Attitudes of pregnant women and mothers of children with orofacial clefts toward prenatal diagnosis of nonsyndromic orofacial clefts in a semiurban set-up in India

Poornima Kadagad; Pascal Pinto; Rajesh Powar

doi:10.4103/0970-0358.90833

Indian Journal of Plastic Surgery, Table of Contents

CC BY-NC-ND 4.0 · Indian J Plast Surg 2011; 44(03): 489-493
DOI: 10.4103/0970-0358.90833

Original Article

Association of Plastic Surgeons of India

Attitudes of pregnant women and mothers of children with orofacial clefts toward prenatal diagnosis of nonsyndromic orofacial clefts in a semiurban set-up in India

Authors

Poornima Kadagad

Department of Oral and Maxillofacial Surgery, KLE VK Institute of Dental Sciences, Belgaum, Karnataka, India
Pascal Pinto

Department of Oral and Maxillofacial Surgery, KLE VK Institute of Dental Sciences, Belgaum, Karnataka, India
Rajesh Powar

¹Department of Plastic Surgery, JN Medical College, KLE University, Belgaum, Karnataka, India

Abstract

PDF Download

ABSTRACT

Objectives: To assess the attitudes of pregnant women and mothers of children with orofacial clefts toward prenatal diagnosis of clefts and elective termination of pregnancy, and to investigate their opinion about who makes reproductive decisions in the family. Design: Two hundred subjects were included in the study prospectively regarding hypothetical prenatal ultrasound diagnosis of clefts. Setting: The study was done in a private tertiary care institution and a teaching hospital. Subjects/Participants: One hundred pregnant women consulting the Obstetrics department and 100 mothers of children with orofacial clefts in the Cleft and Craniofacial Unit were selected. Materials and Methods: Group I subjects were interviewed using a questionnaire and were shown preoperative and postoperative pictures of children treated for cleft lip and palate. Group II subjects were interviewed using a questionnaire. Results: Only 3% of Group I subjects and 2% of Group II opined that they would choose the elective termination of pregnancy if the fetus was diagnosed with a cleft on an ultrasound scan. In Group II, 70% subjects wished to have known about pregnancy affected with cleft prenatally and 96% said they would definitely avail ultrasound scans to determine pregnancy affected by clefts in future. Conclusions: Majority of the respondents from both the groups chose to continue with the pregnancy affected with a cleft when questioned regarding hypothetical prenatal ultrasound diagnosis of the cleft.

KEY WORDS

Orofacial clefts - prenatal ultrasound diagnosis - termination of pregnancy

PDF (260 kb)

