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Fente labiale et palatine

Fetal pregnancy complications


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Description

A cleft lip and cleft palate are malformations of the face that involve an opening in the upper lip that can extend to the palate. The split or opening can be on one side, both sides, or in the middle. A cleft lip can frequently be diagnosed on a morphology ultrasound, but a cleft palate can be more difficult to see.

This birth condition is divided into 4 types:

  • Unilateral (one-sided) cleft lip with no cleft palate
  • Unilateral cleft lip with a cleft palate
  • Bilateral (two-sided) cleft lip with or without a cleft palate.
  • Middle cleft lip with or without a cleft palate

This birth defect occurs in 1 out of every 1,000 births in Caucasian populations and is more common in Asian populations (1 in 600 births) and less common in African populations (1 in 2,500 births).

The majority of children with a cleft lip or a cleft lip and palate do not have the syndrome, but genetic counselling is still recommended.


Causes

There are multiple causes of cleft lips and palates. External factors include taking certain medications, alcohol intake, and folic acid deficiency, though the incidence is higher when a family member has a cleft. In 10% to 15% of children, this defect is associated with a syndrome, which means there are additional medical conditions.


Symptoms to watch for

When diagnosed with an alveolar (upper gum line) cleft, there is a low risk of developing polyhydramnios, which is characterized by an increase in amniotic fluid. If a pregnant woman is not immune to chickenpox, she should avoid being around people with the disease, which is highly contagious.

Keep in mind that a person with chickenpox is contagious two days before any rashes appear. If a pregnant woman has come into contact with someone who is contagious, it is important that she contact her doctor as soon as possible. Preventive treatments, given early, can decrease the risk of infection.


Tests and procedures

Ultrasound follow-up in the third trimester – or depending on clinical course – is recommended to monitor the level of amniotic fluid.

A consultation with the plastic surgery team is carried out during the pregnancy in order to better understand the nature of the defect and to discuss feeding the baby at birth given the cleft palate diagnosis and necessary corrective surgeries that will be carried out.


Treatments and follow up

The assessment of the mother and the unborn baby is done by a multidisciplinary team that includes an obstetrician specializing in maternal-fetal medicine and a plastic surgeon. Several other professionals (a psychologist, for example) may also be part of the team depending on individual needs.

Following the diagnosis of a lip or alveolar cleft, genetic counselling is recommended to assess the risk of chromosomal or genetic abnormalities due to a syndrome. Amniocentesis may be recommended, depending on the diagnosis.

Pregnancy monitoring as well as the delivery can be done in any hospital setting, unless otherwise advised by specialists during the assessment. The delivery of a child with a cleft lip or cleft lip and palate does not cause any particular problems. These children have no difficulty breathing, and their sucking and swallowing reflexes are normal. However, if the palate is open, the ability to suck is impaired. We must therefore adapt a bottle to compensate for the lack of suction. When the palate is intact, sucking is normal and breastfeeding is usually easy.

Below are some photos illustrating different cleft lips before and after surgery.


Resources and useful links

  • Maternal-Fetal Medicine: Principle and Practice, 7th edition, Robert K. Creasy & Robert Resnik, 2014.
  • Prenatal diagnosis of Cleft Lip and Cleft Palate, Cleft Palate Foundation of the American Cleft Palate Association, 2014.

    www.cleftline.org


Photos

Different photos of cleft lips before and after surgery.

  • Photo 1 (before)
    Photo 1 (before)
  • Photo 1 (after)
    Photo 1 (after)
  • Photo 2 (before)
    Photo 2 (before)
  • Photo 2 (after)
    Photo 2 (after)
  • Photo 3 (before)
    Photo 3 (before)
  • Photo 3 (after)
    Photo 3 (after)
Page by

Dr Louise Caouette Laberge, Stéphanie Santos, infirmière clinicienne, Chantal Larcher, infirmière clinicienne

About this page
Updated on 1/25/2021
Created on 1/25/2021
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