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Advanced Ultrasound in Diagnosis and Therapy ›› 2024, Vol. 8 ›› Issue (2): 57-63.doi: 10.37015/AUDT.2024.230038

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  • 收稿日期:2023-07-24 接受日期:2024-05-27 出版日期:2024-06-30 发布日期:2024-07-01

Accuracy of Prenatal Ultrasound in the Diagnosis of Isolated Fetal Cleft Palate in High-risk Patients

Hongmei Wu, MD, Shuqin Li, MD, Fengfeng Shi, MD, Yuxiu Gao, MD, Jiansheng Li, MD()   

  1. Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
  • Received:2023-07-24 Accepted:2024-05-27 Online:2024-06-30 Published:2024-07-01
  • Contact: The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, Shandong, China，e-mail: whmei@qdu.edu.cn

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Abstract:

ObjectiveThe objective of this study was to develop a sonographic technique using two-dimensional (2D) markers for detecting isolated fetal cleft palate (no cleft lip) and to evaluate the ability of 2D and three-dimensional (3D) sonography to image the normal and abnormal palate.

Methods Seventy-three fetuses with a high risk of cleft palate at 12-39 weeks of gestation were referred for specialist ultrasound. A detailed evaluation of the palate was performed through 2D ultrasound, which revealed the appearance of the palatine line in the sagittal plane; the palate and alveolar ridge in the coronal plane of the fetal face; the horizontal plate of the palatine bone in the axial maxillary plane; and the soft palate in the transverse plane of the cavum pharyngis. Subsequently, 3D ultrasound imaging of the palate was performed in all fetuses. Antenatal diagnoses were compared with postnatal findings or autopsy findings.

Results Visualization of 2D markers was accomplished in all fetuses, and 3D assessment was achieved in 97% of fetuses. Cleft palate was suspected in 16 cases (21.9%), among which 14 were suspected on the basis of both 2D and 3D evaluation, and two were suspected only on the basis of 3D evaluation. A normal palate was observed in 57 fetuses (78.1%). The mean gestational age was 27 weeks (range of 12 weeks to 39 weeks). All 16 fetuses with suspected cleft palate were confirmed by postnatal or autopsy findings, no false-positives were observed, and one case with a bifid uvula was missed among 57 fetuses with a presumed normal palate.

Conclusions The fetal palate can be evaluated with 2D markers and 3D sonography. The detection of isolated cleft palate is more sensitive when 2D markers are present in all four planes.

Key words: Sonography, Isolated cleft palate, Three-dimensional, Prenatal diagnosis, Two-dimensional, Fetal palate

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Family history 13*(17.8)
Maternal use of lamotrigine 4 (5.5)
High level of AFP 2 (2.7)
Sonographic findings 57*(78.1)
Polyhydramnios 48#
Retrognathia 10#

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Types of isolate CP Anatomical findings (n) Ultrasonographic findings (n) Accuracy rating (%)
Correct diagnosis Missed or Misdiagnosis
Ⅰ° 2 1 1 50.0
Ⅱ° 6 4 2 66.7
Ⅲ° 8 8 0 100.0

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Case GA MA (y) Reason for Admission Associations Karyotype Utcomes
1 32w 30 Polyhydramnios None Normal Confirmed after delivery
2 20w 33 retrognathia retrognathia, low-set ears Normal TOP/postnatal confirmation
3 24w 27 Family history None Normal Confirmed after delivery
4 29w 23 Amniotic band syndrome Amniotic band syndrome Atypical cleft with exencephaly ND TOP/ postnatal confirmation
5 33w 34 Family history Polyhydramnios Normal TOP/ postnatal confirmation
6 18w 26 retrognathia retrognathia, Polyhydramnios Trisomy18 TOP/ postnatal confirmation
7 25w 30 Maternal use of lamotrigine None ND Confirmed after delivery
8 22w 33 Polyhydramnios Polyhydramnios Single umbilical artery Normal Confirmed after delivery
9 35w 29 Amniotic band syndrome Amniotic band syndrome abnormal ear tag and hands Normal TOP/ postnatal confirmation
10 33w 36 Polyhydramnios Polyhydramnios,Omphalocele Normal TOP/ postnatal confirmation
11 21w 34 Family history hypertelorism, Micrognathia Trisomy18 TOP/ postnatal confirmation
12 20w 28 Polyhydramnios encephalocele, polydactyly shortening of all 4 limbs Trisomy13 TOP/ postnatal confirmation
13 19w 31 Polyhydramnios Polyhydramnios, omphalocele ND Confirmed after delivery
14 16w 27 Polyhydramnios None ND Confirmed after delivery
15 23w 22 Retrognathia retrognathia, Tongue suffix Normal TOP/postnatal confirmation
16 31w 35 Family history None Normal Confirmed after delivery

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Case 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Sagittal + + + + - + + + + - + + + + + +
Coronal + + + + - + - + + - + + + + + +
Axial + + - + - + + + + - + + + + + +
Transverse + + + + - + + + + - + - + + + -

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