References

REFERENCES
1 Lansdown R. Psychological problems of patient with cleft lip and palate: Discussion paper. J Royal Soc Med 1990;83:448-50.
2 Harper DC, Peterson DB. Children of the Philippines, Attitudes toward Visible Physical Impairment. Cleft Palate Craniofac J 2001;38:566-76.
3 Forrester MB, Merz RD, Yoon PW. Impact of prenatal diagnosis and elective termination on the prevalence of selected birth defects in Hawaii. Am J Epidemiol 1998;148:1206-11.
4 Bromage DI. Prenatal diagnosis and selective abortion: A result of the cultural turn? Med Humanit 2006;32:38-42.
5 Macer DR. (1998b). Ethics and Prenatal Diagnosis. In: Milunsky A, editor. Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment. Baltimore: John Hopkins University Press; 1998. p. 999-1024.
6 Bouchard L, Renaud M, Kremp O, Dallaire L. Selective abortion: A new moral order? Consensus and debate in the medical community. Int J Health Serv 1995;25:65-84.
7 Bronshtein M, Blumenfeld I, Kohn J, Blumenfeld Z. Detection of cleft lip and palate by early second trimester transvaginal sonography. Obstet Gynecol 1994;84:73-6.
8 Bronshtein M, Yoffe N, Zimmer E, Blumenfeld Z. Early detection of fetal anomalies by transvaginal sonography. Fetal Matern Med Rev 1993;5:137-46.
9 Gullino E, Serra M, Ansaldi C, Massobrio M, Pagliano M. Bilateral cleft lip and palate diagnosed sonographically at 11 weeks of pregnancy. J Clin Ultrasound 2006;34:398-401.
10 Kurjak A, Azumendi G, Andonotopo W, Salihagic-Kadic A. Three- and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face. Am J Obstet Gynecol 2007;196:16-28.
11 Moore J, Bhide A. Ultrasound prenatal diagnosis of structural abnormalities. Obstet Gynaecol Reprod Med 2009;19:333-8.
12 Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-andrade E, Johnsen SL, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol (2010). [Last accessed on 2011 Apr 03].
13 Donna Kirwan and the NHS Fetal Anomaly Screening Programme (NHS FASP) NHS Fetal Anomaly Screening Programme. Available from: http://www.Fetalanomaly.Screening.Nhs.Uk/Standardsandpolicies . [Last accessed on 2011 Apr 03].
14 Bhattacharya S. Editorial: Winds of change: Hope for cleft lip and palate patients. Indian J Plast Surg 2009;42:1.
15 Zahed L, Nabulsi M, Tamim H. Attitudes towards prenatal diagnosis and termination of pregnancy among health professionals in Lebanon. Prenat Diagn 2002;22:880-6.
16 Wyszynski DF, Perandones C, Bennun RD. Attitudes toward prenatal diagnosis, termination of pregnancy, and reproduction by parents of children with nonsyndromic oral clefts in Argentina. Prenat Diagn 2003;23:722-7.
17 Johnson N, Sandy JR. Prenatal diagnosis of cleft lip and palate. Cleft Palate Craniofac J 2003;40:186-9.
18 Li Z, Ren A, Liu J, Zhang L, Ye R, Li S, et al. High prevalence of orofacial clefts in Shanxi province in Northern China, 2003-2004. Am J Med Genet A 2008;146A:2637-43.
19 Russel KA, Allen VM, Macdonald ME, Smith K, Dodds L. A population based evaluation of antenatal diagnosis of orofacial clefts. Cleft Palate Cranifac J 2008;45:148-53.
20 Vallino-Napoli LD, Riley MM, Halliday JL. An epidemiologic study of orofacial clefts with other birth defects in Victoria, Australia. Cleft Palate Craniofac J 2006;43:571-6.
21 Mossey P, Little J. Addressing the challenges of cleft lip and palate research in India. Indian J Plast Surg 2009;42 Suppl:S9-S18.
22 Singh SK. Smile Train: The ascendancy of cleft care in India. Indian J Plast Surg 2009;42:192-8.
23 Gupte M, Bandewar S, Pisal H. Women’s Role in Decision Making in Abortion: Profiles from Rural Maharashtra. CEHAT (Unpublished document). Available from: http://www.Womenstudies.In/Elib/Abortion/Ab_Womens_Role.Pdf . [Last accessed on 2011 Apr 03].
24 Singh A, Arora AK. How much do Rural Indian Husbands Care for the Health of their Wives. Indian J Community Med 2008;33:19-25.
25 Bronshtein M, Blumenfeld I, Blumenfeld Z. Early prenatal diagnosis of cleft lip and its potential impact on the number of babies with cleft lip. Br J Oral Maxillofac Surg 1996;34:486-7.
26 Blumenfeld Z, Blumenfeld I, Bronshtein M. The Early prenatal diagnosis of cleft lip and the decision making process. Cleft Palate Craniofac J 1999;36:105-7.
27 Chattopadhyay S, Simon A. East meets West: Cross-cultural perspective in end-of-life decision making from Indian and German viewpoints. Med Health Care Philos 2008;11:165-74.
28 Chaurasia AR. The Institutional Context of Fertility and Reproductive Health in Madhya Pradesh, India. Centre for Studies in Demography and Ecology University of Washington Seattle, WA. 98105. Available from: http://www.csde.washington.edu/downloads/00-7.pdf . [Last accessed on 2011 Apr 11].
29 Nusbaum R, Grubs RE, Losee JE, Weidman C, Ford MD, Marazita ML. A qualitative description of receiving a diagnosis of clefting in the prenatal and postnatal period. J Genet Couns 2008;17:336-50.
30 Robbins JM, Damiano P, Druschel CM, Hobbs CA, Romitti PA, Austin AA, et al. Prenatal diagnosis of orofacial clefts: Association with maternal satisfaction, team care, and treatment outcomes. Cleft Palate Craniofac J 2010;47:476-81.
31 Jones M. Prenatal Diagnosis of Cleft Lip and Palate: Detection Rates, Accuracy of Ultrasonography, Associated Anomalies, and Strategies for Counseling. Cleft Palate Craniofac J 2002;39:169-73.
32 Andrews-Casal M, Johnston D, Fletcher J, Mulliken JB, Stal S, Hecht JT. Cleft lip with or without cleft palate: Effect of family history on reproductive planning, surgical timing and parental stress. Cleft Palate Craniofac J 1998;35:52-7.
33 Davalbhakta A, Hall PN. The impact of antenatal diagnosis on the effectiveness and timing of counselling for cleft lip and palate. Br J Plast Surg 2000 ; 53 : 298-301.
34 Matthews MS, Cohen M, Viglione M, Brown AS. Prenatal counseling for cleft lip and palate. Plast Reconstr Surg 1998;101:1-5.
35 Weatherley-White RC, Eiserman W, Beddoe M, Vanderberg R. Perceptions, expectations, and reactions to cleft lip and palate surgery in native populations: A pilot study in rural India. Cleft Palate Craniofac J 2005;42:560-4.
36 Klein T, Pope AW, Getahun E, Thompson J. Mothers’ reflections on raising a child with a craniofacial anomaly. Cleft Palate Craniofac J 2006;43:590-7.
37 Bakheit AM, Shanmugalingam V. A study of the attitudes of a rural Indian community toward people with physical disabilities. Clin Rehabil 1997;11:329-3.