The major issues in obstetric practice in developing countries are the high rates of maternal and perinatal mortality. In most low-income countries health financing systems are not well established so most people pay for health services at the service delivery points. This causes cost-related issues to be of major concern. The main questions that therefore need to be addressed about obstetric ultrasonography in low-income countries is whether the practice improves maternal and neonatal outcomes and whether the service is within the means of most people in these countries. The indications for obstetric ultrasound, guidelines for the use of obstetric ultrasound and the benefits of obstetric ultrasound in low-income countries are discussed and the future of obstetric ultrasound in developing countries is also briefly considered.