Natural history of fetuses with cleft lip

The prospect of fetal surgery for cleft lip is predicated on our ability to accurately identify fetuses with clefts and exclude those that have associ ated anomalies. Prenatal Ultrasound is currently the most appropriate means with which to do this. We renewed the ultrasonographic data from two large perinatal referral institutions to determine the natural history of fetuse s with cleft lip who may be candidates for fetal surgery. Forty fetuses had a cleft lip diagnosed prenatally by ultrasound. In this group, severe asso ciated anomalies were common (30 of the 40) and multiple (23 of the 40) in a majority of fetuses. Life-threatening anomalies, such as central nervous system and cardiac anomalies, were the most common defects. As a result, ma ny fetuses were aborted therapeutically or died in the perinatal period. Ou t of 12 surviving fetuses, only six had isolated clefts, and two surviving fetuses, diagnosed with isolated cleft lip, had no defect identified postna tally. This information has important implications for the perinatal manage ment of fetuses with cleft lip and the potential role of fetal intervention .