Antenatal
Text provided by Richard Davis, Insight Radiology
Antenatal diagnosis of cleft lip is very useful. For the expectant parents, it enables informed preparation before the baby is born, including surgical and feeding issues to be discussed, and a more positive delivery experience for the family. It can also be used to reassure parents who already have a child with cleft lip. Amniocentesis may be considered especially if the cleft is midline.
With careful scanning and high quality equipment, it is now possible to detect virtually all cleft lips at the 18-20 week anatomy scan. This is the best time to obtain a diagnosis. Occasionally cleft lip can be demonstrated as early as 12 weeks.
The most important factor in detection of cleft lip, is the skill of the Sonographer. Occasionally a small cleft, large patient or baby in a difficult position may result in non-detection, but this is rare. Cleft palate with intact lip is, however, difficult to detect antenatally. A small jaw in association with a cleft palate may be detected on ultrasound.
While cleft lip is still detected using conventional 2D ultrasound, the baby’s face can now also be imaged with ultrasound to produce a 3-dimensional (3D) picture. This is very useful to further delineate the lip and face, providing useful images for patient and clinician. It can also be used to reassure parents who already have a child with cleft lip. Some advanced ultrasound machines enable 3D images to be produced in real-time, showing the baby moving, including lips and tongue. This is called 4D (3D plus time), and provides an enhanced 3D image. Due to the increased equipment costs and longer scan time involved with 4D scanning, generally there is an additional charge for this service.
The Sonographer should communicate results with the patient and also directly to the Midwife or Doctor. Some Sonographers can provide information about specialist cleft team referral, and amniocentesis issues, otherwise your Lead Maternity Carer will do the referral to the local cleft team.
