Congenital cardiac malformations (CCM) are the commonest congenital anomalies. Using ultrasonography (US), the incidence of CCM in a selected group of fetuses and the impact of CCM on perinatal and postnatal care was evaluated. The indication for fetal echocardiography (F-ECHO) in 152 pregnancies was a positive family history in 61, fetal arrhythmias seen by routine obstetrical controls in 53, suspected CCM during obstetrical US in 9, growth retardation in 3 and contracted maternal factors in 6. Twenty pregnancies had no special indication. F-ECHO was performed between the 18th and the 39th gestational week. Twenty-seven cardiac malformations were found (18%), 10 of which were important; 3 succumbed at birth, 2 after surgical intervention, 1 was aborted and 4 needed intensive care at birth. Of 53 cases with arrhythmias, 3 needed special care during pregnancy: Digitalis in a case of atrial flutter, sick leave and bedrest in 2 with supraventricular tachycardia, premature delivery in 1 case with complete AV block due to an intraventricular tumor. The extremely high incidence of CCM in this group proves the need for careful fetal evaluation to detect malformations. Nowadays F-ECHO can and should be performed as early as in the 18th gestational week, allowing either to interrupt a pregnancy or to plan delivery in a well-equipped center which provides the necessary measures for these newborns.