**5. Mode and time of delivery**

Even with recent progress in major medical and surgical specialties, the mode and time of delivery of fetuses with antenatal diagnosed abdominal wall defects remains a controversy. Fetal delivery by elective cesarean section is advocated by some centers [119–125], while others consider a vaginal delivery more suitable in cases with diagnosed fetal abdominal wall defect [126–130]. More so, there is no difference in fetal outcome regarding the mode of delivery [131–135]. In cases of omphalocele, delivery by cesarean section is recommended in cases with a large defect, to prevent the sac rupture and the liver damage during labor [136]. However, some researchers found that features such as the size or liver herniation have no importance in establishing the outcome of vaginal delivery [137]. The gestational age for induced delivery or elective cesarean section is another controversy (preterm versus term delivery). Some authors reported more complications and longer hospitalization in preterm deliveries [138, 139]. Others recommend a preterm delivery to optimize the toxic damage of the amniotic fluid to the herniated bowel in gastroschisis [120, 124, 129, 140]. The most recent study presented good results using a protocol for a preterm elective delivery, between 35 and 36 + 6 gestational age for fetuses with gastroschisis. Preterm delivery is not indicated in cases of omphalocele [26]. Still, most studies agree that in utero transport to a specialized pediatric center, where the defect can be corrected, offers an optimal fetal outcome [126, 141].
