Umbilical bulge is a congenital malformation of the abdominal wall defect and is rare (about 1 in 5000 births). It is more frequent in boys. The liver, as well as the intestines, are simply covered by a transparent membrane. This N malformation can be screened for by prenatal ultrasound. My experience is that an early 34-week ultrasound is easier to see than a 39-week ultrasound, because at 39 weeks the baby’s arms and legs are held in front of the belly, obscuring the view. Should the pregnancy continue? An important decision for parents is whether or not to continue the pregnancy. This is not only a medical question, but also an ethical one. At the end of the day, it is the parents who have to face the reality, and as pediatric surgeons, we can only provide some important information to allow the parents to make a final choice. The survival rate of a child ranges from 70% to 95%. The most important factors affecting the survival rate are the presence of congenital heart disease (7 to 47%) and chromosomal variants (up to 20%), which include many syndromes. Common ones include Beckwith Widemann syndrome, in which the child has large internal organs and tongue, a high birth weight, more than four kilograms is common, and low blood sugar at birth. In the absence of these syndromes and congenital heart disease, the survival rate is close to 95 percent. Other disorders include neurological (up to 30%) and cryptorchidism (up to 15%). Treatment options: Treatment after birth depends entirely on the size of the umbilical bulge. It is not only the size of the bulge, but also the ability of the abdominal cavity to accommodate these internal organs. 1. Small umbilical bulge: it can be retracted in one stage to close the abdominal wall defect. 2. Giant umbilical bulge: Most doctors choose conservative treatment to avoid rupture of the umbilical bulge membrane and allow it to epithelialize. The rupture of the plasma membrane should be avoided as much as possible. To reduce infection, some sterile ointment should be applied daily. Wait until the child is a few months, or even a year old, after the skin slowly grows to the cell membrane less before closing the umbilical bulge. 3. Moderate umbilical bulge: Optionally, a silicone patch can be used to temporarily protect the viscera, which can be retracted into the abdominal cavity within a week or so, and then the abdominal wall can be sutured. It is also optional to cover the viscera with skin first, and then add the abdominal muscle layer to cover the viscera when the baby is older (around one year). Complications Recently, a couple with a prenatal fetal umbilical bulge came to me for many consultations and after careful consideration decided to keep the baby. A few hours after the baby was born, I performed an abdominal repair. Three days after birth, the baby did not need a ventilator and started breastfeeding and recovered well. This is a relatively good case. It’s not uncommon for babies to be on a ventilator in the NICU for a week or two after surgery to keep them breathing. I have also seen a case of silicone patch infection in Melbourne. I.e. there will be ups and downs in the treatment of this disease.