A limited form of fetal heart examination is feasible by the ultrasonographer involved in routine scanning, allowing selection of fetuses with major forms of heart disease in the overall pregnant population. Detailed and accurate prediction of cardiac malformation is possible in a specialized center studying pregnancies at increased risk of heart disease in the offspring, and those pregnancies selected by obstetric scanning. Fetal hemodynamics can be studied by Doppler echocardiography allowing new insights into the fetal circulation. Fetal arrhythmias can be documented and successfully treated before birth.