Radiology, Vol 195, 677-684, Copyright © 1995 by Radiological Society of North America
Fetal cleft lip with and without cleft palate: US classification and correlation with outcome
DA Nyberg, GK Sickler, FN Hegge, DJ Kramer and RJ Kropp
Department of Ultrasound, Swedish Hospital Medical Center, Seattle, Wash, USA.
PURPOSE: To develop a prenatal ultrasonographic (US) classification of
cleft lip with or without cleft palate (CL-P) and correlate the
classification with fetal outcome. MATERIALS AND 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%. CONCLUSION: Prenatal classification of fetal CL-P correlates
with fetal outcome. This classification should help counseling and
management.
