Antenatal Diagnosis

1. At the routine 18-22 week anomaly ultrasound scan, an attempt should be made to formally examine the fetal face in 3 planes in all patients. If all three planes cannot be visualised, at least the coronal view (the optimal plane for excluding a cleft) should be sought and examined.
2. If the face is not visualised in low risk cases a repeat ultrasound scan is not necessary. The sonographer should inform the patient that the face was not clearly seen but reassure the patient that there is no obvious structural abnormality.
3. If the face is not visualised in high risk cases a repeat ultrasound scan should be arranged with either the Fetal Medicine Unit or a Consultant Obstetrician/Radiologist.

• personal history of facial cleft
• family history of facial cleft (only if parent, sibling or child of patient is affected)
• patients with epilepsy

1. On the information leaflet pertaining to the routine anomaly scan it should be clearly stated that an attempt will be made to look at the fetal face but that this is not always possible.

  Antenatal Management if a Facial Cleft is Suspected

 

1. 
   To include a 4D scan assessment of the lip and palate (refer to Dr Moran) to better delineate the lesion and aid with antenatal counselling. The initial review will be as soon as possible after diagnosis but because 4D views are best after 24 weeks a follow up 4D scan may be arranged.
   -Make cleft team Sister aware of the referral so that they can also attend.
   -When referring please state clearly the suspected extent of the lesion for auditing purposes.
   -Midline clefts: For suspected midline clefts the outcome may be extremely poor, these must be highlighted in the referral and an urgent appointment requested.
   The patient should be rescanned either by a Consultant Obstetrician/Radiologist or alternatively referred to the Fetal Medicine Unit at the RVI (0191 232 5131 Ext. 25837) for confirmation of the cleft lip/palate, search for other anomalies or soft markers. Counselling should be arranged.
2. If the cleft appears to be isolated the risk of chromosomal abnormalities is low and therefore karyotyping is not justified.
3. An appointment should be made for the patient to see her own Consultant.
4. An appointment should be made for the patient to meet the team who will potentially be undertaking correction of the cleft lip/palate. Antenatally the initial appointment will be with Sister Eileen Stephenson who will arrange to see the patient at the RVI.

    

   Sister Stephenson should be notified when the baby is delivered and will arrange for the cleft lip/palate team to visit the patient and her baby in their Maternity Unit within 48 hours. Where facial clefts are diagnosed postnatally, the cleft Lip/Palate team should be contacted and will also visit the patient and baby within 48 hours

   Sister Eileen Stephenson, Cleft Lip/Palate Coordinator

   RVI: 0191 2325131 Ext. 24562, Radiopager – 07669 033541

   Miss Carolyn Reid, Consultant Plastic Surgeon,

   RVI: - 0191 2325131 Ext. 24145

   Mr Peter Hodgkinson, Consultant Plastic Surgeon,

   RVI: 0191 2325131 Ext. 24145

    

5. A NorCAS form must be completed and sent to the RMSO
6. Information should be available immediately for the woman and partner to study whilst waiting for the various appointments.

P Marsden – August 2001

Date for review – August 2004