Wiesje Maarse1, Chantal W B Boonacker2, Corstiaan C Breugem1, Moshe Kon1, Gwendolyn T R Manten3, Aebele B Mink van der Molen1. 1. Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands. 2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Department of Obstetrics and Gynecology, Fetal Medicine Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
Abstract
OBJECTIVE: Our aim is to introduce and validate a new oral cleft classification system based on prenatal ultrasound for use by professionals in daily practice. METHODS: During a 3-year period (2011-2014), all cases of prenatal oral cleft diagnosed by ultrasound were retrospectively reviewed. A new prenatal ultrasound classification system was introduced. For the purpose of validation, prenatal ultrasound images of oral cleft types were described according to the new classification system and were compared with postnatal findings by reviewing medical records. RESULTS: A total of 103 fetuses with oral cleft were identified by ultrasound. The mean gestation time at detection was 20.4 weeks (95% confidence intervals: 20.0-20.7). The association between oral cleft and other anomalies varied by cleft type; types 2b/3b and 4 were most frequently associated with other anomalies. The measure of agreement between the prenatal and postnatal findings showed a Kappa value of 0.63 (95% confidence intervals: 0.52-0.75), demonstrating the accuracy of this new classification system. CONCLUSION: A new prenatal oral cleft classification system is presented. This system appears to be accurate, and it shows the variation in the risk of associated anomalies for each cleft type. We expect that ultrasonographers will be able to use the new classification in daily practice.
OBJECTIVE: Our aim is to introduce and validate a new oral cleft classification system based on prenatal ultrasound for use by professionals in daily practice. METHODS: During a 3-year period (2011-2014), all cases of prenatal oral cleft diagnosed by ultrasound were retrospectively reviewed. A new prenatal ultrasound classification system was introduced. For the purpose of validation, prenatal ultrasound images of oral cleft types were described according to the new classification system and were compared with postnatal findings by reviewing medical records. RESULTS: A total of 103 fetuses with oral cleft were identified by ultrasound. The mean gestation time at detection was 20.4 weeks (95% confidence intervals: 20.0-20.7). The association between oral cleft and other anomalies varied by cleft type; types 2b/3b and 4 were most frequently associated with other anomalies. The measure of agreement between the prenatal and postnatal findings showed a Kappa value of 0.63 (95% confidence intervals: 0.52-0.75), demonstrating the accuracy of this new classification system. CONCLUSION: A new prenatal oral cleft classification system is presented. This system appears to be accurate, and it shows the variation in the risk of associated anomalies for each cleft type. We expect that ultrasonographers will be able to use the new classification in daily practice.