A prenatal diagnosis of orofacial clefts will have consequences on the care for this child. It will allow parents to receive better information on the malformation, and therefore to have a better understanding of its origin and its treatment. All this will take place outside the context of birth, a moment of joy, which can be spoiled by the arrival of a child with an unexpected face. The diagnosis well before birth allows parents to learn about the malformation and to meet the surgical teams who care for it. It also allows to meet parents who have experienced the same ordeal, or to chat wit other parents on forums on the internet. This diagnosis really makes it possible to realize what the orofacial cleft is, and to understand the real surgical possibilities.
For the medical team, this diagnosis makes it possible to meet the parents well before the birth, to explain the malformation of the baby and its treatment. It especially helps to reassure parents about neonatal surgery (in the first month of life), and to ease the family’s very understandable anxiety . It allows to establish and strengthen a relationship of trust between the parents and the surgical team, essential to care for this child from birth.
But a prenatal diagnosis can also be a risk for the child to see its development stop. There are sometimes parental demands for termination of pregnancy after cleft palate diagnosis. It is up to the doctors, and the surgeon in particular, to explain the possibilities of surgery for this child, to explain that an image, even very clear, is still just an image and does not predict the child’s future capabilities at all. This interruption is prohibited by law because it is a curable malformation and not life-threatening. (See “What the law says”).
The antenatal diagnosis of cleft lip depends on many factors: position of the child, quality of the ultrasound, habit and experience of the sonographer, … The cleft lip discovery rate before birth has been increasing steadily for ten years. Today, in our center, nearly 9 out of 10 children with cleft lip or orofacial cleft were diagnosed before birth.
Ultrasound examinations carried out at the mother’s house make it possible to monitor the pregnancy’s progress. The first, around the 12th week, confirms the presence of an embryo, the number of children to be born and the date of delivery, the “term”.
The second ultrasound performed around the 22nd week is called morphological, because it will allow the study of the child’s forms, the size of his limbs, his brain, the appearance of his face … it is during this ultrasound scan that a cleft lip can be seen by the sonographer. But it studies only the form, not the functions, not the future capabilities of the examined child.
The third ultrasound is performed around the 32nd week, it analyzes the position of the child, the possibilities of this child’s movement during childbirth, it is therefore sometimes called “obstetric”.
These three ultrasounds are recommended by obstetrician gynecologists and are covered by health insurance. They can be performed by your gynecologist, your obstetrician, a midwife or a radiologist. If the diagnosis of cleft lip or orofacial cleft is made, an additional ultrasound is often requested in a specialized center for an antenatal diagnosis.
“A pregnant woman in a state of distress can ask a doctor to terminate her pregnancy. This interruption can be carried out only before the end of the 12th week of pregnancy “(Law N ° 2001-588 of July 4, 2001, art.2)
“The abortion can be carried out at any time … if the unborn child is suffering from a disease … incurable at the time of diagnosis. “(Law No. 2001-588 of July 4, 2001, art.11)
(Title II: Criminal provisions, Chap.2: illegal termination of pregnancy) “The interruption of one’s pregnancy is punishable by 2 years of imprisonment and a fine of 30 000 euros when it is carried out, … after expiry of the period allowed by law … without medical reason. (Law No. 2001-588 of July 4, 2001, art.14-II)