The prenatal diagnosis of hypoplastic left heart syndrome is becoming more common since the advent of fetal echocardiography as a reliable modality to assess cardiac anatomyin utero.In addition, staged reconstructive surgery and cardiac transplantation have markedly improved neonatal survival. Consequently, obstetricians increasingly have the opportunity to implement prenatal and intrapartum strategies when hypoplastic left heart syndrome is recognized prenatally. In this chapter, we will review the appropriate diagnostic studies, counseling techniques, antepartum surveillance, and intrapartum care that are recommended in these difficult cases.