Fetal cleft lip with and without cleft palate: US classification and correlation with outcome.
OBJECTIVE
To develop a prenatal ultrasonographic (US) classification of cleft lip with or without cleft palate (CL-P) and correlate the classification with fetal outcome.


METHODS
During a 5-year period (1988 to 1993), 65 fetuses with CL-P were identified with prenatal US at one of two referral centers for high-risk obstetric cases. Sonograms from each case were prospectively and retrospectively evaluated. Clefts were classified into one of five categories: type 1, cleft lip alone (n = 5); type 2, unilateral cleft lip and palate (n = 15); type 3, bilateral cleft lip and palate (n = 20); type 4, midline cleft lip and palate (n = 21); and type 5, facial defects associated with amniotic bands or limb-body-wall complex (n = 4).


RESULTS
The US classification correlated with severity of defect and fetal outcome. Type 4 and 5 clefts were universally associated with concurrent anomalies and a fetal outcome, type 1 clefts with a lower rate of anomalies (20%), and type 2 and 3 clefts with intermediate prognosis. Chromosome abnormalities also varied with the type of cleft as follows: type 1, 0%; type 2, 20%; type 3, 30%; type 4, 52%; and type 5, 0%.


CONCLUSIONS
Prenatal classification of fetal CL-P correlates with fetal outcome. This classification should help counseling and management.
Nyberg
D A
DA
Department of Ultrasound, Swedish Hospital Medical Center, Seattle, Wash, USA.
Sickler
G K
GK
Hegge
F N
FN
Kramer
D J
DJ
Kropp
R J
RJ
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging; D002971:Cleft Lip / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging* / Q000196:embryology; D002972:Cleft Palate / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging* / Q000196:embryology; D005260:Female; D005315:Fetal Diseases / Q000145:classification / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal