and bilateral clefts of varying severity, and all families felt that this was helpful in understanding the situation.…”