In spite of the best postnatal care, a number of congenital anomalies lead to the death or severe disability of the child being born. Improved diagnostics, more reliable prenatal prognosis, increased knowledge of pathophysiology and milder surgical procedures have enabled prenatal treatment in selected cases. While only few randomized studies are available so far, the results are not complete and ethical problems are involved in the procedures. Novel gene or stem cell therapies and tissue cultures may open totally new treatment possibilities in the future.