*4.3.2. Delivery management*

If the lung mass has resolved or is small with no mediastinal shift or hydrops, BPS itself is not an indication for early delivery or cesarean delivery [68]. Neonatal respiratory problems would be unlikely. For fetuses with large masses that cause mediastinal shift and/or hydrops, delivery should be planned for a tertiary care center with an intensive care nursery capable of resuscitation of a neonate with respiratory difficulties, including capability of extracorporeal membrane oxygenation (ECMO), and with pediatric surgeons experienced in care of these infants [68]. If hydrops develops after 32 weeks of gestation, early delivery is recommended, possibly with the use of EXIT. In EXIT, the fetus is partially delivered and intubated without clamping the umbilical cord. Uteroplacental blood flow and gas exchange are maintained by using inhalational agents to provide uterine relaxation and amnioinfusion to maintain uterine volume. This provides time for initiating extracorporeal membrane circulation to stabilize the infant, thus creating a controlled situation before resection of BPS in another operating room [68].
