The Hard Palate Sweep: a multiplanar sonographic method for prenatally detecting cleft palate

Prenatal diagnosis of cleft palate is challenging with a low detection rate. We propose the “Hard Palate Sweep”, a 2D method which enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep. This was a prospective study performed in pregnant patients between 13 and 40 weeks of gestation. The fetus is scanned in the axial plane, in a supine position with the head extended. It starts anteriorly at the alveolus and terminates posteriorly where the palate articulates with the sphenoid bone. For practical reasons the sweep is described in 5 consecutive planes: a) The alveolus. B) The alveolus-hard palate interface c) The dome of the hard palate d) The transverse palatine suture e) The posterior edge of the palate. Palate integrity was determined prenatally and confirmed postnatally. Test feasibility and performance indices were calculated. Six hundred seventy-six fetuses were included. The Hard Palate Sweep was successfully performed in all cases. Nineteen cases were determined to have a cleft palate. Of these, 13 cases were excluded due to lack of postmortem confirmation, leaving 663 cases for analysis; 657 were prenatally determined to have an intact palate and 6 were determined to have a cleft palate. All cases determined to have a cleft palate were confirmed postnatally. 655 Of the 657 cases prenatally determined to have an intact palate, were confirmed postnatally. Tow cases prenatally determined to have an intact palate were diagnosed postnatally with rare forms of cleft palate, rendering 75% sensitivity and 100% specificity (p < 0.001). The Hard Palate Sweep is a highly effective method for prenatally detecting a cleft palate at any stage of pregnancy. This method is feasible and reproducible, offering high sensitivity and specificity. Implemented routinely, this method is expected to increase the prenatal detection of cleft palate.