邱宗鴻醫師

Reality

1.        Newborns with harelip and/or cleft palate usually frighten their parents and obstetricians as well, especially when routine sonographic screening had ever been done and the defect missed prenatally.

2.        Bearing babies with such defect, mother's self-esteem was frequently insulted; health-providers mostly felt frustrated; and tend to deny of the reality present.

3.        Easy to screen and recognize the integrity of fetal upper lip when fetus is in good scanning position, whenever one performs routine ultrasound examination and takes a glance at this region.

Goal (positive aspect)

1.        Shorten the grief period from chaos; denial-rejection; acceptance; and appropriate positive reaction.

2.        Earlier exposure to knowlegable counselling and get well prepared for postnatal planned surgical repaires.

3.        Earlier relief of anxiety for expectant mothers who ever had history of babies with harelip and/or cleft palate.

Dilemma (negative aspect)

Too early to put patients falling in depth of guilty feeling, anxiety; and depression, make them hardly can't get through the gestational period. Rejected to the reality and opted to ternimate the affected pregnancy, although ethically inappropriate.

Scanning Plane

1.        Coronal scanning on midfacial portion of fetus as early as 20 weeks of gestation.

2.        Clearly to defme nose tip, bilateral alae nasi, philtrum, upper lip and gingival ridge, oral cavity, cross-section of tongue, lower lip and gingival ridge, and mentum.

3.        Diagnosis (avoid interposition of umbilical cord, fingers on lips ; also avoid presence of fetal yawning)

4.        Unilateral harelip is present when an interrrupted continuity of upper lip echogenicity is demonstrated, with alae nasi equally appropriate opposition to the upper lip.

5.        Unilateral harelip with cleft palate is present when an interrupted continuity of upper lip echogenicity is demonstrated, with alae nasi skewly adjacent to the upper lip.

Confirmation of affected laterality with ultrasound

1.        Define fetal lie and position first.

2.        When fetus facing to the examiner, the affected side is contrary to the laterality seen on the screen.

3.        When fetal back is facing with examiner, the affected side is the same laterality seen on the screen.

4.        Bilateral harelip and cleft palate is present when premaxilla is clearly shown.