Are isolated facial cleft lip and palate associated with increased perinatal mortality? A cohort study from the West Midlands Region 1995-1997

Objective. To investigate the association between cleft lip and/or palate and perinatal mortality. Methods. A retrospective review was performed of cases of cleft lip/palate born to West Midlands residents from 1995 to 1997. Perinatal mortality for identified cases was compared with all births from 1995 to 1997. Results. 347 cases of cleft lip and/or cleft palate were delivered from 1995 to 1997. Thirty-six pregnancies were terminated due to parental wishes - 2 were registerable births. There were 310 spontaneous registerable births (stillbirths/livebirths) with cleft lip and/or palate and 1 further late fetal loss. In 220 (70.5%), the lesion was isolated. Of these, there were 7 perinatal deaths, 5 had post mortems and no additional anomalies were identified. In 92 (29.5%) cases other abnormalities were identified. The overall perinatal mortality rate (PNMR) in the West Midlands, was 10.0/1000 total births. The overall PNMR for babies with facial clefts was 89.7/1000 total births. The PNMR for those with associated anomalies was 228.3/ 1000 live/still births. The PNMR for isolated facial clefts was 31.8/1000 live/still births, significantly higher than the background population ( OR 3.3, 95% CI: 1.5 - 7.0). Conclusion. Consideration should be given to screening the fetus at 20 - 24 weeks for facial deformity. This has implications for detection both of fetal anomalies and of a population at risk for adverse outcome.