Screening time and detection rate of prenatal ultrasonography at different pregnancy trimesters for fetal congenital cleft lip and palate

doi:10.3877/cma.j.issn.1673-5250.2022.04.010

Objective

To investigate the clinical value of prenatal ultrasonography for the diagnosis of fetal congenital cleft lip and palate during 16-18 gestational weeks.

Methods

A total of 1 134 fetuses who underwent regular prenatal examination in Guangzhou Women and Children Medical Center from January 1, 2019 to June 30, 2020 were selected into this study. Nuchal translucency (NT) screening combined with median sagittal section of fetal face and posterior nasal triangle section were used in first trimester (11-13^{+ 6} gestational weeks). Congenital cleft lip and palate were scanned by coronal section of nasal lip and palatal axis section at 16-18 gestational weeks and 20-24 gestational weeks. The pregnancy outcomes of all patients were followed up and the detection rate of fetal cleft lip and palate by prenatal ultrasonography at different pregnancy trimesters were compared. Furthermore, 200 healthy fetuses who underwent regular prenatal examination at same hospital from July to December 2020 were selected to be screened for fetal congenital cleft lip and palate during 11-13^{+ 6}, 16-18, and 20-24 gestational weeks, respectively, and the success rate and examination time were recorded and compared. Intraclass correlation coefficient (ICC) was used to evaluate the consistency of the results between two operators. The procedure followed in this study was in line with the requirements of the Helsinki Declaration of the World Medical Association revised in 2013. Informed consent for clinical research was obtain from pregnant mothers of each fetus.

Results

① A total of 30 fetuses (2.6%, 30/1 134) were confirmed with congenital cleft lip and palate after birth or induced labor. Of these, 29 cases were confirmed by prenatal examination and 1 case was confirmed postnatally (isolated cleft palate). Among the 29 fetuses with congenital cleft lip and palate diagnosed by prenatal examination, 15 were live births and 14 were induced labor. ②The detection rates of congenital cleft lip and palate at 11-13^{+ 6}, 16-18, and 20-24 gestation weeks were 73.3% (22/30), 93.3% (28/30) and 93.8% (15/16), respectively. ③The ICC of the 200 pregnant women examined by two operators for congenital cleft lip and palate was 0.85 (95%CI: 0.80-0.91). ④ The completion rates of screening for congenital cleft lip and palate at 16-18 and 20-24 gestational weeks were 74.0% (148/200) and 90.0% (180/200), respectively, which were significantly higher than that at 11-13^{+ 6} gestational weeks (74.0%, 148/200), and all differences were statistically significant (χ²=17.344, P<0.001; χ²=37.961, P<0.001). The screening time for fetal congenital cleft lip and palate at 16-18 and 20-24 gestational weeks were (3.7±1.6) min and (2.9±1.4) min, respectively, which were significantly shorter than that at 11-13^{+ 6} gestational weeks [(13.1±3.6) min], and the difference was also statistically significant (t=27.598, P<0.001; t=30.513, P<0.001).

Conclusions

The detection of fetal congenital cleft lip and palate by prenatal ultrasound at 16-18 gestational weeks has the advantages of short time-consuming and high diagnostic rate.

Key words: Cleft lip, Cleft palate, Congenital abnormalities, Ultrasonography, prenatal, Prenatal diagnosis, Pregnancy trimester, first, Pregnancy trimester, second, Fetus

图4 胎龄为17^＋1周，1例先天性唇腭裂胎儿超声声像图[图4A：胎儿颜面部鼻唇冠状切面显示上唇连续性中断(箭头所示)；图4B：胎儿颜面部上牙槽骨轴切面显示上牙槽骨排列紊乱(箭头所示)；图4C：胎儿颜面部腭轴切面显示双侧腭裂(箭头所示)]

图5 1 134例先天性唇腭裂胎儿的诊断流程图

表1 200例不同胎龄胎儿超声检查先天性唇腭裂的完成率和检查时间比较

不同胎龄		例数	完成[例数(%)]	检查时间(min，±s)
11~13^＋6周		200	148(74.0)	13.1±3.6
16~18周		200	180(90.0)	3.7±1.6
20~24周		200	192(96.0)	2.9±1.4
总体比较
	统计量		χ²＝44.769	F＝687.868
	P值		<0.001	<0.001
11~13^＋6周 vs 16~18周
	统计量		χ²＝17.344	LSD-t＝27.598
	P值		<0.001	<0.001
11~13^＋6周 vs 20~24周
	统计量		χ²＝37.961	LSD-t＝30.513
	P值		<0.001	<0.001
16~18周 vs 20~24周
	统计量		χ²＝5.530	LSD-t＝3.631
	P值		0.019	<0.001

表1 200例不同胎龄胎儿超声检查先天性唇腭裂的完成率和检查时间比较

不同胎龄		例数	完成[例数(%)]	检查时间(min，±s)
11~13^＋6周		200	148(74.0)	13.1±3.6
16~18周		200	180(90.0)	3.7±1.6
20~24周		200	192(96.0)	2.9±1.4
总体比较
	统计量		χ²＝44.769	F＝687.868
	P值		<0.001	<0.001
11~13^＋6周 vs 16~18周
	统计量		χ²＝17.344	LSD-t＝27.598
	P值		<0.001	<0.001
11~13^＋6周 vs 20~24周
	统计量		χ²＝37.961	LSD-t＝30.513
	P值		<0.001	<0.001
16~18周 vs 20~24周
	统计量		χ²＝5.530	LSD-t＝3.631
	P值		0.019	<0.001

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