DOI 10.1515/jpm-2012-0137 J. Perinat. Med. 2013; 41(3): 287–294 Bénédicte Michel*, Christian Debauche, Graham Hutchings, Pierre Bernard, Jean-Marc Biard, Geneviève François, Bénédicte Bayet and Olivia Williams Pregnancy and neonatal outcome following an antenatal diagnosis of cleft lip and palate Abstract Aim: To identify the significance of associated antenatal ultrasound findings on long-term prognosis following the antenatal diagnosis of cleft lip/palate [CL(P)]. Patients and methods: Retrospective case note analysis of patients seen at a single tertiary referral centre with a diag- nosis of CL(P). The patients were classified as those with unilateral or bilateral clefts and then further subdivided according to the presence of associated anomalies, and these were related to pregnancy and neonatal outcome. Results: A total of 125 singleton pregnancies were seen at the antenatal diagnostic unit, 14 of which were sub- sequently lost to follow-up. Eighty-two (65.6%) had a diagnosis of unilateral CL(P) and 43 (34.4%) a bilateral CL(P). Seventy-five foetuses (67.5%) had no other anoma- lies detected on antenatal ultrasound. Seventeen patients (15%) underwent a termination of pregnancy. A normal postnatal outcome was seen in 79% of liveborn infants overall. Only 50% of foetuses diagnosed with a single minor anomaly and 4% of the foetuses in whom more than two minor anomalies or one major anomaly had been detected on ultrasound had a normal postnatal outcome. Infants with bilateral CL(P) had a significantly reduced incidence of a normal postnatal course (60% vs. 87.5%, P < 0.01). Conclusion: In cases of CL(P), there is a high incidence of associated anomalies detected on antenatal ultrasound and these significantly increase the risk of poor neonatal outcome. Keywords: Antenatal diagnosis; associated malforma- tions; cleft lip and palate; termination of pregnancy. *Corresponding author: Bénédicte Michel, MD, Department of Neonatology, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium, E-mail: benedicte.michel@uclouvain.be Christian Debauche: Department of Neonatology, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium; and Unit of Fetal Medicine, Cliniques Universitaires Saint- Luc, Catholic University of Louvain, Brussels, Belgium Graham Hutchings: Department of Obstetrics, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium Pierre Bernard: Department of Obstetrics, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium; and Unit of Fetal Medicine, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium Jean-Marc Biard: Unit of Fetal Medicine, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium Geneviève François: Department of Paediatrics, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium Bénédicte Bayet: Department of Plastic Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium; and Unit of Fetal Medicine, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium Olivia Williams: Department of Neonatology, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium Introduction Congenital malformations are diagnosed in 2.5% to 3% of births. Cleft lip or cleft lip and palate [CL(P)] are one of the most frequent of these anomalies with a prevalence estimated at 0.9 to 2 per 1000 live births with racial and geographic variation. The incidence is estimated at 1.2 per 1000 live births in Western Europe [10, 13]. Diagnos- tic antenatal ultrasound has become a routine exami- nation in Europe in the late 1970s to early 1980s [16]. It has the benefits of being both relatively inexpensive and non-invasive. Clefts are generally classified into cleft lip (CL) with or without cleft palate [CL(P)] and cleft palate (CP) based on epidemiological and embryological data [8, 21]. The severity of the malformation can extend from a simple indentation of the lip to an extensive bilat- eral CL(P). In 1995, a classification was proposed by Nyberg et al. [22]: Type 1, cleft lip only; Type 2, unilat- eral CL ± P; Type 3, bilateral CL ± P; Type 4, midline CL+P; Type 5, facial defects associated with amniotic bands or limb-body wall complex [22]. Alternative classification systems have been offered based on post natal findings [24, 26]. Brought to you by | Dalhousie University Authenticated Download Date | 5/17/15 11:39 PM