As the diagnosis of septal hernia by fetal ultrasound is no longer a big problem, the treatment of septal hernia in the fetal period is increasingly becoming the main contradiction in clinical work, as we can see clinically, most septal hernia will have unstable breathing after birth, but it can be stabilized after oxygen or assisted breathing, and some of them need to be put on a ventilator after birth to solve the symptoms, and at this time it is difficult to transfer to a neonatal surgical treatment center, and it requires a vehicle ventilator and specialized ICU staff to save the baby. It is difficult to transfer to the neonatal surgical center, which requires a ventilator and ICU staff, but after early diagnosis, intrauterine transfer is possible, i.e., the mother goes directly to the neonatal surgical center, so that the period can be directly treated. At present, the Department of Fetal Medicine and the Department of Neonatal Surgery of our hospital have received and treated fetal septal hernia from all over the country, and have made the treatment rate reach 90%, which is at the leading level in China. The treatment of fetal septal hernia is generally designed in three steps. Step 1: Determine the mildness and severity The discovery of fetal diaphragmatic hernia does not require too much stress. The first step is to understand the gestational week, the left and right sides, and whether chromosomal abnormalities have been ruled out by chromosomal screening. The next most important thing is the assessment of fetal lung development, which requires the calculation of LHR by ultrasound measurement of the remaining normal lungs, if the ratio is greater than 1.4, it is mild, less than 1.0 is severe, and between 1.0-1.4 is moderate; if it cannot be calculated and measured you need to hurry to find a hospital that has the conditions to calculate and measure it, and it is very significant to make a clear diagnosis before 32 weeks. Combine with MR examination to further clarify the diagnosis and also to exclude other combined malformations. The most common problem at present is that there are conditions for MR examination, but no doctors can look at the film, which is a problem in most areas. Another possibility is to come to us for examination, and only those who are convenient to come can make an appointment in advance. Those who really have difficulties can contact the local hospital, which will issue an invitation for me to consult, providing timely help for the general public in need. Other common judgments are: the earlier the gestational week of detection, the worse the prognosis, with 25 weeks as the boundary; left is better than right because the right side is often accompanied by liver herniation into the chest cavity; liver herniation is a sign of severity, which can herniate into the left and right, with the right side being more common; excessive amniotic fluid is also an important indicator; one of the twin fetuses has a septal hernia, which is treated as severe regardless of the severity; Step 2: Definite treatment plan If the fetus is diagnosed before 32 weeks intrauterine fetal tracheal occlusion is preferred to improve the prognosis by increasing the intratracheal pressure; hormonal treatment of the fetus is also a routine adjuvant treatment with betamethasone or dexamethasone; open fetal surgery is not done in principle, but can be considered if there is a special need. The diagnosis of mild or moderate can continue the pregnancy in anticipation of treatment after birth. If after 32 weeks Intrapartum or neonatal treatment is the main choice. The principles of intrapartum treatment are: the gestational week is already greater than 32 weeks, excessive amniotic fluid, LHR less than 1.4 but within 1.0, or in slightly greater than 1.4 but with other combined risks, and experience or conditions for intrapartum surgery can be relaxed; however, intrapartum surgery is not done as a routine treatment. For septal hernia that is assessed to be mild, surgical treatment is usually chosen 48 hours after birth when the newborn’s physiological condition is stable. Step 3: Preparation of treatment conditions Because the main pathophysiology of fetal septal hernia is fetal pulmonary hypertension and pulmonary hemorrhage secondary to fetal lung dysplasia, the required conditions and preparations need to be considered from the fetal period. In utero, the fetus can develop like a normal fetus, but at the beginning of life, after the onset of respiration, it gradually shows symptoms. Prenatal hormone therapy requires betamethasone or dexamethasone as the base treatment; fetoscopy and basic operative techniques required for tracheal occlusion; a team for fetal surgery during labor, including obstetrics, pediatric surgery, anesthesia, ultrasound, and neonatal ICU; a neonatal surgery team; skilled practice in ventilator use and high-frequency oscillatory ventilator application; and preparation for ECMO or NO if available. Fetal septal hernia Treatment of fetal septal hernia requires a combination of many conditions and a deep understanding of the pathology and physiology of fetal septal hernia, and any wrong choice of treatment or error due to one step in the chain may result in treatment failure and unnecessary outcomes. Therefore, when it is determined that a fetus needs to be born in a continuing pregnancy, it is its best choice to choose an experienced fetal medicine or neonatal surgery rescue center for consultation and treatment. Currently there is no hospital in China that can manage the diagnosis and treatment of fetal diaphragmatic hernia in an integrated way, except our hospital, so we especially remind that you can contact us if you need to do it very satisfactorily.