Although a great deal of controversy surrounds the concept of routine ultrasound screening, 70% of pregnant women in this country undergo ultrasound examination. Assessment of the fetal heart including a four-chamber view is recommended when ultrasound scans in the second and third trimester are performed. The accurate diagnosis of structural heart disease and cardiac dysrhythmias is now possible with advances in ultrasound and fetal echocardiography. Increased prenatal screening and genetic counseling have improved the management of these complicated pregnancies. It is hoped that the detection of significant congenital heart disease will continue to increase leading to further advances in medical and surgical treatment, improved patient care, and favorable perinatal outcomes.