AbstractObjectiveThe objective of the study was to examine the correlation between fetal myocardial performance index (MPI) and hemoglobin (Hb) levels.MethodsIt is a prospective study involving singleton pregnancies at risk of fetal anemia as a result of maternal anti‐D alloimmune disease. Right and left ventricle (LV) MPIs were evaluated by ultrasound up to 72 h before cordocentesis. Zeta‐score values for fetal MPI and Hb levels were calculated, and correlation was examined with linear regression analysis. Significance level was set as 0.05.ResultsFourteen singleton pregnancies underwent 31 cordocentesis procedures at a mean gestation of 28.2 ± 4.1 weeks. Zeta‐score values for LV MPI, isovolumetric relaxation time (IRT), and ejection time (ET) correlated significantly with fetal Hb zeta‐score (LV MPI zeta = 3.816 + 0.336 × Hb zeta, r = 0.59, p < 0.001; LV IRT zeta = 2.643 + 0.218 × Hb zeta, r = 0.45, p = 0.01; LV ET zeta = −2.474 − 0.271 × Hb zeta, r = −0.42, p = 0.02). LV isovolumetric contraction time (ICT) zeta‐score and right ventricle (RV) MPI did not show significant correlation (LV ICT zeta, r = 0.35, p = 0.054; RV MPI, r = 0.12, p = 0.53).ConclusionLV myocardial performance not only remains preserved but also is actually enhanced in cases of moderate/severe fetal anemia. © 2014 John Wiley & Sons, Ltd.