The Early Prenatal Diagnosis of Cleft Lip and the Decision-Making Process

In 1996, Bronshtein et al. published an article entitled “Early prenatal diagnosis of cleft lip and its potential impact on the number of babies with cleft lip” in the British Journal of Oral and Maxillofacial Surgery. In this article, Bronshtein et al. revealed that, in their experience, a cleft of the lip could be identified accurately using transvaginal sonography at 13 to 16 weeks' gestation. Of interest was the observation that, in 15 cases where cleft lip was detected, the pregnancy was terminated in all but one case. The only couple that did not choose to terminate subsequently stated that they would terminate a future pregnancy if the fetus was observed prenatally to have a cleft lip. The notion of pregnancy termination for a relatively minor malformation raises a number of issues. In order to address those issues and to relate experiences in the U.S. to those reported in Israel, the following two papers were invited. In the first, Zeev Blumenfeld and colleagues update their experiences and discuss some practical, moral, and ethical issues. In the second paper, Marilyn Jones presents her perspective on the issue based on her experiences in Southern California. Readers are invited to react and respond to these two papers by submitting a letter to the editor. Readers are also encouraged to submit other issues or controversies related to the care and/or study of cleft lip and palate and craniofacial anomalies to the editor for discussion.