Fetal cleft lip and palate: sonographic diagnosis and postnatal outcome

This is a retrospective analysis of neonatal outcome in 32 fetuses diagnosed over a 3 1/2-year period as having cleft lip and palate by ultrasonographic examination. Unilateral versus bilateral complete cleft lip was accurately diagnosed in fetuses after 16 weeks' gestation. Incomplete cleft lip was more easily detected after 27 weeks' gestation. In only three newborns was the severity of the cleft overappraised. In no instance was a complete cleft lip mistakenly diagnosed as an incomplete form. The fetuses with labial clefting also were categorized sonographically as those without associated abnormalities (n = 15) and those with other detectable anomalies (n = 17), of which 5 had autosomal trisomy. One neonate assessed in utero to have an isolated unilateral incomplete cleft lip had vertebral/rib anomalies and died soon after birth of unsuspected pulmonic stenosis. This study confirms the accuracy of prenatal sonographic examination and underscores the high incidence of spontaneous fetal loss (terathanasia) that occurs whenever cleft lip/palate is associated with aneuploidy or other malformations.