In both of these examples, knowledge about the presence and severity of congenital cardiac defects facilitated management of labor and delivery and allowed perinatal care to be optimized. The critical role of echocardiography in prenatal diagnosis is evident, and both the accuracy and safety of the test are now well established. The structures in these images are small, however, and random movements of the fetus make for a challenging and time-consuming examination. Despite these factors, fetal echocardiography has provided clinicians with earlier diagnosis of heart disease and a better understanding of fetal hemodynamics. Today, a dedicated fetal echocardiogram can detect nearly 100% of serious congenital heart disease. Yet most pregnant women do not have a fetal echocardiogram but rather undergo a general obstetric ultrasound that may detect only around a third of fetal heart disease. To improve detection, some propose universal fetal echocardiography. But others cite cost and lack of specialized personnel as barriers that prevent echocardiography for every fetus. Fetal Echocardiogram is done in select patients. The best way to improve pickup in majority if the patients is by training sonologists to perform a more thorough evaluation. It has been traditionally taught that a four chamber visualisation is enough but current experiences suggest that may not be enough. A better evaluation would include a 4 chamber, a 5 chamber and a 3 vessel evaluation(3). References Medical ultrasonography Cardiac imaging