Fetal midline anomalies involve defects in the central portion of the body including the brain, face, heart, and abdomen. This article discusses pre-natal management strategies for fetuses suspected to have abdominal wall defects called abdominal wall closure complex or ACC. Prenatal screening and diagnostic tests are recommended to evaluate the extent of the anomalies present and develop a management plan, which may include further monitoring, termination of pregnancy, or delivery and post-natal care depending on the severity and prognosis.